Patient’s murder leads to soul searching, shift to ACEs science in UCSF medical clinic

Patient’s murder leads to soul searching, shift to ACEs science in UCSF medical clinic

It was the murder of a beloved patient that led to a seismic shift in the Women’s HIV Program at the University of California, San Francisco: a move toward a model of trauma-informed care. “She was such a soft and gentle person,” said Dr. Edward Machtinger, the medical director of the program, who recalled how utterly devastated he and the entire staff were by her untimely death.

“This murder woke us up,” he said. ”It just made us take a deeper look at what was actually happening in the lives of our patients.” The Women’s HIVprogram, explained Machtinger, was well regarded as a model of care for treating HIV patients – reducing the viral load of HIV in the majority of its patients to undetectable levels.

But the staff was clearly missing something. A closer look at the lives of their patients revealed that 40 percent were using hard drugs – including heroin, methamphetamine and crack cocaine, according to Machtinger. Half of them suffered clinical depression, the majority had isolated themselves due to deep shame associated with having HIV, and many experienced violence.

“And way too many of our patients were dying,” he said. “When we did an analysis of why they died, the vast majority of deaths were related to trauma – either directly through murders or indirectly through substance abuse, overdose, depression and suicide.”

His patients were not dying from HIV, he said, “but from a lifetime history of trauma.”

This led the clinic to integrate into its practice the science of adverse childhood experiences, known as ACEs science, which explores the lifetime toll on physical, emotional, social and economic health linked to childhood experiences of everything from physical or sexual abuse to living with an alcoholic parent or witnessing violence outside the home.

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California Assembly Health Committee OKs ACEs resolution 16-0

ImageThe California Assembly Health Committee today approved, by a vote of 16-0, a resolution to encourage statewide policies to reduce children’s exposure to adverse childhood experiences. California took a page from Wisconsin’s playbook with the introduction of legislation (California Assembly Concurrent Resolution (ACR) No. 155) on May 28. It drew upon ideas from Wisconsin’s legislation (Senate Joint Resolution 59), approved by the legislature this early this year. Both the Wisconsin resolution and the California proposal encourage state policy decision-making to consider the impact of early childhood adversity on the long-term health and well being of its citizens.

Before the vote was taken on June 17, the lead sponsor of the California bill, Assemblymember Raul

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Another study shows abuse-physical illness link

In a review of 24 studies of more than 48,000 adults, researchers found that child abuse raises the risk of physical illness as much as psychological problems, according to a recent article in Medical News Today.

The study was published in this month’s issue of Psychosomatic Medicine: Journal of Biobehavioral Medicine. Picture 8

According to study co-author Cinnamon Stetler, Ph.D., an assistant professor of psychology at Furman University in South Carolina:

“Your exposure to really severe stressors like abuse in childhood may program the body’s stress system to respond in ways that may be adaptive in the immediate environment, but over the long term can be maladaptive and take their toll.”

In the study’s conclusions, the researchers said:

However, studies often fail to include a diverse group of participants, resulting in a limited ability to draw conclusions about the population of child abuse survivors as a whole.

That’s one reason so many organizations are starting ACE Studies of their own. This year, six states — Arkansas, California, Louisiana, South Carolina, Montana, New Mexico and Washington — are including the ACE questionnaire in their Behavioral Risk Factors Surveillance System (BRFSS), which each state does every year to assess its population’s health status.

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