Dr. Arnd Herz

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.

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Baltimore BSC faculty and planning team

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When a group of community organizations in Baltimore came together in 2015, they already knew trauma figured large in many lives. There was violence in the community, in schools, and in community members’ homes. Police brutality occurred. Many suffered the loss of loved ones to incarceration or death. There were house fires and homelessness. Much of the dysfunction was systemic and rooted in racism, according to a report on a collaborative effort to restructure city organizations and agencies. The goal was to build community resilience.

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Would pregnant women participate in surveys from their doctors asking them about whether they had experienced trauma in their childhood? In surveying moms-to-be at two Northern California Kaiser sites, clinicians discovered that the women were receptive to filling out an adverse childhood experiences (ACE) survey, according to a study that was published earlier this year in the Journal of Women’s Health.

In fact, researchers found out that the vast majority of pregnant women — 91 percent of the 375 women— were “very or somewhat comfortable,” filling out the ACE survey. Even more, 93 percent, said that they were comfortable talking about the results with their doctors. The women were surveyed from March through June 2016 at Kaiser Permanente clinics in Antioch and Richmond, CA.

ACE refers to the groundbreaking CDC/Kaiser Permanente Adverse Childhood Experiences Study that tied 10 types of childhood trauma, including living with an alcoholic family member or experiencing verbal abuse from a parent, to a host of health consequences. (Got Your ACE Score?)

The higher the number of ACEs that people have, researchers learned, markedly increases their risk for poor health outcomes, as well as social and economic consequences. Having four ACEs, for example, nearly doubles a person’s risk for heart disease and cancer, raises the risk of attempted suicides by 1200 percent and alcoholism by 700 percent.

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