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PACEs in Medical Schools

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One state. One year. (Partial) Cost of ACEs = $5.2 billion.

Jane Stevens ·
In looking at the impact of childhood trauma, you can’t get much clearer than this: In 2017, ACEs among Tennessee adults led to an estimated $5.2 billion in direct medical costs and lost productivity from employees missing work. That’s just one year, according to the new report, “ The Economic Cost of ACEs in Tennessee ," released on Feb. 1, 2019 by The Sycamore Institute in Nashville, Tenn. And to provide some perspective, $5.2 billion is one-seventh of the state’s annual budget . This $5.2...
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Preventable trauma in childhood costs north America and Europe US$ 1.3 trillion a year [WHO]

Karen Clemmer ·
By World Health Organization (photo by WHO/Malin Bring) The findings of a new study on the life-course health consequences and associated annual costs of adverse childhood experiences (ACEs) show that preventable trauma in childhood costs north America and the European Region US$ 1.3 trillion a year. The article, published in the Lancet and co-authored by Dinesh Sethi and Jonathon Passmore, Programme Manager, Violence and Injury Prevention, WHO/Europe, looks at the legacy of ACEs and their...
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Study finds meditation and aerobic exercise relieves stress in medical school students (EurekAlert)

Karen Clemmer ·
Rutgers, Released May 4, 2020, Journal of Alternative and Complementary Medicine. Rutgers professor and medical school student collaborating on research touched by pandemic. Rutgers Robert Wood Johnson Medical School student Paul Lavadera expected his career would put him on the front lines of dealing with medical emergencies. But he never could have imagined he'd be graduating during the biggest global pandemic in a century when he joined forces two years ago with Tracey Shors,...
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Study: Stress Disorders Linked to Greater Infection Risk [mercurynews.com]

By Lisa Rapaport, Reuters, October 31, 2019 People who have stress disorders like PTSD may be more vulnerable to potentially life-threatening infections, especially if they are diagnosed at younger ages or dealing with other psychiatric issues, a recent study suggests. Researchers examined data on 144,919 people diagnosed with post-traumatic stress disorder (PTSD), adjustment disorders common after a major life change like a death or move, and other stress-related conditions. They also...
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The Center for Youth Wellness Launches Childhood Adversity Screening Program with Leading North Carolina Health Systems [PR Newswire]

Jim Hickman ·
Charlotte pilot program with Atrium Health and Novant Health supports state's goal to address social, economic and environmental health to improve child and family health outcomes The Center for Youth Wellness (CYW) announced it is partnering with two leading U.S. health systems in the Southeast to launch a screening program on childhood adversity. CYW's National Pediatric Practice Community (NPPC) has done on-site training at the headquarters of Atrium Health and Novant Health in Charlotte,...
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TIC: News and Notes for November 2019

Scott A Webb ·
ACEs, Adversity's Impact Podcast: Dr. Nadine Burke Harris Vital Signs: Estimated proportion of adult health problems attributable to adverse childhood experiences and implications for prevention - 25 states, 2015-2017 Animal study shows how stress and mother's abuse affects infant brain LGBTQ, traumatized homeless youth more vulnerable to being trafficked: Report How do these pediatricians do ACEs screening?Early adopters tell all When family relationships become toxic: The trauma of...
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TIC: News and Notes for the Week of October 21, 2019 [dhs.wisconsin.gov]

Scott A Webb ·
ACEs, Adversity's Impact There is only one boat: The myth of normalcy by Dr. Gabor Mate Understanding historical trauma to strengthen community Childhood trauma linked to early, premarital childbirth and poor health for women Early life racial discrimination linked to depression, accelerated aging When mothers are killed by their partners, children often become 'forgotten' victims. It's time they were given a voice Children's language skills may be harmed by social hardship Does racism...
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Tools and how to use them is focus of second webinar on Community Resiliency Model, May 14, 2020

Carey Sipp ·
The second of two free Community Resiliency (CRM) webinars with Elaine Miller-Karas , key creator of the CRM, will be held Thursday, May 14, from 11 a.m. - 12:30 p.m. ET, (10 a.m. CT; 9 a.m. MT, and 8 a.m. PT) and will include the practical application of tools of the model. CRM is an ACEs science-based biological model for helping individuals become emotionally regulated during natural disasters and other dysregulating times. Miller-Karas will be joined by CRM trainers from Wilmington, NC:...
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Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID-19 Pandemic [jamanetwork.com]

