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PACEs in Pediatrics

Tagged With "ACEs in Medical School"

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Graduations, non-linear paths, & the importance of getting started

Lori Chelius ·
With graduation season upon us, I have been thinking a lot about one of my favorite graduation speeches. It’s the speech that Shonda Rhimes, creator of Grey’s Anatomy, gave in 2014 at Dartmouth College. She references the typical expected advice from a graduation speech: “Follow your dreams. Listen to your spirit. Change the world. Make your mark. Find your inner voice and make it sing. Embrace failure. Dream. Dream and dream big..." And then she says, “I think that’s crap.”
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Healthy Spaces December 2019 Webinars

Aldina Hovde ·
Healthy Spaces: Promoting Healthy and Resilient Communities December 2019 Webinars 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. Preventing Child Abuse and Neglect (PCAN) Date & Time: Tuesday, December 10,...
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Hearing in House Education and Labor Early Childhood Subcommittee addresses intersection of trauma and education

Dr. Nadine Burke Harris (l) and Karina Chicote, Churchill Fellow from western Australia meet after congressional hearing After watching the hearing on a monitor in the overflow room, Karina Chicote, a Churchill Fellow from western Australia, and I hustled to the hearing room in hopes of speaking to the lead witness, Nadine Burke Harris, MD, the first Surgeon General of the State of California. She was deep in conversation with others, including a young woman who wanted to tell her how...
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Helping families cope with the trauma of school shootings

Laurie Udesky ·
More than 214,000 students have experienced gun violence in their schools since the first tragic shooting at Columbine High School in 1998, according to data analysis by the Washington Post . The most recent incident occurred just days ago on May 18th; a student killed 10 people at Santa Fe High School in Sante Fe, Texas. The National Child Traumatic Stress Network has provided the following downloadable resources: Tips for parents on media coverage Parent Guidelines for helping youth after...
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Helping Teenagers Feel 'Connected' to School Yields Benefits 20 Years Later [blogs.edweek.org]

Marianne Avari ·
By Sarah Sparks, Education Week, June 24, 2019. Adolescents can be challenging for educators to keep engaged—but putting in the effort to make them feel connected to school can pay off well into adulthood. In a study published this morning in the journal Pediatrics, researchers at the federal Centers for Disease Control and Prevention tracked more than 14,000 middle and high school students over 20 years. They found that students who felt connected to their school and family as adolescents...
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Heyman Oo integrates ACEs science as foundation of pediatric care

Sylvia Paull ·
Dr. Heyman Oo, a 34-year-old primary care pediatrician, first learned about the science of adverse childhood experiences in medical school at a grand rounds held around 2012 at Rady Children’s Hospital in San Diego, which she attended from 2009 to 2014. The presenter was none other than Dr. Nadine Burke Harris, a pediatrician who went on to become California’s first Surgeon General. The founder and former director of the Center for Youth Wellness drew millions of views for her TED talk on...
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HOPE, Engagement, and COVID19

Bob Sege ·
As children grow and develop, engaging with the larger community around them provides a sense of “mattering” — a sense that their participation in the community really does matter. The emergency conditions now in effect provide numerous opportunities to children and teens to pitch in. Here are a few ideas . . .
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How collaboration helps clinic in San Mateo County, CA, tackle ACEs in children

Laurie Udesky ·
Dr. Elizabeth Grady is a pediatrician at the South San Francisco Clinic, a community clinic of San Mateo Medical Center. She and Susana Flores , a senior public health nurse with San Mateo County Health, spoke with me about how the clinic and other health agencies in San Mateo have been able to craft ways to work together to prevent and heal toxic stress in children. Grady also talked about how she and Flores have been working with the Resilient Beginnings Collaborative (RBC), a group of...
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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 Does Trauma Affect a Person’s Interaction with Their Child? (www.nicabm.com) & Commentary

