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PACEs in Medical Schools

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Blog Post

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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Borderline Personality Disorder has Strongest Link to Childhood Trauma [eurekalert.org]

By Mike Addelman, EurekAlert!, November 18, 2019 People with Borderline Personality Disorder are 13 times more likely to report childhood trauma than people without any mental health problems, according to University of Manchester research. The analysis of data from 42 international studies of over 5,000 people showed that 71.1% of people who were diagnosed with the serious health condition reported at least one traumatic childhood experience. The study was carried out by researchers at The...
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California unveils ACEs Aware initiative to screen for trauma

Laurie Udesky ·
Will screening for adverse childhood experiences (ACEs) in California be mandatory? No, but it’s recommended. Will there be training for physicians and staff on how to screen? Yes. Who will be reimbursed for screening patients in California? Physicians who serve patients in the state’s Medi-Cal program — for now. For more answers to these and other questions that surfaced during a Dec. 4 webinar introducing Californians to a new statewide initiative, read on. Come January 1, California will...
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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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COVID-19 and Healthcare worker's families: behind the scenes of frontline response [thelancet.com]

By Amine Souadka, Hajar Essangri, Amine Benkabbou, et al., EClinical Medicine, May 17, 2020 During the COVID-19 outbreak, healthcare professionals are exposed to a high-risk of infection and mental health problems, but also fear of contagion and spreading the virus to their families. In fact, considering them as individuals implies looking beyond their function as frontline responders and taking into account their societal role as parents, spouses and offspring. While work-family balance is...
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CPTSD and Social Awkwardness: Another Source of Isolation

Anna Runkle ·
For those of us who grew up with abuse and neglect at home, it can be hard to know how to ACT in social situations. Here's an example.... Have you ever been to a hotel where there is a person who is there to carry your bags, and even though you didn’t ask, they carry your bags to the room and it’s totally awkward, and you think “I’m supposed to give them a tip, right? I’ve, like seen this on TV. But you don’t have cash, and they’re just standing there ," and you think, "What do I do? What do...
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Cultivating Deliberate Resilience During the Coronavirus Disease 2019 Pandemic [jamanetwork.com]

By Abby R. Rosenberg, JAMA Pediatrics, April 14, 2020 Coronavirus disease 2019 (COVID-19) is affecting our health care community in unprecedented ways. As a pediatric oncologist who studies resilience in the context of illness, I started thinking about what this pandemic means for our professional resilience a few weeks ago, when the first US patient with fatal COVID-19 died in my home city of Seattle, Washington. Promoting resilience among health care workers and organizations starts with...
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Doulas & Covid-19: A toolkit for doulas (DONA International)

Karen Clemmer ·
Please the attached toolkit for more information. From the toolkit: Best practices when working with clients Given how new this virus is, we currently have very little data on how it might affect pregnant people and newborns. Guidelines from the CDC outline recommendations for how to support pregnant and laboring people with Coronavirus. (3) There is currently no evidence that the virus is spread from mother to baby in utero, or that it is transmitted in human milk. (4)
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Dr. Felitti Teaching New ACE Information on National TV with Dr Brian Alman

Dr. Brian Alman ·
Everybody benefits from the ACE Study and here is a very recent discussion on TV with Dr. Vincent J. Felitti and Dr. Brian Alman. Past, Present and Future generations are impacted by family members ACE scores and their lack of successful resolutions. Traumas can be healed after they are identified, understood and treated with a variety of proactive strategies. Listen to the fascinating lessons from Dr. Felitti and learn more about yourself, your family, stress, habits and addictions, as well...
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Dr. Vincent J. Felitti, M.D. has been recognized with the Albert Einstein Award of Medicine by the International Association of Who’s Who [kentuckyreports.com]

By Kentucky Reports, November 9, 2019 Dr. Vincent J. Felitti has over 50 years of experience in the field of Internal Medicine with extensive knowledge in the areas of childhood trauma, the genetic disease Hemochromatosis, and obesity. Serving as a Clinical Professor of Medicine at the University of California since 1982, Dr. Felitti’s knowledge and experience is broad and significantly biopsychosocial. Dr. Felitti achieved his Medical Degree from Johns Hopkins in 1962 after being inspired...
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During COVID-19: The need for your skills. Self-care resources. Share your TI responses? Thank you!