By Tait Shanafelt, Jonathan Ripp, Mickey Trockel, JAMA, April 7, 2020 The coronavirus disease 2019 (COVID-19) pandemic has become one of the central health crises of a generation. The pandemic has affected people of all nations, continents, races, and socioeconomic groups. The responses required, such as quarantining of entire communities, closing of schools, social isolation, and shelter-in-place orders, have abruptly changed daily life. Health care professionals of all types are caring for...
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University of Florida Graduate Public Health Course: Trauma-Informed Approaches for Individuals, Communities, and Public Health: Student Project Summaries

Lindsey King ·
The University of Florida College of Public Health and Health Professions partnered with Peace4Tarpon under the Robert Wood Johnson Mobilizing Action for Resilient Communities (MARC) grant. Together they created 2 online graduate courses that focus on addressing ACEs and creating trauma-informed and resilience-based programs from a public health approach. Peace4Gainesville and Peace4 TheBigBend have also contributed to these courses. This post is intended to showcase some of the work of the...
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Vital Signs: Estimated Proportion of Adult Health Problems Attributable to Adverse Childhood Experiences and Implications for Prevention [cdc.gov]

By Melissa T. Merrick, Derek C. Ford, Katie A. Ports, et al., Centers for Disease Control and Prevention, November 5, 2019 Summary What is already known about this topic? Adverse childhood experiences are common and are associated with many poor health and life outcomes in adulthood. What is added by this report? Nearly 16% of adults in the study population reported four or more types of adverse childhood experiences, which were significantly associated with poorer health outcomes, health...
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When Hidden Grief Gets Triggered During COVID-19 Confinement

Tian Dayton ·
first published by The Meadows 4/15/20 Our sense of loss during the current COVID-19 crisis can trigger hidden emotions from when we experienced a sense of loss before. Whatever early losses you have had in your life — whether they be your own divorce, your parents, or both, or the abandonment of one parent, a childhood or parental illness or death, financial upheaval, constant moving around, or growing up with parental addiction or adverse childhood experiences (ACEs) — they are likely to...
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Why Emotional Eating Can Be a Consequence of Trauma

Rachel Eddins ·
Research suggests that trauma can be a cause of emotional eating, or the drive to consume “comfort foods,” to manage the negative emotions directly related to past negative events.
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World Premiere: Stress & Resilience: How Toxic Stress Affects Us, and What We Can Do About It [developingchild.harvard.edu]

By Center on the Developing Child, Harvard University, November 13, 2019 When the stress in your life just doesn’t let up, and it feels like you have no support to get through the day—let alone do everything you need to do to be the best parent you can be—it can seem like there’s nothing that can make it better. But there are resources that can help, and this kind of stress—known as “toxic stress”—doesn’t have to define your life. In this video, learn more about what toxic stress is, how it...
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12 Things I Wish My Doctor Understood About Childhood Trauma

Anna Runkle ·
It doesn’t happen that often anymore, but one place where I almost always get triggered with my Childhood PTSD symptoms is when I visit the doctor. I could never even put this into words before. But now that I’m mostly healed from my Childhood PTSD symptoms, I want to express what I wish my doctors – all the doctors of my life – had understood about the effects of Childhood trauma, about me. Note: This is one of my most personal posts ever. Unless you’re someone who really prefers text, I...
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7 Ways to Help a Child Deal with Traumatic Stress

Hilary Jacobs Hendel ·
Traumatic stress feels awful. Thankfully, there are small things we can all do to help relax a hyperaroused nervous system.
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ACEs Community Spotlight Series: Dr. Richard Honigman, Central Nassau Pediatrics

Margaret Wayne ·
For our second community spotlight interview, I spoke with Dr. Richard Honigman, a pediatrician at Central Nassau Pediatrics in Levittown and infant mental health advocate. We discussed the importance of addressing childhood adversity and the relevant work he is doing both inside and outside his practice. Please note that responses have been adjusted for length and clarity. Dr. Honigman is also the first recipient of the 2019 Ed Tronick Award for Distinguished Contribution to Infant-Parent...
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ACEs Research Corner — November 2019