Christine Cissy White ·
Has anyone seen this video posted on the National Institute for the Clinical Application of Behavioral Medicine (NICAMB) blog? "According to Dr. Ruth Lanius, a parent's experience of trauma can impact their ability to form a close, intimate relationship with their child." Ruth Buczynski, PhD Those of us Parenting with ACEs sure know that's the truth. Developmental trauma impacts our ability to form close and intimate relationships with ourselves, other adults and our children. The video was...
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Hundreds Attend ACEs Town Hall Featuring California Surgeon General Nadine Burke Harris (with video) [northcoastjournal.com]

By Iridian Casarez, North Coast Journal, November 22, 2019 The Sequoia Conference Center on Humboldt County Office of Education’s campus was at capacity, 448 people had landed a seat — while at least another 100 watched from a live stream in a separate room. The draw was a conversation among California’s first Surgeon General Nadine Burke Harris and a panel of locals spearheading Humboldt County’s efforts to alleviate the impacts of Adverse Childhood Experiences, also known as ACEs. “Thank...
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Immigrant teens, parents explore ACEs, resilience in 5-week course with family doc

Laurie Udesky ·
Dr. Angela Bymaster, a family doctor in San Jose, Calif., was determined to find a way to teach ACEs science to her patients. Teens would come to the Washington Neighborhood Clinic clearly depressed by a range of problems at home that were contributing to risky sexual behavior and marijuana use, as well as preventable health problems like extreme obesity.
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Researchers share learned lessons from screening for adverse childhood experiences in pediatric clinics

Laurie Udesky ·
What are the reasons that parents or caregivers do not fully disclose their own or their young children’s ACEs when asked to fill out an ACE screening form in their child’s pediatrician’s office? That was one of the many questions raised in a recent webinar entitled Screening for Adverse Childhood Experiences in the Pediatric Primary Care Setting: Practical Considerations and Lessons Learned . Dr. Kavitha Selvaraj, an attending physician at the Ann & Robert H. Lurie Children’s hospital...
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In ACEs Connection webinar, physicians talk trauma, offer tips for helping pediatric immigrant patients

Laurie Udesky ·
Dr. Raul Gutierrez, a pediatrician in the San Francisco Bay Area, said he and his fellow clinicians see constant fear and its health consequences every single day among the largely immigrant and Latino population they serve. It’s all the result of anti-immigrant policies and the news cycle that feeds the fear. Dr. Raul Gutierrez “It is almost inescapable with the repercussions of immigration policy on the radio, television, social media and from friends and family,” Gutierrez told the 69...
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Increasing Resilience: Primary Healthcare Providers' Opportunities to Promote Protective Factors Before and After Childhood Trauma [avahealth.org]

By Machelle D. Madsen Thompson and Bart Klika, Academy on Violence and Abuse, March 2020 Lifespan research reveals that although ACEs are common, many people are able to move toward recovery and achieve reportedly good functional status. This resilience does not occur in isolation but is supported by a composite of protective factors that empower a child to return to functional status following ACEs. Resilience is observed when a child is immersed in positive influences, such as supportive...
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Inequality in Children's Brain Development - UC Davis Center for Poverty Research

Gail Kennedy ·
Friday, February 23, 2018 - 3:10pm - 4:30pm | 2203 SS&H, Andrews Conference Room Kimberly Noble, Associate Professor of Neuroscience and Education, Columbia University MORE INFO Dr. Kimberly Noble is a developmental cognitive neuroscientist and pediatrician who studies socioeconomic disparities in children’s neurocognitive development. She received her undergraduate, graduate, and medical degrees from the University of Pennsylvania and trained at the Sackler Institute for Developmental...
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Interactive training on nature and health for health care providers, Oakland, Ca

Laurie Udesky ·
October 27, 2018 8:45 AM 5:00 PM PDT Calling all health care providers! Save the date! Saturday October 27th, 2018 Join The Center for Nature and Health and Primary Care Clinic, UCSF Benioff's Children's Hospital: When: Saturday, October 27th, 2018, 8:30 a.m.–5:00 p.m. (Outdoor time included!) Where: CHORI Library, 5700 Martin Luther King Jr. Way, Oakland, Ca Register now: www.bitly.com/ucsf- nature2018 Featured speakers: Daphne Miller, MD, Physician and author Jose Gonzalez, Founder, Latino...
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Intergenerational associations of parent adverse childhood experiences and child health outcomes [ Pediatrics]

