Jane Ellen Stevens

Dr. Jeffrey Brenner: “I believe ACE scores should become a vital sign, as important as height, weight, and blood pressure.”

This video looks at the relationship between ACEs and hospital emergency rooms.

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Dr. Jeffrey Brenner is founder and executive director of the Camden Coalition of Healthcare Providers, and a 2013 MacArthur Foundation genius award winner. He did groundbreaking work in Camden, N.J., by using data to identify people who were hospital emergency room “frequent fliers”. He found that between their trips to the ER, little or nothing was done to help them improve their health. So, he began putting basic services in place to help these people. His work was written up in a New Yorker article — The Hot Spotters, by Dr. Atul Gawande — in  2011.

That article sent a shock of electricity through me — not only because it was so well written, but because Brenner was on to a solution for markedly reducing health care costs. However, it seemed to me that there was a piece missing —  if Brenner knew about the CDC’s Adverse Childhood Experiences Study, he (and other physicians) might be able to identify the people who suffer most in our society more quickly.

Today, an essay Brenner wrote about how the medical community has neglected the ACE Study, even though its findings were published in 1998, appeared on Philly.com’s The Field Clinic blog. It’s well worth a read. Here’s part of it:  

For nearly 15 years we’ve had the secret to delivering better care at lower cost in America.  The information has sat, hidden away in the medical literature, and barely mentioned among physicians.  It’s a remarkable story of bias. The neglect of this information by the medical community tells you a lot about our failings as a profession and the poor training we receive.  It’s also a powerful commentary on the values of our society and the biases built into our society’s view of health and healthcare.

In the 1990’s, a physician at Kaiser Permanente in California, Dr. Vincent Felitti, conducted a mail survey with 17,000 middle class patients.  He asked them questions about traumatic events that might have happened to them as children.  Incredibly, over 70% of people receiving the survey responded, and they gave permission to connect their survey answers to their medical records.

….In the work that I do in the City of Camden building interventions for high-cost complex

patients, the issue of early life trauma and compounding later life trauma has become a core one.  Many of our high utilizers of the local healthcare system tell us horrible stories of their childhood, when asked.  We’ve recently published research on these findings.  To read our report, click here.

In my training as a family physician, I was told not to pull up the lid on something you don’t have the time and training to deal with, like early life trauma.  I am deeply embarrassed in looking back at my career caring for patients in Camden because I followed this advice too often.  It’s likely that many of my patients had early life trauma that was probably sitting right below the surface, but I rarely asked.  It’s frightening to open up a Pandora’s box in a 10-15 minute visit of an overwhelmed primary care office.

10 comments

  2. […] Nadine Burke Harris M.D., CEO of Center for Youth Wellness , is a nationally prominent pediatrician, at the forefront of advocacy, “catalyzing change”.  She is aggressively implementing the research on ACEs, screening 100% of patients for ACEs.   Dr. Harris, Dr. Felitti and others, such as Dr. Jeffrey Brenner exhort all to incorporate ACE scores as ‘basic information’ in medical practice much like “vital signs”. […]

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  3. Jane, what a great article at the right time. Teri Barila and team are presenting to the school board Tuesday to adopt and support a policy statement for our school district. One board member that is struggling is a doctor, this article is going right into the presentation. As always, you do such a wonderful job keeping us informed….as well as your team.

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  5. Jane, I love what you’re doing here! After I learned about ACE and took the test, I went looking for info about how to recover when you’ve got a high score. Counseling, reading books about healing and forgiveness, journaling, meditation—they all help. I did wonder why my M.D. didn’t seem to really “take in” what I was saying about early experience, as she was focused on purely physical symptoms. You are right on the mark, bringing all of this information together in one place. Thank you again and again; your efforts will help multitudes.

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    • Thanks for your kind words, Liz. There’s a resilience questionnaire after the ACE questionnaire in the “Got Your ACE Score” tab — you can derive some resilience practices from it. We’ll be putting more info about resilience practices — individual, family and community — in the Resource Center of ACEsConnection.com later this spring.
      Cheers, Jane

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      • Thanks; good to know. Most helpful to me lately is the book “Forgive for Good,” by Dr. Fred Luskin, whose methods are clinically proven to provide peace and healing to those who are able to become forgiving people. It’s powerful.

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  6. We really do need to pull to the surface exactly what you have dared to do here Jane Ellen. It is scary, worrisome and many feel unequipped but if we began there, so much money – not time because that is exactly what the suffering need most from us – would be saved. Our medical world needs to stop working out of the disordered & diseased model and start examining humans from a developmental & attachment paradigm. I stopped a long time ago looking at my clients from the
    ” What is wrong with you? ” to the “What happened to you ? ” point of view.

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    • Thanks for commenting, Mark. Dr Felitti has noted that people with high ACE scores have great swaths of their childhood that they don’t remember. Thanks for the link!

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