Dr. Arnd Herz, a self-described champion for ACEs science, would like nothing more than to witness a greater appreciation of how widespread adverse childhood experiences are. Herz, a pediatrician and director of Medi-Cal Strategy for the Greater Southern Alameda Area for Kaiser Permanente Northern California, would also like to encourage more people in health care to engage in a trauma-informed care approach, a change in practice that he says not only benefits patients, but also health care providers and their staff.
“It makes so much sense,” say Herz. “This is why I went into medicine. I don’t want to just click off diagnoses, but create relationships and help people by understanding them better, and trauma-informed care is just a way to bring compassion back into the care that we do.”
For the uninitiated, a trauma-informed approach includes an awareness that adverse childhood experiences (ACEs) are common, knowing how to recognize the signs and symptoms of trauma, creating a safe environment where the focus is on “What happened to you?” rather than “What’s wrong with you?”, engaging trauma survivors as equal decision-makers in their care, and offering patients referrals to supportive services as needed, according to a report by the Substance Abuse and Mental Health Services Administration and a primer by the Center for Health Care Strategies.
In practice, Herz describes how clinicians use a trauma-informed approach to forge closer ties with patients and at the same time discover how ACEs may lurk beneath the surface of a health condition.
“I see so many children who really struggle with obesity at a young age,” explains Herz, who is based at Kaiser Permanente in Hayward, Calif., which is testing ACEs screening of children from 12 months through 5 years old in a three-year pilot study that began in 2016. He says that he sees many patients whose weight and height are on par for a number of years and then suddenly veer off course as a child begins gaining weight. “I’ll ask ‘What happened?’, and sometimes it’s that the grandmother has moved in and is overfeeding the child,” explains Herz. But often there’s another explanation.
“I pointed to the growth curve and asked ‘What happened two and a half years ago?’ And the mom said, ‘Dad came back from jail and is living with us,’” reports Herz as he cites the case of one patient. And he didn’t stop there — he wanted to find out how the mom and the child experienced the father’s return. “And I looked at her and said, ‘So, it’s been stressful?’ And she said yes.”
“And rather than talking to her about removing the sodas, and exercising more and removing the junk food,” continues Herz, “I talked to her about the stress and how can we make things feel better, because the weight gain was in response to stress.” Herz made sure they were safe and when the mother expressed interest, helped her and the child link up with a psychologist for additional support.