Laurie Udesky ·
To what extent do parents' adverse childhood experiences (ACEs) affect ACEs and health status among their children? Linking data of 350 parents and their children from the 2012 Southeastern Pennsylvania Household Health Survey (HHS) and the Philadelphia ACE Survey, researchers found statistically significant correlations between parents' ACE scores and their children's health status. "Our results suggest that the full scope of health effects of ACEs is not limited to the exposed individual.
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Interim report of the President’s opioid commission says its final report will address early intervention strategies for children with ACEs

On August 8, President Trump spoke to the opioid crisis in this country and declined to declare a national emergency as recommended by the “President’s Commission on Combating Drug Addiction and the Opioid Crisis.” Instead, the President emphasized the law and order aspects of the problem and the importance of preventing drug use in the first place since addiction is so hard to overcome. The Commission will make a final report in the fall. The recently released interim report makes eight...
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4 years after integrating ACEs science, Pueblo, CO clinic improves services for families; cuts ER costs, doctor stress

Laurie Udesky ·
Four years ago, Dr. Leslie Dempsey would never have talked about ACEs — adverse childhood experiences — with her patients. Now ACEs is a common topic. “Just as I don’t feel awkward asking someone if they smoke or do intravenous drugs, I don’t really feel awkward talking about their childhood traumas in a way that it relates to their health. It’s just integrated into obtaining background and social history,” she says. Dr. Leslie Dempsey Dempsey is a physician in obstetrics who oversees a team...
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5 Things to Know as California Starts Screening Children for Toxic Stress [californiahealthline.org]

By Barbara Feder Ostrov, California Healthline, January 7, 2020 Starting this year, routine pediatric visits for millions of California children could involve questions about touchy family topics, such as divorce, unstable housing or a parent who struggles with alcoholism. California now will pay doctors to screen patients for traumatic events known as adverse childhood experiences, or ACEs, if the patient is covered by Medi-Cal — the state’s version of Medicaid for low-income families. The...
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8 Myths About Screening For Adverse Childhood Experiences

Laura Shamblin ·
I’d like to take this opportunity to address some of the objections to screening for ACEs that I have come across. It is true that some areas of research are still emerging, such as protocols, but in other ways we are twenty years behind using the information we have to make a positive difference in our patients lives and in training new physicians to be more comfortable addressing social and experiential determinants of health.
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9 Big Questions as California Starts to Screen Kids for Trauma, ACEs [salud-america.org]

By Amanda Merck, Salud America!, February 12, 2020 Early childhood adversity like abuse and divorce is a root cause of many of the greatest public health challenges we face today. But doctors don’t even screen children for exposure to adversity. That’s changing in California, thanks to Dr. Nadine Burke Harris and other child advocates. As of Jan. 1, 2020, almost 100,000 physicians in 8,800 clinics will be reimbursed for routinely screening Medi-Cal patients for adverse childhood experiences...
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A Community Approach to Trauma Sensitivity / Making a Difference Conference in MA in November

Christine Cissy White ·
The 6th Annual Making a Difference Conference for SESPs, Foster/Adoptive and Kinship Caregivers and their Professional Partners will be held in Marlborough, MA on November 14, 2017. The theme is A Community Approach to Trauma Sensitivity. There will be at least two talks will be about ACEs! Speakers/Topics: Keynote: Managing the Hearts and Souls of Many, Dana Royster-Buefort, M.Ed., C.A.G.S. Workshops Tackling ACEs by Building Resilient Communities , Renee D Boynton-Jarrett, MD, ScD . Note:...
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A fast, easy way for pediatricians to screen kids for ACEs...and other health issues

Laurie Udesky ·
Last November, the California Department of Managed Care gave its stamp of approval to a new version of Whole Child Assessment 2.0 , a tool that screens for children’s adverse childhood experiences (ACEs). It was recommended as part of recently passed legislation calling for trauma screening for children in California. But the Whole Child Assessment 2.0 (WCA) does more. It also queries patients about other critical safety and health issues, including whether they have enough to eat, whether...
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A Health Problem and An Opportunity: Screening for Adverse Childhood Experiences [medium.com]

