Report: To reduce childhood trauma, train professionals [CTPost.com]

I completely understand the time flow problem.. I was lucky... myself and another pediatrician were hired primarily to take hospital call (my main job became resuscitating and stabilizing babies for our nursery) and that meant there were few patients in the day clinic... so I had an hour with every patient... this made the time issue a non-issue... but I was concerned... if our practice built itself up... how would we manage... so I found the SEEK project... by Dr. Howard Dubowitz from the University of Maryland.... 

The PSQ (Patient Screening Questionnaire) would likely for most pediatricians raise as many hairs about time management and workflow as giving the ACEs questionnaire.  However, Dr. Dubowitz has this down.... 

 

1. You have to know your community resources... that is hard... there are so many "programs" in communities that you can refer patients to... but if you don't know about them (and most physicians in a community do not) than you cannot know your resources.... I spent 6 months getting to know the resources in and out... and putting together an information packet for physicians on our resources... 

 

2. His program basically is like a mini how to make your office trauma informed (though he may not have realized that was what he was doing).  All the staff have to understand why the SEEK PSQ is being given to parents.. The physicians decide who will give the questionnaire and how the information will get to the doctor. Personally for me... I worked to get the questionnaire in the parents hands before their visit.. My goal was getting it into the binder we gave to our new parents.  We also gave Ages and Stages developmental screening  so we worked with Dr. Dubowitz ... did we really have to ask SEEK at all the 0 -1 year visits... he said no so that gave us flexibility.. I did a trial of putting an ACEs screen in with a cover letter for the 4 month visit.... (and always have a pre-screen ACEs questionnaire before any pediatric behavioral health visit).  it was working pretty well and I am certain flow wouldn't have been disrupted much... (though I didn't have an opportunity to see in the real world if that was true because we had so much time with parents).... 

 

Any way here is the information for SEEK and the SEEK PSQ (one can see the questions though not ACEs are certainly getting at similar issues).. 

 

http://theinstitute.umaryland.edu/seek/seek_pq.cfm

 

http://umm.edu/programs/childr...tection/seek-project

 

Let me know what you think... I have a bunch of information and videos from SEEK from Dr. Dubowitz. 

 

Howard Dubowitz, MD, MS, FAAP

Professor of Pediatrics

Chief, Division of Child Protection; Director, Center for Families

Department of Pediatrics, University of Maryland School of Medicine

 

520 W. Lombard Street, Baltimore, MD 21201

Admin. Asst 410.706.1703    Direct 410.706.6144

Email: hdubowitz@peds. umaryland. edu     Fax 410.706.3017

 

thanks Tina

 

 

Absolutely, Tina.  I think that workflow is the biggest issue for docs that I run into - compounded by the lack of time, and thirdly, their discomfort with the subject matter and fourth - concern (which is unfounded) that all of a sudden they will have to refer most of their patients to a mental health or other practitioner!  You may be interested in checking out this site/video with Dr. Bonnano:   http://www.raisingresilientkids.com/ 

 

Perhaps if more physicians (and other people!) learned this information, they would be more likely to talk about toxic stress that their patients are experiencing and what it is doing to their health and vitality.  We have some nurses in Maine using the screen with expectant and new parents who are in recovery programs.  It has made a tremendous improvement in their clinical work, their relationships with their patients, their patients mobilization re: their own chronic conditions, and "might" be improving "compliance" with visits.  We aren't sure about this yet.

Thank you Sue, I have to say..... I have been trying to discuss with pediatric colleagues the damaging effects of childhood abuse for a long time (before the term ACEs or toxic stress existed) and this has been the hardest thing I think I have ever attempted....

 

I appreciate your comment.. It helps me keep my strength and helps me to not give up....Thanks a bunch. 

 

Tina 

 

Thank you Tina Marie for your honest, forthright and true comments.  We continue in Maine to support physicians and their practices to figure out how to incorporate ACEs into the well child exam - not necessarily the screen, but greater sensitivity and awareness of the issues and challenges that are facing families and kids and the relationship of these to trauma, behavior, substance abuse, etc.  Our society isn't comfortable talking about this "stuff" - so we all, physicians included, have to get over ourselves, get informed and get involved with the people in our lives, who we care for, etc.  Thanks again. 

I agree. I modeled infant attachment in the nursery and in the newborn infant visits especially for my moms who had been in fostercare themselves. you see the best training is having the experience yourself of being homeless, interacting as a kid with child welfare and growing up in poverty. A doc w/ that experience is not someone to be afraid of (by other docs--but is a useful team member). When my colleagues want to send the biting and head banging toddler off to mental health where the child goes down the path of conduct disorder diagnosis and is at 3 on stimulants and either a mood stabilizer or antipsychotic, my kids aren't why.... Because I ask about ACEs and take the time to discuss how the environment is producing these behaviors. I know that there are other doctors who get this too but we are too few and far between. Infant mental health is not about infants it is about infants and the most important people to them, their caregivers and medications are not the correct answer. Meds are drugs that if they do anything simply 'numb' the child out of the child making learning and exploration even harder and can leave older kids w/the impression that they are ill when it is their environment that is sick and needs remediation. How many of as adults would long accept living with a big man who threatens our life, our siblings life, is everyday beating us or our younger brother, everyday yells and calls us terrible names...gets so drunk the person is terribly scary and wouldn't want to get away from that person... As a grown up we can try to escape or decide to take psyche drugs at 5 we cannot escape and will either act out or in... We can be medicated by adults but that does not address the problem. And if the problem is allowed to persist there will be teens who to survive need to use alcohol or marijuanna themselfs. Should we be surprised absolutely not. These kids aren't bad kids they are trying to get relief from impossible internal misery. We the doctors failed them. I am 100% serious in saying we Pediatricians failed our kids. We may like to use the excuse well I'm not trained in that and on and on well we know better being a doctor means learning a lot more than you know. When these kids shoot up a school we are responsible ... Read the sandy hook report... It clearly states the pediatrician bore some responsibility....please Pediatricians live up to your responsibility... Stop saying there is nothing you can do or this is beyond the scope of my training....compassion and empathy and concern for the young children you care for is beyond the scope of your training... No this is not easy but only because the entire profession has not embrassed what we must do.... Screen for and educate about ACEs/toxic stress. And we should not chastise or bully the pedi in our group brave enough to do so.... She may just know something you don't.