Mimi graham ·
Dear Trauma F riends and C olleagues: The COVID 19 pandemic offers a critical opportunity to share your unique skills in coping with stress and trauma. Many of us and the families we serve may be shifting through the stages of change and grief----denial, anger, bargaining, acceptance---about this pandemic. You may be adjusting to telehealth and virtual visits but know that our families need your reassurance and help in regulating and coping. Hope you’re all practicing self-care while you...
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Emergency Department Admissions for Child Sexual Abuse in the United States from 2010 to 2016 [jamanetwork.com]

By Jesse J. Helton, Jason T. Carbone, et al., JAMA Pediatrics, November 4, 2019 For children who have been sexually abused, emergency department (ED) professionals provide immediate medical care, including testing and treatment for sexually transmitted infections, prophylaxis for potential HIV exposure, and emergency contraception. In some cases, ED clinicians conduct forensic examinations to assist with child protection and criminal investigations. Physicians and nurses in EDs are among the...
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Emotional Well-Being and Coping During COVID-19 [psychiatry.ucsf.edu]

From Weill Institute for Neurosciences, UCSF, May 2020 These are unprecedented times. We need to work extra hard to manage our emotions well. Expect to have a lot of mixed feelings. Naturally we feel anxiety, and maybe waves of panic, particularly when seeing new headlines. A recent article by stress scientist and Vice Chair of Adult Psychology Elissa Epel, PhD, outlines the psychology behind the COVID-19 panic response and how we can try to make the best of this situation. Our anxiety is...
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For Community Health Centers, a Hands-On Guide to Building Partnerships [chcf.org]

By Carlina Hansen, California Health Care Foundation, October 15, 2019 Before joining CHCF, I spent almost 20 years as executive director of the Women’s Community Clinic in San Francisco. In my time there, we forged some valuable partnerships to serve our clients and community, including our merger with another community health center, HealthRIGHT 360. It was during the merger process that I learned first-hand one of the biggest challenges to forging such partnerships — and it wasn’t what I...
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Forsyth County Trauma Informed Care Network

Laneita Williamson ·
The Forsyth County Trauma Informed Network is taking great strides into recognizing and addressing community post Covid-19 impacts. PowerPoint attached.
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From Trauma-Informed to Asset-Informed Care in Early Childhood [brookings.edu]

By Ellen Galinsky, Brookings Institute, October 23, 2019 The focus on “toxic stress,” ACEs (Adverse Childhood Experiences), and trauma-informed care have been game-changers in the field of early childhood development. They have helped us recognize the symptoms of trauma, provide appropriate assistance to children, and understand that prolonged adversity in the absence of nurturing relationships can derail a child’s healthy development. Just look at the media’s and the public’s reaction to...
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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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Got time for a little brainstorming with ACEsConnection?

Jane Stevens ·
On Friday, March 20, 2020, you're invited to join me to talk about how we, as a community, can continue to guide and educate ourselves about to deal with the effects of the spread of Covid-19, and how to continue those efforts with people who don't yet know about ACEs science. And, given this last week, how we can provide more support to stay in the front of our brains instead of feeding our amygdala.
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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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Healing Hurt People: Helping Victims of Violence Heal from Their Trauma and Become Community Peer Health Workers [citywidestories.com]

By Michael Butler, City Wide Stories, November 1, 2019 Healing Hurt People started in 2008 as an initiative to help victims of violence heal and deal with the trauma of their injuries; more than a decade later the organization has created a sustainable model for hospitals across the city of Philadelphia. Young men that have dealt with violence are encouraged to go through training, become community peer health workers, and help those who have gone through similar experiences. We spoke with...
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Healthy Spaces December 2019 Webinars

Aldina Hovde ·
Healthy Spaces: Promoting Healthy and Resilient Communities December 2019 Webinars Funding provided by the New Jersey Department of Children and Families The New Jersey Chapter, American Academy of Pediatrics (NJAAP) believes that all children deserve to feel safe and secure in their home, at school, and while at play. The Healthy Spaces program aims to address adverse childhood experiences (ACEs) through partnerships with pediatric/family healthcare teams, schools and communities.
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Home Gun Safety Queries in Well-Child Visits [jamanetwork.com]