Harise Stein ·
[Editor's note: Dr. Harise Stein at Stanford University edits a web site -- abuseresearch.info -- that focuses on the health effects of abuse, and includes research articles on ACEs. Every month, she's posting the summaries of the abstracts and links to research articles that address only ACEs. Thank you, Harise!! -- Jane Stevens] Jackson DB, Chilton M, Johnson KR, Vaughn MG. Adverse Childhood Experiences and Household Food Insecurity. Am J Prev Med. 2019 Nov;57(5):667-674. PMID: 31522923...
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Announcing Trauma and Resilience Competencies for Nursing Education

Kathleen Wheeler ·
The authors are pleased to announce the Trauma and Resilience Competencies for Nursing Education. These competencies serve as a guideline of minimal expectations and reflect essential knowledge, skills and behaviors for three levels of nursing education: 1) undergraduate, 2) graduate, and 3) psychiatric nurse practitioner programs. The Trauma and Resilience Competencies, developed in 2018 at the Egan School of Nursing and Health Studies at Fairfield University in Connecticut by an Expert...
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At the scene of a house fire, ACEs cast long shadows

Peter Chiavetta ·
I am on the scene of a house fire in a town near where I live in Brant, NY. As part of my duties as EMT with my fire company ambulance (I'm first assistant chief firefighter), I make sure firefighters who are working a fire stay healthy while they’re fighting it, especially firefighters with ACEs.
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Becoming Trauma Informed (Millstein JGIM 2020)

Megan Gerber MD MPH ·
When I look at Victoria through a clearer lens, there are many clues—her anxiety, troubled marriage and family life, avoidance of physically intrusive examina- tions. I realize that I hardly know her at all. I focus on her health issues, and despite many stumbles, we have a nice rapport. I accept whatever she is willing to share about her tumultuous home life, but I do not ask how it all came to be so. Now I float with her in a reservoir of pain and shame.
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Cancer as a survivor

Christine Cissy White ·
Many people use the phrase CPTSD to stand for PTSD from complex trauma. To me, C-PTSD means cancer and PTSD. I have cancer and I’m a trauma survivor. I’m a survivor with cancer but not yet a cancer survivor. Will I be a survivor squared?
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CenteringParenting Recognized as Innovative Pediatric Intervention in New Report from The Center for the Study of Social Policy [globenewswire.com]

By Vandana Devgan, Centering Healthcare Institute, November 15, 2019 Centering Healthcare Institute (CHI) is honored to share that its pediatric group care model CenteringParenting®, has been recognized by The Center for the Study of Social Policy (CSSP) as an innovative pediatric intervention in its latest study. "Fostering Social and Emotional Health: Common Threads to Transform Everyday Practice and System" , released as part of the Pediatrics Supporting Parents (PSP) initiative, shares...
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Fed Up With Deaths, Native Americans Want to Run Their Own Health Care [nytimes.com]

By Mark Walker, The New York Times, October 15, 2019 When 6-month-old James Ladeaux got his second upper respiratory infection in a month, the doctor at the Sioux San Indian Health Service Hospital reassured his mother, Robyn Black Lance, that it was only a cold. But 12 hours later James was struggling to breathe. Ms. Black Lance rushed her son back to the hospital in western South Dakota, where the doctors said they did not have the capacity to treat him and transferred him to a private...
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GABOR MATÉ JOINS EP. 3 on May 21 with Darrell Hammond and Filmmaker Michelle Esrick. [crackedupmovie.com]

CRACKED UP THE EVOLVING CONVERSATION TRAUMA AS THE ROOT CAUSE OF ADDICTION With DARRELL HAMMOND DIRECTOR MICHELLE ESRICK and RENOWNED TRAUMA AND ADDICTION EXPERT GABOR MATÉ, M.D. author of In the Realm of Hungry Ghosts: Close Encounters With Addiction MODERATED BY JANE STEVENS, FOUNDER OF ACES CONNECTION Hosted by ACES Connection Thursday May 21st at 2pm PDT / 3p MT / 4p CT / 5pm EDT FREE FOR ALL WHO REGISTER! IF YOU REGISTER, BUT CAN NOT ATTEND, YOU WILL RECEIVE A RECORDING WITHIN ONE WEEK.
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Governor Cuomo’s Cancer Research Initiative Disappointing. No ACES included.