Dayna Long ·
By Dayna Long, Medium, May 19, 2020 A consensus of scientific research demonstrates that cumulative adversity, especially when experienced during critical and sensitive periods of development, is a significant contributing factor to some of the most harmful, persistent, and expensive health challenges facing our nation. Adverse Childhood Experiences (ACEs) are highly prevalent, experienced in all communities, and are likely to increase during the COVID-19 emergency [i] [ii] [iii] [iv] [v].
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A Kaiser pediatrician, wise to ACEs science for years, finally gets to use it

Laurie Udesky ·
Dr. Suzanne Frank has known about the impact of childhood adversity on young lives for decades. She’s seen the fallout in the faces of young people huddled in beds at a children’s shelter where she worked years ago. She’s seen it as the regional child abuse services and champion for the Permanente Medical Group. And she’s seen it in hospital examination rooms where, as a member of the Santa Clara County’s Sexual Assault Response Team, she’s been called in to examine shell-shocked children...
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A Message from the President of the Illinois Chapter, American Academy of Pediatrics

Elise Groenewegen ·
Dear Illinois ACE Connection members, Children and families from all demographic and socioeconomic backgrounds in Illinois experience trauma, adversity, and chronic stress. Social determinants such as where we live, work, and play, can further exacerbate positive or negative physical, emotional, and behavioral health issues. The critical factor that determines if a child, family, and/or community can manage trauma, adversity, and chronic stress successfully is resilience : the process by...
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A National Agenda to Address Adverse Childhood Experiences

Christina Bethell ·
What are ACEs and Why Do They Matter? In 2016 1 , nearly half of U.S. children – 34 million kids – had at least one Adverse Childhood Experience (ACE) and more than 20 percent experienced two or more. The new brain sciences and science of human development explain how ACEs can have devastating, long-lasting effects on children’s health and wellbeing. These events resonate well beyond the individual child to have far-reaching consequences for families, neighborhoods, and communities. ACEs...
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A New Documentary About Breaking the Cycle of Trauma is Launching This Fall!

Charlotte Graham ·
We are thrilled to announce the premiere of Wrestling Ghosts , a documentary about breaking the cycle of trauma, at the LA Film festival on Sept. 27th. “Incredible. Haunting and strange and beautiful and incredibly moving.” -Dan Cogan, Founder Impact Partners Wrestling Ghosts follows the epic inner journey of Kim, a young mother who, over two heartbreaking and inspiring years, battles the traumas from her past in order to create a new present and future for her and her family. In this...
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A Pediatrician's View Of Paid Parental Leave [NPR.org]

Samantha Sangenito ·
Paternity leave can make a big difference in a dad's long-term engagement with the child, doctors find. Paid family leave also fosters breastfeeding and reduces the incidence of maternal depression. As part of All Things Considered's series Stretched: Working Parents' Juggling Act , NPR talked with Dr. Benard Dreyer , a developmental and behavioral pediatrician at the New York University School of Medicine and president of the American Academy of Pediatrics, to get a better sense of what the...
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ACE-Aha Moments & Parenting: Meet Aprel Phelps Downey

Christine Cissy White ·
Aprel Phelps Downey What was your ACEs Aha moment? When did you first hear about ACEs and what impact did/does it have on you? How do ACEs impact you as a parent? How is your parenting impacted by past trauma? What’s been most helpful to you as a parent parenting with ACEs? What’s been most challenging for you as a parent parenting with ACEs? What has parenting taught you? What have you learned? How do you manage complex family relationships? What inspires/encourages and helps you? I know...
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ACE Fact Sheets to Give Your Doctors, Patients & Beyond (free downloads)

Veronique Mead ·
I was first inspired to create a fact sheet summarizing the effects of adverse childhood experiences (ACEs) after reading a comment in “Got Your ACE score?” A reader wished she had a form to give her doctor that documented the vast body of evidence explaining how early trauma increases risk for chronic physical and mental health conditions and much more. I could relate.
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ACEs & African Americans Community on ACEs Connection