By Carole H. Stipelman, Greg Stoddard, Kyle Bata, et al., JAMA Pediatrics, October 28, 2019 Firearms are a leading cause of death in US children, and the rate of suicide by firearms in people aged 10 to 19 years has increased since 2008.1 In the United States, 4.6 million children (approximately 7%) live in households with at least 1 gun that is stored loaded and unlocked.2 Safe storage of guns and ammunition may decrease the occurrence of self-inflicted or unintentional firearm injury to...
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How Can a Doctor Stop from Burning Out in the Pandemic? (greatergood.berkeley.edu)

Over the din of the negative pressure machine, I shouted goodbye to my patient. I zipped my way out of one of the little plastic enclosures in our emergency department (ED). With disgust and a bit of fear, I carefully shed my gloves, gown, and face shield. Only my precious mask remained on my face. I thought, This is a whole new world, and I hate it . The problem is that I’m losing that deep feeling of connection with patients, which is such an important part of this work. A few weeks ago,...
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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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Hundreds of Miles From Home, Nurses Fight Coronavirus on New York's Front Lines [nytimes.com]

By Jenny Gross, The New York Times, April 28, 2020 Each night at dusk, in an otherwise desolate Times Square, hundreds of nurses in blue scrubs gather to board buses that take them to hospitals across New York City. Of the thousands of nurses who have come from other states to shore up New York’s hospitals, more than 4,000 are staying in Midtown Manhattan. During the day, many rest at their hotels, amid darkened Broadway marquees, quiet streets and boarded up shops. At night, they face...
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`I'm never going to be the same': Medics grapple with mental trauma on COVID-19 front line (msn.com)

Anne Messman, a veteran emergency room physician in Detroit, knew something was wrong when she developed insomnia and became unusually irritated with people she loved. Messman and thousands of other healthcare workers across the United States are grappling with psychological traumas that mental health professionals say are more commonly associated with soldiers returning home from far-flung battlefields. The unrelenting horror of COVID-19 has exacted a toll on healthcare workers who have...
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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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KPJR Films Virtual Showcase Registration Including Live Twitter Townhall [kpjrfilms.co]

TRAUMA-INFORMED IN THE AGE OF CORONAVIRUS A virtual discussion featuring Alice Forrester, PhD, CEO of Clifford Beers from RESILIENCE, Jim Sporleder, Trauma Informed Consultant and former Principal of Lincoln High School shown in PAPER TIGERS, and James Redford, Director of both RESILIENCE & PAPER TIGERS. During this time of social isolation, KPJR Films is reaching out to share our documentary films and trauma-informed tools with communities nationwide. KPJR Films will launch KPJR...
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Last week to register or apply for a scholarship--Creating a Resilient Community Conference

Kelsey Visser ·
This is the final week to register or request a scholarshi p to attend the virtual Creating a Resilient Community: From Trauma to Healing Conference on April 21st. This virtual event with cutting edge community resilience and trauma healing speakers Dr. Kenneth Ginsburg and Dr. Wendy Ellis will provide a platform to convene as a community to learn, connect, and envision a path forward together to transform our region into one of prevention, hope, healing and resilience for all. Conference...
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Med school free rides and loan repayments — California tries to boost its dwindling doctor supply (calmatters.org)

Primary care doctors are a hot commodity across California. Students are being lured by full-ride scholarships to medical schools. New grads are specifically recruited for training residencies. And full-fledged doctors are being offered loan repayment programs to serve low-income residents or work in underserved areas. These efforts are intended to ease or stave off the physician shortage expected to peak within the next decade in California. By 2030, the state will be short some 4,000...
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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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NPPC's Pilot Site Case Studies: Lessons Learned from ACEs Screening Implementation

Molly Peterson ·
The Center for Youth Wellness' National Pediatric Practice Community on ACES (NPPC) is a co-designed community committed to collaborative learning. To promote this learning, we have been working with six pilot sites over the last year, representing practices of various sizes and service delivery settings, to implement ACEs screening and intervention. Beyond supporting these practices with the logistics of implementation, the broader goal was to discover and share real-world best practices,...
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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.
Comment

Re: A Nurse Survivor Shares Her Story and Concerns

Lisa Eason ·
Thank you Laneita. We all need a strong reminder that we never know what another has gone through. And we also need to consider making a commitment to ourselves to try to never leave someone worse off than how we found them. In your case you were left worse off, by the judgmental words. I am sad that you had to experience that, especially from we nurses. I sincerely hope that nursing and physician programs teach ACES content, as well as have their students evaluate their own ACE scores and...
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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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Information and Updates on COVID-19 [acpm.org]

