I met Dr. Nadine Burke Harris shortly after she had been appointed by Governor Newsom to be the first Surgeon General for the State of California. It was at that time that I was first introduced to the concept of Adverse Childhood Experiences (ACES) and its link to poor health outcomes and decreased life span. However, after viewing Dr. Burke – Harris’s TED Talk on ACES I picked up on more subtleties of the condition and harkened back to my days in Private Practice as a Pediatric Dentist in Inglewood, CA. (TED Talk) I was always surprised by the fact that so many of my patients were asthmatic (which I had attributed to them living in the smog filled Los Angeles Basin) and I was bothered by the fact that some were labeled ADHD or were taking behavior modifying medications. Most of these children came from single parent homes, many of them were in foster care and for the most part they were just good kids. The children from my Private Practice are all grown up now but I wonder … what would their ACES Score have been had they been evaluated ? Considering that many of them likely suffered from separation anxiety and other childhood stressors that resulted in them being in a single parent household or being placed in the Foster Care System, the likelihood that they will suffer from long term health effects is significant. The likelihood that they will die early is heart wrenching.
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What are ACES ?
ACES Scores are generated as a result of a patient survey and /or patient interview. As a proven area of Public Health Crisis why has the ACES Survey not been mandated for children or implemented nationally as a part of the standard of care ? The infrastructure is already in place for the supportive services, interventions and follow-up to be implemented in these groups to prevent the progression of the condition. As Dr. Burke – Harris stated, “ACES is the single most unaddressed public health issue facing our nation today”. The Original ACES Survey does not include questions that capture any of the effects of overt or systemic racism. However there are now modified versions of the ACE Survey such as the CYW’s ACE -Q Tool and the PEARLS tool that includes 10 questions from the original ACE Study Survey as well as 7 other questions about bullying, racism, homelessness, community violence, involvement with foster care system or lack of food.
Who is Screening for ACES?
The American Academy of Pediatrics, the recognized authority in Pediatric Medical Care, states that the Medical Home is the ideal place for addressing trauma and published a White Paper on ACES in 2014. The White Paper sets the stage, discusses the process, addresses readiness to change, prepares physicians for the process and refers to identifying ACES in the Pediatric Medical Practice as quality improvement. The American Academy of Pediatrics also concurs that additional ACES should be included such as bullying, racism et.al.
The momentum is now beginning to grow. As of January 2020 Medi-CAL Physicians can bill for ACES Screenings. Hence there should be some traction in the foreseeable future. As Dr. Burke -Harris stated, “When we recognize this as a Public Health Crisis then we can use the right toolkit to address it”; “….this condition is treatable and beatable.”
Written/Submitted by Katrina Eagilen DDS Dental Executive on Figueroa Street Los Angeles, CA