ACEs Connection envisions a resilient world where ALL people thrive. We are an anti-racist organization committed to the pursuit of social justice. In our work to promote resilience and prevent and mitigate ACEs, we intentionally embrace and uplift people who have historically not had a seat at the table. ACEs Connection celebrates the voices and tells the stories of people who have been barred from decision-making and who have shouldered the burden of systemic and economic oppression as the...
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ACEs and resilience research roundup: Paternal ACEs, family resilience, reforming health care

Laurie Udesky ·
CC by SA 3.0 Parental Adverse Childhood Experiences and Pediatric Healthcare Use by 2 Years of Age EA Eismann, AT Folger, NB Stephenson… - The Journal of Pediatrics , 2019 … ACEs and several child outcomes,8, 9, 10, 11, 12 but less is known about the intergenerational impact of paternal ACEs .7, 13 The … 12 months, 15 months, 18 months, and 24 months of age, based on Bright Futures and the American … Adverse childhood experiences ( ACEs ) are associated with forced and very early sexual...
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ACEs, biomarkers and the cost of adversity

Laurie Udesky ·
How useful and necessary are biomarkers in telling the story of how toxic stress from adverse childhood experiences and resilience can impact a child’s long-term health? In the introduction to an article in the journal BioEssays , Dr. Kathryn Ridout, a Kaiser Permanente San Jose psychiatrist, and her co-authors examine what is known about two biomarkers and quote data on child maltreatment and its economic burden over time that says it all. “When totaling the costs of health care, child...
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ACEs champion pediatricians talk about life and practice in a COVID-19 world

Laurie Udesky ·
With the advent of the COVID-19 pandemic, healthcare providers everywhere are changing how they care for their patients. I asked a few members of the ACEs in Pediatrics community what they’re doing differently. Dr. R.J Gillespie, pediatrician at The Children’s Clinic in Portland, OR. Dr. R.J. Gillespie Gillespie says that, as much as possible, they’re switching to virtual visits, which allows them “to comfort and reassure our patients face-to-face as much as possible without risking their...
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ACEs Research Corner — January 2020

Harise Stein ·
Research papers this month include links between ACEs and bullying, dropping out of high school, adult disability, and the effects of countering ACEs.
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ACEs Research Corner — March 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 science. Thank you, Harise!! -- Jane Stevens] Brown SM, Bender K, Orsi R, McCrae JS, Phillips JD, Rienks S. Adverse childhood experiences and their relationship to complex health profiles among child...
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ACEs Research Corner — October 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] Zhang L, Zhang D, Sun Y. Adverse Childhood Experiences and Early Pubertal Timing Among Girls: A Meta-Analysis. Int J Environ Res Public Health. 2019 Aug 13;16(16).
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ACEs research roundup: Intergenerational poverty; TIC curriculum; obesity; opioids, school-based health

Laurie Udesky ·
Health Status of Children Enrolled in a Family Navigator Program to Eliminate Intergenerational Poverty , Clinical Pediatrics All Traumas Are Not Created Equal JAMA Pediatrics Adverse Childhood Experiences: A Case-Based Workshop Introducing Medical Students to Trauma-Informed Care The Journal of Teaching and Learning Resources The Evidence on School-Based Health Centers: A Review Global Pediatric Health Adverse Childhood Experiences in Infancy and Toddlerhood Predict Obesity and Health...
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ACEs research roundup: preschool suspensions; trauma inquiry; foster youth; school success

Laurie Udesky ·
Adverse childhood experiences and preschool suspension expulsion: A population study , Child Abuse & Neglect S Zeng, CP Corr, C O'Grady, Y Guan The state of the science on trauma inquiry , Women's Health A Lewis-O'Connor, A Warren, JV Lee, N Levy-Carrick A Positive Youth Development Approach to Improving Mental Health Outcomes for Maltreated Children in Foster Care: Replication and Extension of an RCT of the Fostering Healthy Futures Program , American Journal of Community Psychology...
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ACEs research roundup: Trauma response in an HIV clinic; ACEs and school nursing; protective factors and school outcomes; using the WCA