Peter Chiavetta ·
I attended the presentation of Governor Cuomo's Cancer Research Initiative at the Buffalo Science Museum October 22, 2019. Brad Hutton Deputy Health Commissioner State of NY presented. Erie County Health Commissioners in attendance. It had all the data on the 4 major cancers in the East Side of Buffalo, NY. https://www.health.ny.gov/diseases/cancer/cancer_research_initiative/docs/erie_presentation.pdf I'm all excited. Prepared with 2 dozen ACE handouts. Sat quietly for the 45 minute power...
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How do these pediatricians do ACEs screening? Early adopters tell all.

Laurie Udesky ·
Last week, three pediatricians — with a combined experience of 15 years integrating ACEs science into their practices — reflected on the urgency they felt several years ago that prompted them to begin screening patients for childhood adversity and resilience when there was practically no guidance at all. Along their journey , they accumulated a list of lessons learned for other pediatricians and family clinics to use. The three pediatricians participated in the ACEs Connection webinar,...
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How trauma-informed care promotes healing: Patient Narrative

Megan Gerber MD MPH ·
So pleased that KevinMD published this patient narrative. I was encouraged to share it here as well! https://www.kevinmd.com/blog/2...romotes-healing.html By MEGAN R. GERBER, MD | CONDITIONS | JULY 26, 2019 As physicians, we face the formidable task of working with patients who appear angry, never content with care or “made better” by anything we do. They may be known as “difficult,” unpleasant, or demanding. These patients are the most challenging and often the least rewarding to care for.
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Jones: Day 2: Soda, cigarettes and trauma: How Adverse Childhood Experiences alter brain chemistry, cultivate unhealthy habits and prompt premature death

Linda Manaugh ·
Patients would carry soda into Dr. Gerard Clancy’s office, with cigarettes tucked away for after therapy. Often victims of abuse or violent crime, they would seek soothing but risky behaviors to cope. Overweight. Chronic pain. Chronic obstructive pulmonary disease. Type II diabetes. His former patients will die younger than they should, he said. Clancy conducted therapy sessions until he became president of the University of Tulsa in 2016. At his psychiatry clinic, he saw firsthand how a...
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Mount Sinai Announces Center for Stress, Resilience and Personal Growth [newswise.com]

Newswise — (New York, NY – April 30, 2020 ) -- Mount Sinai Health System (MSHS), one of New York’s largest integrated health systems, announced today the launch of the Mount Sinai Center for Stress, Resilience and Personal Growth, a first-of-its-kind initiative in North America that is designed to address the psychosocial impact of COVID-19 on the mental health and lives of frontline health care providers at Mount Sinai and will serve as a model for institutions and communities around the...
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My son was hospitalized and now he has PTSD

Stephanie Kennelly ·
“Grant, do you remember when you were in the hospital?” “Yes… they came to take the blood and I turned into a werewolf.” Original Post It happened quickly. A year ago my three year old had a collarbone fracture, it became infected and within 24 hours the situation was emergent. A week long hospital stay, one month with a PICC line and two months on oral antibiotics. Finally, the labs finally came back normal. The X-Ray was clean. Gillette Children’s Hospital closed our case. But the healing...
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New Study Reveals Annual Cost of Childhood Adversity in California Is Approximately $113 Billion [prnewswire.com]

Marianne Avari ·
SAN FRANCISCO , Jan. 28, 2020 /PRNewswire/ The Center for Youth Wellness announces the release of an in-depth study on the health-related cost of adverse childhood experiences (ACEs) in the state of California . A number of studies have investigated the cost of child maltreatment, but the current study, entitled " Adult health burden and costs in California during 2013 associated with prior adverse childhood experiences ," is the first to examine the cost associated with adult health...
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NPPC shares lessons learned and results from ACEs screening pilot sites

Laurie Udesky ·
For Dr. Mercie Digangi, a pediatrician at Kaiser Southern California in Downey, CA, ACEs screening provided a crystal clear before-and-after in how she changed treatment plans for her pediatric patients, she explained to attendees of a December 2 webinar organized by the National Pediatric Practice Community on ACEs (NPPC) and cosponsored by ACEs Connection. Dr. Mercie Digangi One case that turned ACEs screening into a never-go-back moment for her was a three-year-old who was speech-delayed.
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Nurturing relationships in childhood boost adult mental health, relationships

