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PACEs in Pediatrics

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Dr. Claudia Gold: Empathy & Listening as ACE-Informed Practice

Christine Cissy White ·
"You are absolutely not doomed from having ACEs."
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DULCE helps pediatricians in Oakland, CA, prevent toxic stress in newborns

Laurie Udesky ·
On a recent day in early March, Laura Lopez met a former patient of hers in the waiting room of Highland Hospital’s pediatric clinic in Oakland, CA. The patient had forgotten her Medi-Cal card and called Lopez asking for help. But in the brief conversation, Lopez, a family specialist with the DULCE program, learned about some dire changes in the patient’s life. Laura Lopez “Without me even asking, she shared with me that she had separated from her partner, that she needs to apply for food...
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Early Bird registration ends Feb 2 for the AAP Trauma Informed Pediatric Provider Course

Tammy Piazza Hurley ·
Early bird registration ends soon for the 2019 AAP Trauma Informed Pediatric Provider (TIPP) Course scheduled March 2-5, 2019 in San Antonio, TX. Learn from other pediatric healthcare providers about the recent science, evidence base and treatments of adversity, resiliency and toxic stress. AAP Past-President, Dr. Colleen Kraft, will deliver the keynote presentation Pediatricians as Leaders in Addressing Toxic Stress and Trauma in Children . For more information, a schedule of speakers and...
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Fathers & ACEs with Trauma Dad & Father's Uplift CEO: Tuesday, September 12th

Christine Cissy White ·
What supports exist to "uplift" fathers who have survived abandonment, abuse or torture as children? Where can men go to discuss the joys, struggles and issues of being a father with ACEs? Where are the men who face hard, heavy and complicated realities to make life easier and lighter for all who come after? We found two of them and they will be the featured guests in the next Parenting with ACEs chat . Meet Charles Clayton Daniels, Jr. of Father's Uplift and "Trauma Dad" Byron Hamel. Both...
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Finding the Right Words About COVID-19 [chcf.org]

By Kate Meyers, California Health Care Foundation, March 26, 2020 Health care organizations in California and around the US are working incredibly hard to prepare for or respond to a surge of patients suffering from symptoms related to COVID-19. Appropriately, preparation has focused on trying to ensure adequate numbers of health care professionals and sufficient supplies and equipment in the right places at the right times as the demand grows. That focus on numbers and logistics is...
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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 New Parents Make Room for Uncertainty

Claudia Gold ·
A new program for parents and infants, thanks to generous support from Mill Town Capital , is coming to Pittsfield, Massachusetts. The Hello It’s Me Project shines a spotlight on these tender new relationships, investing resources around the birth of a baby with the long-term goal of building a healthy community from the bottom up. When world-renowned child development researcher Dr. Ed Tronick spoke in the spring of 2018 for an audience of a wide variety of practitioners in Berkshire County...
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Helping New Parents Make Room for Uncertainty

Claudia Gold ·
A new program for parents and infants, thanks to generous support from Mill Town Capital , is coming to Pittsfield, Massachusetts. The Hello It’s Me Project shines a spotlight on these tender new relationships, investing resources around the birth of a baby with the long-term goal of building a healthy community from the bottom up. When world-renowned child development researcher Dr. Ed Tronick spoke in the spring of 2018 for an audience of a wide variety of practitioners in Berkshire County...
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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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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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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 Guide to Providing Telehealth During the COVID-19 Crisis

Daren Casagrande ·
Many of us in the mental health field are being thrust into unfamiliar territory as clinicians in the midst of the COVID-19 response. We either risk personal health (and the health of our clients) by seeing people in person, or needing to utilize technologies that we may be unfamiliar with. Further, those technologies have fluid legal/ethical standards (and is even more fluid at present to accommodate the pandemic), and which require different skill sets that in-person therapy. I am...
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A Guide to Providing Telehealth During the COVID-19 Crisis