Laurie Udesky ·
The association of trauma with the physical, behavioral, and social health of women living with HIV: Pathways to guide trauma-informed health care interventions YP Cuca, M Shumway, EL Machtinger, K Davis… - Women's Health Issues, 2019 Reflections on National Association of School Nurses’ (NASN’s) History NASN President's Inaugural Address LG Combe - 2019 Adverse childhood experiences and protective factors with school engagement A Robles, A Gjelsvik, P Hirway, PM Vivier, P High - Pediatrics...
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ACEs Screening

Morgan Vien ·
This is a collection of resources regarding screening for ACEs . This list aims to give a broad overview and is not all-inclusive. We welcome suggestions; if you have any, please comment below! This resource list is organized in alphabetical order. Pediatric Campus in Santa Rosa ACEs screeners, 2019 Description: ACEs screeners for 4m-11y and 12y-18y in English and Spanish are in the attachments below. Whole Child Assessment (WCA) , 2019 Description: The Whole Child Assessment (WCA) is a...
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ACEs screening in CA — a Q and A with Dr. Dayna Long

Laurie Udesky ·
Last year, the California Department of Health Care Services rolled out its plans for universal screening for trauma among its pediatric and adult Medicaid population. Beginning January 1, 2020, California physicians were able to receive an incentive payment of $29 for each pediatric patient screened for ACEs using the PEARLs ( Pediatrics Adverse Childhood and Resilience Study) tool. Dr. Dayna Long talked with ACEs Connection staff reporter Laurie Udesky about ACEs science, what led to the...
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After 5-year journey to integrate ACEs science, Santa Rosa, CA, pediatric clinic is trauma-informed, from head to toe

Jane Stevens ·
Dr. Meredith Kieschnick was among the first physicians in the U.S. to hear the term, "adverse childhood experiences". That was in 1998, early on in her career as a pediatrician, when the CDC-Kaiser Permanente Adverse Childhood Experiences Study (ACE Study) published its initial findings in the American Journal of Preventive Medicine . “I attended a conference at which (Dr. Vincent) Felitti spoke,” she recalls. Felitti, at that time director of the Health Appraisal Center at Kaiser Permanente...
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All hands on deck (from a distance): remote care for traumatized moms and babies

Jonathan Joseph Goldfinger ·
Dear colleague, Coronavirus is forcing providers and allied professionals serving mothers and babies to make unprecedented decisions. Should pregnant women needing care go through our hospital quarantine entrance? Should moms deliver without partners, family or doulas present? Be sent home early before key screenings or jaundice treatment are completed? To make matters worse, our systems aren't ready for basic remote care of mothers and infants now "socially distanced". Prenatal, post-partum...
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Alternative IHEBA with ACEs for California (and Other) Pediatricians

Ariane Marie-Mitchell ·
If you are a pediatrician serving Medicaid managed care patients in California, then you are required to use the Staying Healthy Assessment or an alternative IHEBA (Individual Health Education Behavioral Assessment) at all well-child visits. The bad news is that getting approval to use an alternative IHEBA is a tedious process. The good news is that as of October 27, 2016 the Whole Child Assessment (WCA) is available for use in English and Spanish. Most importantly, the WCA has been...
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Alternative IHEBA with ACEs for California (and Other) Pediatricians

Ariane Marie-Mitchell ·
If you are a pediatrician serving Medicaid managed care patients in California, then you are required to use the Staying Healthy Assessment or an alternative IHEBA (Individual Health Education Behavioral Assessment) at all well-child visits. The bad news is that getting approval to use an alternative IHEBA is a tedious process. The good news is that as of October 27, 2016 the Whole Child Assessment (WCA) is available for use in English and Spanish. Most importantly, the WCA has been...
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American Acad of Pediatrics Policy Statement - Immigration policies need to be trauma-informed [www.medpagetoday.com]

Leslie Lieberman ·
The American Academy of Pediatricians has made a bold statement about the proposed DHS policy to separate children from their parents and the use of detention - clearly linking these policies to their potential to traumatize children. To that end, children should never be separated from a parent unless it is for the child's safety, and the Department of Homeland Security should discontinue the use of family detention and use community-based alternatives to detention to treat immigrant...
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