Christina Bethell ·
We're proud to announce major research that suggests that positive childhood experiences — such as supportive family interactions, caring relationships with friends, and connections in the community — are associated with reductions in chances of adult depression and poor mental health, and increases in the chances of having healthy relationships in adulthood. This association was true even among those with a history of adverse childhood experiences.
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ACEs Research Corner — May 2020

Harise Stein ·
[Editor's note: Dr. Harise Stein at Stanford University edits a web site -- abuseresearch.info -- that focuses on the health effects of abuse, and includes research articles on ACEs. Every month, she's posting the summaries of the abstracts and links to research articles that address only ACEs. Thank you, Harise!! -- Jane Stevens] Williams AB, Smith ER, Trujillo MA, et. al. Common health problems in safety-net primary care: Modeling the roles of trauma history and mental health. J Clin...
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Of interest: Spend June 5 with members of the new National Academies report: Realizing Opportunity for All Youth

edward strickler ·
Of interest: Spend June 5 with members of the new National Academies report: Realizing Opportunity for All Youth Announcement in ACES Connection calendar : June 5 Calendar Announcement https://www.acesconnection.com/event/realizing-opportunity-for-all-youth-discussion-the-new-national-academies-report or at Institute of Law, Psychiatry and Public Policy, University of Virginia (ILPPP) https://ilppp.virginia.edu/OREM/JuvenilePrograms/Course/144 Working with the National Academies of Sciences,...
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Diagnosing and Treating Systemic Racism (NEJM)

Karen Clemmer ·
June 10, 2020. Michele K. Evans, M.D., Lisa Rosenbaum, M.D., Debra Malina, Ph.D., Stephen Morrissey, h.D., and Eric J. Rubin, M.D., Ph.D. For the New England Journal of Medicine. For physicians, the words “I can’t breathe” are a primal cry for help. As many physicians have left their comfort zones to care for patients with Covid-19–associated respiratory failure, the role of the medical profession in addressing this life-defining need has rarely been clearer. But as George Floyd’s repeated...
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Inside Boston Hospitals, A Reckoning With Racism (WBUR)

Karen Clemmer ·
By Martha Bebinger, June 19, 2020, WBUR As calls for racial justice continue on Boston streets, conversations have shifted to what’s next. That’s true inside hospitals as well, where the life-long effects of racism play out every day. “You could almost take any chronic disease in America, diabetes, hyper-tension, and there will be higher rates and worse outcomes in Black Americans,” says Dr. Rose Olson, a resident physician at Brigham and Women’s Hospital. “That’s not due to biology or...
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THURSDAY!! Cracked Up, The Evolving Conversation: Generational Trauma - Breaking the Cycle [crackedupmovie.com]

CRACKED UP THE EVOLVING CONVERSATION Episode 4: Generational Trauma - Breaking the Cycle with Darrell Hammond, Comedian, actor, SNL Legend Michelle Esrick, Filmmaker, activist Bessel van der Kolk, MD, Author of The Body Keeps the Score Jane Stevens, Founder of ACES Connection and special guest Jane Fonda Academy Award-winning actor, producer, author and activist Thursday June 25th at 1pm PDT / 2p MT / 3p CT / 4pm EDT Hosted by ACEs Connection THE PRICE OF THIS LIVE EVENT IS $12.50 We have...
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Childhood Physical Neglect Is Associated With Exaggerated Systemic and Intracellular Inflammatory Responses to Repeated Psychosocial Stress in Adulthood (PMC)

Karen Clemmer ·
By Hannah M. C. Schreier, Yuliya I. Kuras, [...], and Nicolas Rohleder Abstract Experiences of child maltreatment are associated with a host of adverse mental and physical health outcomes in adulthood. Altered reactivity to psychosocial stress exposure may partially explain known associations between early experiences of maltreatment and later life health. The present study focuses on examining whether experiences of child maltreatment are associated with physiological reactions to initial...
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Resilience for Children & Families: Being Brave When Things are Hard

Building Resilience with Children During Racial Discrimination & Violence: This attached Resilience Brief for Children has been the hardest one I have written yet. I have been an active advocate for the equal treatment of people from all backgrounds, religions, ethnic heritages, orientations, and families my entire life. It is hard to see the pain present today, not only due to COVID19 but also due to the harm and anger we see daily in the news. I want to share a story about the person...
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Reimagining Healthcare as a Community Investment

