Since August 2016, more than 300 three-year-olds who visit Kaiser Permanente’s pediatric clinics in Hayward and San Leandro have been screened for adverse childhood experiences (ACEs), such as living with a family member who is an alcoholic or losing a parent to separation or divorce. But when the idea to screen toddlers and their families for ACEs was first broached at the Kaiser Permanente Hayward Medical Center, the staff were, in a word, “angsty,” says Dr. Paul Espinas, who led the effort.
The staff was worried that if they screened for ACEs, their interactions with patients would be negative. However, an off-site weekend training for pediatricians in October 2015 changed all that.
One of the most significant takeaways from the training – which included an Alameda County public health expert and area experts in domestic violence, toxic stress, resilience and community health from the Kaiser system — was learning about the important connections between high ACEs scores and health outcomes, Espinas explained.
“ACEs are the new cholesterol,” he said. “If you don’t screen for it, and you don’t look for it, you’ll never find it, but it has more health impacts than you imagine.”
ACEs comes from the CDC-Kaiser Permanente Adverse Childhood Experiences Study (ACE Study), groundbreaking research that looked at how 10 types of childhood trauma affect long-term health. They include: physical, emotional and sexual abuse; physical and emotional neglect; living with a family member who’s addicted to alcohol or other substances, or who’s depressed or has other mental illnesses; experiencing parental divorce or separation; having a family member who’s incarcerated, and witnessing a mother being abused.
Subsequent ACE surveys include racism, witnessing violence outside the home, bullying, spanking, losing a parent to deportation, living in an unsafe neighborhood, and involvement with the foster care system. Other types of childhood adversity can also include being homeless, living in a war zone, being an immigrant, moving many times, witnessing a sibling being abused, witnessing a father or other caregiver or extended family member being abused, involvement with the criminal justice system, attending a school that enforces a zero-tolerance discipline policy, etc.
Thirty-eight percent of children in every state have at least one ACE, according to an analysis of the 2016 National Children’s Health Survey by the Child & Adolescent Health Measurement Initiative (CAHMI) at the Johns Hopkins Bloomberg School of Public Health.