Research shows only a tiny percentage of physicians integrating PACEs science

Three relatively recent studies from different parts of the U.S. show that only a tiny percentage of physicians, medical school faculty and other healthcare providers are integrating practices and policies based on the science of positive and adverse childhood experiences (PACEs).

Why it matters: For people in the PACEs community, the following is news that’s 20 years old: Adverse childhood experiences are common, preventable and linked to six out of the top ten leading causes of death in the United States.

As one of the studies noted: “Positive and negative experiences in childhood shape our trajectory of health or illness for our entire lives, and this impact can be attributed to the brain-body physiology that results from our experiences during childhood.”

The science is well established. Thousands of research papers have been published about the long- and short-term health effects. Every U.S. state has done an ACE survey, many more than one. Legislation addressing childhood trauma and PACEs science has been passed in 39 states. Dozens of books have been written about the topic, including two bestsellers; one of those—Bessel van der Kolk’s The Body Keeps the Score—has been on the New York Times paperback bestseller list for 178 weeks. Physicians who have been early adopters for more than a decade say they would never go back to not integrating it into their practices.

In 2016, only eight out of 192 medical schools included content about childhood trauma, and that could be just a single lecture. Early adopters in the medical community know that if PACEs science isn’t integrated into medical schools, benefits of its knowledge will never get to patients. And people WANT their doctors to know about this. Donna Jackson Nakazawa, author of Childhood Disrupted: How Your Biography Becomes Your Biology and How You Can Heal, posted this article on ACEsTooHigh.com: Childhood trauma leads to lifelong chronic illness—so why isn’t the medical community helping patients? It’s had more than two million page views and hundreds of comments.

Who did the studies and why? In Muskegon County, MI, Resilience Muskegon, a community organization created by mental health agency HealthWest, did a survey of county residents that showed a huge disconnect between the healthcare system, which is highly rated, and the health of people in the county. A local ACE survey showed that 31.4 percent of adults have experienced 4 or more ACEs, nearly three times the number in the original CDC-Kaiser Permanente Adverse Childhood Experiences Study, which showed 12.5 percent had an ACE score of 4 or higher. This prompted researchers to recruit 226 physicians from Mercy Health, a hospital and healthcare system that serves 85% of the county, to participate. They asked if they knew about ACEs science, if they used it in their practice, and if they had a personal history of ACEs.

In Texas, researchers from the University of Texas and the University at Albany, NY, recruited 85 healthcare providers from Central Texas that included physicians, nurses, social workers and other staff who were at least 18 years old and providing care in a medical setting to women or children in Central Texas. Going into the study they thought that most healthcare workers would know about ACEs. They thought that most screened for traditional ACEs such as substance use or mental health issues, more often than ACEs such as bullying or community violence, and they thought that most patients would self-disclose common ACEs. They also thought that healthcare providers familiar with ACEs would implement ACE-informed strategies for patients, such as providing resources for patients or creating an ACE-informed culture in their practice. They were remarkably off target.

In Illinois, a team comprising three medical students and four medical school faculty noticed that “very, very few of our colleagues knew anything about childhood trauma,” says Dr. Audrey Stillerman, one of the authors who is clinical assistant professor in the Department of Family and Community Medicine at the University of Illinois at Chicago. They were also interested in why this science that has existed for decades hasn’t been integrated into medical education so that it could become a part of clinical practice. What’s the rub? they wondered. Why isn’t medical education just different now? The team developed a survey to explore these questions; 81 faculty members from the University of Illinois College of Medicine and Rush Medical College in Illinois responded.

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