From American College of Preventive Medicine, May 2020 Preventive Medicine Physicians are our nation's first line of defense against pandemic disease. They are responding to the current COVID-19 pandemic with dedication, expertise and unfailing commitment to public health. We are curating a collection of well-vetted resources on COVID-19 for physicians, families and anyone interested in learning more about the coronavirus. Read our new blog, Preventive Medicine Responds to COVID-19 HERE. [...
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Forsyth County Trauma Informed Care Network

Laneita Williamson ·
The Forsyth County Trauma Informed Network is taking great strides into recognizing and addressing community post Covid-19 impacts. PowerPoint attached.
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Commentary: Why so many black Americans are dying from COVID-19 and how to make health care equitable (sandiegouniontribune.com)

Evidence suggests that during the early phase of the coronavirus pandemic, blacks are suffering the greatest death rates compared to all other ethnic groups. Why? I can assure you that the coronavirus does not discriminate based upon skin color or ethnicity. Instead, it has a predilection for populations with the highest rates of chronic diseases, poor access to health care and too little information from trusted sources. For decades, the National Medical Association — which represents more...
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"Addiction begins with solving a problem, the problem of human pain, emotional pain"

Laurie Udesky ·
In his groundbreaking book , In the Realm of Hungry Ghosts: Close Encounters with Addiction , trauma and addiction expert Dr. Gabor Maté writes, “There are almost as many addictions as there are people.” ACEs Connection founder and publisher Jane Stevens read that quote as a springboard to asking Maté to define addiction and explain whether or not it is always rooted in adverse childhood experiences. Maté, along with filmmaker Michelle Esrick and Saturday Night Live star Darrell Hammond,...
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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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What Do We Do? What Do We Do Now?

Jane Stevens ·
People’s response to the great chasms of structural inequities glaringly laid bare by the COVID-19 pandemic have been further inflamed by the murder of George Floyd and deaths of other African Americans in recent weeks. The acute emergency of the pandemic has eased, but the violence inflicted on racial minorities and now those who are protesting the inequities in our society has compounded the outrage. Right after the pandemic began running riot across the US, I often heard people ask: When...
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Could Community Health Workers and Promotores de Salud Help California Respond to COVID-19? (CHCF Blog)

Karen Clemmer ·
By Rob Waters, June 4, 2020, California Health Care Foundation. Aida Meza has been working as a promotora de salud, a community health worker, since she moved across the border from Tijuana, Mexico, to the San Diego area 23 years ago. She came to Chula Vista with her husband, an American citizen, so they could send their kids to better schools. “At first I cried every day because I wanted to go back to my home,” she said. Then the principal at her children’s school, Vista Square Elementary,...
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NEW Trauma-informed Care Podcast (CME provided)

Megan Gerber MD MPH ·
Join us as we delve into the paradigm-shifting ethos of trauma-informed care with renowned expert Dr. Megan Gerber. Dr. Gerber is an Associate Professor of Medicine at Boston University School of Medicine and serves as Medical Director of Women’s Health for VA Boston where she directs the Women’s Health Fellowship. Dr. Gerber edited the textbook, “Trauma-informed Health Care Approaches: A Guide for Primary Care.” We discuss the framework for trauma-informed universal precautions, as well as bas
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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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Doctor Goes Viral for Explaining How Biases Affect the Healthcare Black Patients Receive (Distractify)

Karen Clemmer ·
By Robin Zlotnick, June 9, 2020, Distractify. If you want concrete evidence of deeply ingrained racism, look no further than our doctors and healthcare workers. Dr. Jennifer Lincoln is going viral on TikTok for explaining just how rampant implicit bias is in hospitals and doctors' offices. She highlights a 2016 study , which found that about half of white medical students and residents subscribed to the false narrative that Black people feel less pain than white people and were more likely...
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2020 Health Equity Call for Research (AAMC)

Karen Clemmer ·
2020 Health Equity Call for Research: AAMC Consumer Survey of Health Care Access Introduction In recognition of the importance of research and the dissemination of evidence-based solutions to achieve health equity, the AAMC (Association of American Medical Colleges) founded the Collaborative for Health Equity: Act, Research, Generate Evidence (CHARGE), a forum for investigators, clinicians, and community partners to collaborate and improve upon research that aims to minimize disparities in...
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