Daren Casagrande ·
ACEs in Pediatrics community manager's note: Although this post by Daren Casagrande is geared toward mental health providers, I thought it had material that could be useful to a wider swath of health care providers. Please comment below if you have any questions or suggestions. --- Laurie Udesky Many of us in the mental health field are being thrust into unfamiliar territory as clinicians in the midst of the COVID-19 response. We either risk personal health (and the health of our clients) by...
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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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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 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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Adverse Childhood Experiences (ACE) Study: Beyond Screening in Pediatrics

Claudia Gold ·
The evidence is clear. When bad things happen to us as young children, we are at significantly increased risk for not only mental health problems, but also a wide range of physical health problems including asthma, heart disease, and even early death. These "bad things" all involve disruptions in caregiving relationships. A national movement directed at screening for ACEs in pediatric practices has emerged from this work. My suggestion that the implication of the Adverse Childhood...
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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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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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Announcing a New Parenting and ACEs Blog from Stress Health, an Initiative of the Center for Youth Wellness

Diana Hembree ·
Research shows that the right kind of support and care can mitigate the impact of toxic stress in children and help them bounce back.
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As California Moves to Screen Children for Childhood Trauma, Poverty Has To Be Part of the Equation

Jim Hickman ·
In California, we are coming full circle in recognizing the connection between poverty and health.
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BABY ACES: When we consider the traumas that qualify as ACEs, babies need their own list.

Laura Haynes Collector ·
Babies are obviously very different from older children developmentally, including their ability to understand and process trauma. Indeed, a baby may be completely unaware of an actual ACE— say, the incarceration of their father— which a middle schooler would be painfully aware of. Yet at the same time, the baby could be much-more-acutely impacted by the secondary effect of this same ACE: a sad, stressed, and distracted mother. Similarly, if a parent dies in a car accident when a child is in...
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Bay Area Doctors Target Health Consequences of Childhood Trauma [sfchronicle.com]

By Erin Allday, San Francisco Chronicle, January 5, 2020 A screening tool developed by Bay Area pediatricians to identify adverse childhood experiences, ranging from homelessness and food insecurity to physical and sexual abuse, will now help doctors statewide address trauma affecting patients’ health. The California Department of Health Care Services approved the tool — called PEARLS, for Pediatric ACEs and Related Life-Events Screener — last month. As of Jan. 1, its use is covered by...
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Shifting the focus from trauma to compassion

Laurie Udesky ·
photo: Rolf Schweitzer/CCO Dr. Arnd Herz, a self-described champion for ACEs science, would like nothing more than to witness a greater appreciation of how widespread adverse childhood experiences are. Herz, a pediatrician and director of Medi-Cal Strategy for the Greater Southern Alameda Area for Kaiser Permanente Northern California, would also like to encourage more people in health care to engage in a trauma-informed care approach, a change in practice that he says not only benefits...
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Some 350 Florida Leaders Expected to Attend Think Tank with Dr. Vincent Felitti, Co-Principal Investigator of the ACE Study; Expert on ACEs Science

Carey Sipp ·
Leaders from across the Sunshine State will take part in a “Think Tank” in Naples, FL, on Monday, August 6, to help create a more trauma-informed Florida. The estimated 350 attendees will include policy makers and community teams made up of school superintendents, law enforcement officers, judges, hospital administrators, mayors, PTA presidents, child welfare experts, mental health and substance abuse treatment providers, philanthropists, university researchers, state agency heads, and...
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Strengths-based Approaches to Screening Families for Health-Related Social Needs in the Healthcare Setting [Center for the Study of Social Policy]

Laurie Udesky ·
How do you screen families to determine whether they have enough to eat or if they feel safe in their homes or communities without alienating them? In this new brief, authors Dr. Renee Boynton-Jarrett and JoHannah Flacks describe strength-based approaches to screening for health related social needs.
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Study shows most pregnant women and their docs like ACEs screening

