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 and teens.
Since January 2017, Frank, a pediatrician at Kaiser Permanente’s San Jose campus, has been screening her patients for adverse childhood experiences, along with fellow pediatricians. In doing so, the campus joined Kaiser Hayward and Kaiser San Leandro in a regional rollout of ACEs screening of pediatric patients. It began first at Kaiser Hayward in January 2016, which designed the protocol and is analyzing the results.
For those unfamiliar with such screenings, ACEs comes from the CDC-Kaiser PermanenteAdverse 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.
The ACE Study found that the higher someone’s ACE score – the more types of childhood adversity a person experienced – the higher their risk of chronic disease, mental illness, violence, being a victim of violence and several other consequences. The study found that most people (64%) have at least one ACE; 12% of the population has an ACE score of 4. Having an ACE score of 4 nearly doubles the risk of heart disease and cancer. It increases the likelihood of becoming an alcoholic by 700 percent and the risk of attempted suicide by 1200 percent. (For more information, go to ACEs Science 101. To calculate your ACE and resilience scores, go to: Got Your ACE Score?)
Other ACEs 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, and attending a school that enforces a zero-tolerance discipline policy.
Following the lead of Kaiser Hayward, pediatricians in the San Jose clinic began screening 3-year-olds by having their parents fill out ACEs surveys.
The 10-question ACEs survey, adapted from one designed by the Center for Youth Wellness (see attached) asks parents to read a list of statements and write down a total number of ACEs at the top of statements that apply to their child. For example, in the CYW form, parents are asked if, “At any point since your child was born: Your child’s parents’ or guardians were separated or divorced.” Or, “Your child lived with a household member who served time in jail or prison.”CYW ACE-Q CHILD