Jennifer A Walsh ·
At this point, COVID-19 has been a part of our lives for nearly six months now. While the most recent current events are not unfamiliar social problems, this pandemic has provided us with a stronger lens with which to see many of the underlying inequities within our communities. This article, “The Moral Determinants of Health,” explores these inequities by illustrating the systemic imbalances within the field of medicine and the amount of resources we allocate to solving problems as opposed...
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Help Navigating the Road to Community Resiliency

Becky Haas ·
The first time I ever heard the words trauma-informed care and the Adverse Childhood Experiences (ACEs) study was in the summer of 2014. At the time, I was working for the local Police Department as the Director of a grant-funded Crime Reduction Project aimed at reducing drug-related and violent crime. Of the many program goals, one was to develop a rehabilitative corrections program for felony offenders with addictions in order to reduce recidivism. Though I’ve lived in this region for...
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Navigating Trauma in Your Personal Statement for Medical School (In-Training)

Karen Clemmer ·
By Britt D. K. Gratreak, July 21, 2020, University of Arizona College of Medicine - Tucson I applied to medical school twice. In retrospect, I was unsuccessful the first time for a few reasons: my timing was terrible, I had too much humility about my achievements, and I didn’t ask for enough opinions about my application from people who were rooting for me. My trauma was also too raw and recent to write in a way for strangers to understand. After taking a few years to focus on research, I...
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ACEs and Gynecological Problems - A Conversation Starter

Dianne Couts ·
Gynecological problems as a result of ACEs, and particularly of Childhood Sexual Abuse (CSA), are rarely discussed in books and articles about the ACEs. The author would like to see that issue become part of the ACEs conversation.
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Donald Trump is the product of abuse and neglect. His story is common, even for the powerful and wealthy.

Jane Stevens ·
“In order to cope,” writes Mary Trump, “Donald began to develop powerful but primitive defenses, marked by an increasing hostility to others and a seeming indifference to his mother’s absence and father’s neglect….In place of [his emotional needs] grew a kind of grievance and behaviors—including bullying, disrespect, and aggressiveness—that served their purpose in the moment but became more problematic over time. With appropriate care and attention, they might have been overcome.”
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Does VP Candidate Kamala Harris know about ACEs?  You bet!

Nadine Burke Harris, California’s Surgeon General, has a lot in common with the vice presidential candidate Kamala Harris—Jamaican heritage, surname, home state—and a commitment to addressing ACEs and toxic stress. As reported in the New Yorker article by Paul Tough, “The Poverty Clinic,” Dr. Harris told Kamala Harris, then San Francisco district attorney, about ACEs in 2008 and in response, she offered to help. District Attorney Harris then introduced her to professor of child and...
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Does racism make us sick? Amid a national reckoning, the question gains new importance [sfchronicle.com]

Karen Clemmer ·
By Tatiana Sanchez, San Francisco Chronicle, August 24, 2020 Elaine Shelly has lived with multiple sclerosis for 30 years. But she said she still panics whenever she has to see a new neurologist because of racial discrimination she’s experienced in the past. Even getting a proper diagnosis for her illness was a battle. “I’d go to these neurologists who would tell me that Black people don’t get M.S. and that I must be mentally ill,” said Shelly, 63, of San Leandro. A former print journalist,...
Comment

Re: What’s behind burnout in trainee physicians (Contemporary Pediatrics)

Jeoffry Gordon ·
YES, BUT! Even to use the term "burnout" is to buy into the oppressive perspective of an immoral, exploitative medical system. The real issue is "moral anguish" of clinicians who must work in an industrial environment where productivity and efficiency and an oppressive constraining electronic medical record trump attention, caring and compassion. Traditionally in medicine trainees (residents) learn best by being pushed, stressed, and dominated by the learned superiors (Germanic model). Now,...
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Cost-effectiveness of Leveraging Social Determinants of Health to Improve Breast, Cervical, and Colorectal Cancer Screening (JAMA)

Karen Clemmer ·
By Giridhar Mohan, MPH; Sajal Chattopadhyay PhD., JAMA Oncol. Published online June 18, 2020. doi:10.1001/jamaoncol.2020.1460 Key Points Question What are the costs of interventions leveraging social determinants of health to improve breast, cervical, and colorectal cancer screening, and are they cost-effective? Findings In this systematic review of 30 unique economic evaluations, the median intervention cost per participant was $123.87, the median incremental cost per additional person...
 
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