Laurie Udesky ·
Photo/ CreativeCommons Would pregnant women participate in surveys from their doctors asking them about whether they had experienced trauma in their childhood? In surveying moms-to-be at two Northern California Kaiser sites, clinicians discovered that the women were receptive to filling out an adverse childhood experiences (ACE) survey, according to a study that was published earlier this year in the Journal of Women’s Health. In fact, researchers found out that the vast majority of pregnant...
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Survey: Healthcare providers, community organizations weigh in on California's ACEs screening program

Laurie Udesky ·
In January, California took a historic leap forward to promote universal ACEs screening of the state’s 13 million adults and children in the Medi-Cal program. The eventual goal is to promote ACEs screening for all patients, but this is a first step in dealing with a major issue that ACEs science has identified: that many children will develop serious health problems later in life because the healthcare system is not currently set up to detect the roots of those problems. The term ACEs, which...
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The Power of a Baby's Laugh

Former Member ·
Peek-a-boo: A window on baby's brain By Anna Lacey BBC Health Check   http://www.bbc.com/news/health-24553877   Baby laughter: What it reveals about your baby's brain Continue reading the main story Health Check A baby's first smile is an...
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The quest to find biomarkers for toxic stress, resilience in children — A Q-and-A with Jack Shonkoff

Laurie Udesky ·
The JPB Research Network on Toxic Stress , led by Dr. Jack Shonkoff, is working on developing biological and behavioral markers for adverse childhood experiences (ACEs) and resilience that they believe will be able to measure to what extent a child is experiencing toxic stress, and what effect that stress may be having on the child’s brain and development. The JPB Research Network on Toxic Stress is comprised of scientists, pediatricians and community leaders, and is a project of the Center...
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The Relentless School Nurse: Soap, Toothbrushes & Sleeping on Concrete Floors

Robin M Cogan ·
Earlier in the year, I wrote a blog post about one of my newest students who was saving food that was served in school to bring home to her family. The 4-year-old girl, a recent immigrant from Guatemala, was storing food in her pants pockets instead of eating at school. Here is a link to the blog post: Pockets Filled With Chicken and Other Social Determinants of Health Yesterday, I was privileged to see this little girl welcome the guests for the end of year celebration as the students move...
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Toxic Childhoods [politico.com]

Alissa Copeland ·
Often times, a pediatrician or medical professional well-versed in the effects of ACEs or toxic stress can be the initial bridge to services, support, and building resilience for children, youth and families served by child welfare. It's exciting and encouraging to read about more and more pediatricians grounding their medical practice within ACEs framework. A toddler came into my examination room recently at Bayview Child Health Center in Bayview Hunters Point, an underserved, largely...
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Trauma education and mindfulness help youth living amid gun violence

Laurie Udesky ·
Armon Hurst, 2nd from left, first row, Teens on Target, courtesy of YouthAlive! Eighteen-year-old Armon Hurst serves as vice president of the student body at Castlemont High School in Oakland, Calif. He has a 4.0 grade point average, is an avid baseball player, and is slated to go to college next year. But until a few years ago, Hurst would find himself waking from nightmares in the middle of the night. It was difficult to concentrate at school, and he wasn’t eating well. Armon Hurst “There...
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Trauma presents unique challenges to ELL students [PilotTribune]

Laurie Udesky ·
photo by Liz/ CC2.0 Editor's note: This excerpt from an article in the Storm Lake Pilot-Tribune in Storm Lake, Iowa highlights how teachers in the Storm Lake School District are being trained in how to recognize trauma in their English Language Learners, which make up the majority of the student population . "With 63 percent of Storm Lake’s students being English language learners (ELL), cultural diversity is a given for teachers. But the trauma inherent with immigrants and refugees in...
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Update on bills re: childhood adversity in California Legislature

