By PAUL NATINSKY
As the movement toward recognizing social determinants of health gains momentum, Dr. Scott Grant is working to bring training in how to help children affected by Adverse Childhood Experiences (ACEs) to resident physicians at Children’s Hospital of Michigan.
ACEs are traumatic events that children ages 0 to 17 face. According the Centers for Disease Control and Prevention (CDC), they include experiencing or witnessing violence at home, parental separation, mental illness or substance misuse in a family member who lives in the home and other negative stressful events.
ACEs have real and lasting consequences for children. The CDC lists increased injury risk, elevated rates of sexually transmitted infections, maternal and child health problems, teen pregnancy, involvement in sex trafficking, and a wide range of chronic diseases and leading causes of death such as cancer, diabetes, heart disease, and suicide among them.
Children growing up with toxic stress from adverse experiences may have difficulty forming healthy and stable relationships. They may also have unstable work histories as adults and struggle with finances, jobs, and depression throughout life. Children who experience adverse events can unwittingly pass these traits on to their own children.
Grant first became aware of ACEs and the problems they caused when he heard a TED talk in Arizona during his residency training. He said the concept didn’t originate within the medical community, but among social work, juvenile justice and related groups of professionals who interact with troubled children as a core part of their job. Grant said the concept first registered in pediatric circles just a few years ago.
Grant completed a Master Trainer course in the Michigan ACE initiative and decided to help work the program’s knowledge base into residency programs in which he is involved.
He developed a six-week curriculum for seven or eight residents at Children’s Hospital of Michigan. The series consists of video presentations and discussion sessions for an hour per week. At the time of our March interview he was three weeks into his first foray and planning a second cohort.
“This is the first time that a formal ACEs curriculum has been done within the residency program,” said Grant. His goal within the next 12 to 18 months is to build ACEs training into the formal part of the curriculum for residents and develop it as a rotation or elective for “people who are passionate about this topic.”
The concept of ACEs and their effect on childhood development trace back to early 1990s studies and have been employed by various professionals to differing extents ever since.
“Pediatricians are a little bit late to the party on this. We’re here now and I hope I can convince more and more of my colleagues that this is an important aspect of being a pediatrician. I can be a voice for our residents and trainees across the country on how to develop a more trauma-informed lens,” said Grant.
He said he feels strongly that ACEs training should be a mandatory part of all residency curriculums and hopes within the next five to eight years that will be the case. The difficultly, he said is that there is no consensus around how this information should be applied to primary care or pediatric care or how it should be taught. “So we’re trying it this way to see how it resonates with (residents) and (work toward) an effective model.”
Grant’s early message about ACE training and the perspective it brings centers on:
-Realizing that adversities are common and often not the result of willful negligence or parental failure;
-Recognizing that there is hope and that neuroscience dictates that intervention can help, although time and patience are required;
-Working to develop a “trauma-informed lens” and learning to move away from a focus on “What is wrong with you?” to “What happened to you?”
Grant welcomes input and support and can be reached at SGrant3@dmc.org
or through MIAAP.