It was around 2010 that Dr. Angela Bymaster was seeing a disturbing pattern in the histories of her adult patients. She already knew that patients who saw her at the Valley Homeless Health Care Program in San Jose, CA, where she worked at the time, were homeless or recently homeless. What was most troubling to Bymaster was knowing that their current precarious existence could have been prevented.
“Over and over and over again I was hearing the same stories of abuse in childhood and neglect, incarceration, moving around a lot, a lot of trauma for them as children,” said Bymaster, who as a family physician always took her adult patients’ in depth pediatric histories. She now works for the Washington Neighborhood Health Clinic, a school health clinic in San Jose that’s part of a non-profit School Health Clinics of Santa Clara County.
Bymaster became aware of the landmark CDC/Kaiser Permanente Adverse Childhood Experiences Study in 2007. The study showed a link between 10 types of childhood trauma and adult onset of chronic disease, violence and being a victim of violence, among other outcomes.
“Immediately when I heard about [the study], it just really struck a chord with me, because it agreed with so much that I had seen – with illness being more severe in people who had significant stresses as children,” she said. “It just connected a lot of dots for me. I was really struck by how severe and frequent I would hear those stories from my homeless patients.”
It was the consistency of hearing stories about her patients’ ACEs that compelled Bymaster to document what her patients experienced as children. Her study, recently published in the Journal of Health Care for the Poor and Underserved, she explained, adds to the growing body of research on ACEs and health outcomes.
To capture data related to her patients’ adverse childhood experiences, Bymaster and her fellow researchers asked 125 patients from the Valley Homeless Health Care Program to respond to the original 10-question ACE survey. In addition, the study included questions about traumatic brain injury (TBI), learning disabilities, post-traumatic stress disorder, and whether their main caregiver had ever changed — all of which, she explained, appeared to be common among her patients.
TBIs in particular really stood out. In Bymaster’s conversations with patients she said she repeatedly heard unusually dramatic stories of head injuries experienced in childhood. “I literally had a patient who said, ‘My dad hit me in the head with a baseball bat when I was 15, because I made him mad.’” Noting that there was a dearth of research at the time looking at the association between homelessness and TBIs, she thought the question was important to include.