When Vermont State Legislator and physician Dr. George Till heard Dr. Vincent Felitti present the findings of the CDC’s Adverse Childhood Experiences Study at a conference in Vermont last October, he had an epiphany that resulted in a seismic shift in how he saw the world. The result: H. 762, The Adverse Childhood Experience Questionnaire, the first bill in any state in the nation that calls for integrating screening for adverse childhood experiences in health services, and for integrating the science of adverse childhood experiences into medical and health school curricula and continuing education.
That Vermont would be the first in the nation to address adverse childhood experiences so specifically in health care at a legislative level isn’t unusual. More than most states, Vermont is a “laboratory of change” for health care. It has embraced universal health care coverage for all Vermonters, and it passed the nation’s first comprehensive mental health and substance abuse parity law. (Washington State passed a law in 2011 to identify and promote innovate strategies, and develop a public-private partnership to support effective strategies, but it was not funded as anticipated. The Washington State ACEs Public-Private Initiative is currently evaluating five communities’ ACE activities.)
Vermont is also a state grappling with a number of social and health problems, including high rates of underage and binge drinking and a highly publicized drug-abuse crisis. A bright spotlight was shown on the state’s drug-related ills with Governor Shumlin’s single-issue state of the state address.
The ACE legislation came about as a result of the state’s activist traditions. Knowledge of the ACE Study had been percolating among people in several state-level departments. Essentially, the study links adverse childhood experiences with the adult onset of chronic mental health, physical health and social health issues. Other studies have shown short-term consequences in school-age children; ACEs are the best predictor for poor health and the second-best predictor for academic failure. Last year, says Kathy Hentcy, chronic disease prevention specialist at the Vermont Department of Health, the cross-agency group developed a consensus that the findings and implications of the ACE Study would be a focal point to convene diverse leaders from around the state for a series of meetings: a state-wide meeting, followed by a series of regional meetings. The goal was to plant seeds in communities around the state to examine the root causes of childhood trauma and find solutions.
The first meeting — VT ACE Conference: Improving Clinical Outcomes for Complex Patients – was where Till, a specialist in obstetrics and gynecology, had his epiphany. The conference was structured to encourage physicians, mental health experts, educators, state officials, legislators, corrections personnel, and others, to talk with each other and share ideas. The statewide conference set the stage for plans to be developed and implemented at the regional level. Hentcy says the high noise level of the breakout sessions reflected the energetic engagement