Kelly Hardy ·
Below is an updated table of bills that address childhood adversity in the Legislature in 2019. The list is not exhaustive, so please email Kelly Hardy with Children Now if you think a bill is missing and/or if you have any questions. Email: khardy @childrennow.org . Here are key dates for the remainder of the legislative session: July 10 = last day for bills to pass out of policy committees July 12 – August 12 = Summer recess August 30 = last day for fiscal bills to pass out of committee...
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Upstreamist in Action: In a Texas Clinic, Lawyers Are Health Care Providers [Health Begins]

Karen Clemmer ·
Upstreamists are changemakers pioneering practices that improve health by blending medical and social care . In this series of profiles, HealthBegins highlights some of these bold leaders and their innovations, in settings large and small. Their stories show us that the journey upstream is not only necessary — it’s possible. The People’s partnership began in 2012, when two puzzle pieces clicked together. The clinic’s Chief Medical Officer, Dr. Louis Appel, a pediatrician with an interest in...
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UT San Antonio Researchers Pilot Ways to Help Youth Deal with Trauma [expressnews.com]

Kay Reed ·
(retrieved from https://www.expressnews.com/news/education/article/UT-San-Antonio-researchers-pilot-ways-to-help-15015016.php#photo-18954339 ) Before 12-year-old Rihanna Briseño started taking classes at Good Samaritan Community Services, she was quick to dislike people and get angry. The Rhodes Middle School sixth-grader didn’t know why, but sometimes her brain told her the right thing was to beat another kid up. “I would say those things that I’m not going to say now,” Rihanna told the...
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Webinar covered how to build trauma-informed connections via telehealth

Laurie Udesky ·
When Dr. Erika Roshanravan, a family physician with CommuniCare in Woodland, CA, thinks back to her patient visits prior to the COVID-19 pandemic, one way she drew their deep-seated concerns was to ask the reason for the visit and to interject throughout, “Is there anything else?” And it’s asking that question during phone and video visits that has also helped her understand the true reason for her patients’ needs now, she told people who attended an ACEs Aware webinar on April 29 entitled:...
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Wellness and Resiliency Toolkit for Kids with Trauma

Heidi Beaubriand ·
I'm excited to share a booklet created for youth in Oregon foster care at a Wellness camp this summer. Youth were provided with these quick, easy and effective (and evidence based) "Mindful Moments" exercises in their Wellness Toolkits and they were practiced throughout the day at camp so that they could be remembered in times of stress and dysregulation. The exercised are designed to quickly bring them back to a state of calm. The youth really enjoyed them, and found them easy and...
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What Our Children Need Us to Know, Right Now

Jondi Whitis ·
Teaching children how to better navigate crisis, right now.
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What the ACEs Screening Movement Can Learn from the Healthcare Hotspotting Movement

Jim Hickman ·
No brief intervention or short-term infusion of services is a silver bullet that will overcome the long-term harm caused by structural racism, poverty, and multi-generational trauma.
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When Parents Fear "It's All My Fault"

Claudia Gold ·
Many of my colleagues in the field of early childhood mental health work with what are termed "high risk" populations. Children of drug addicted parents, victims of child abuse, and families in abject poverty. While the challenges these families face are daunting, I find myself feeling some envy for my colleagues whose clients are in such obvious distress that the need for intensive treatment of parent and infant is not in question. In my rural, small-town population things are not so clear.
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Who's integrating ACEs?

Jane Stevens ·
2015 article about Children's Clinic in Portland, OR, doing ACEs history on parents of four-month-old babies.  2014 article about pediatricians taking ACEs  history on ACEsTooHigh.com.   Center for Youth Wellness, San Francisco,...
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Why Kids With ACEs Shouldn't Get a Pass on Chores

Diana Hembree ·
Don't worry that chores are too stressful for kids with ACEs, says trauma researcher Bob Sege, MD. “You don’t want to coddle them,” Sege said, “because the message they will get is that they are damaged goods. They need to know that the adversity they suffered is only one part of them; it’s not all of them.”
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