The Impact of Childhood Experiences on Patient Health: AD to Encourage Trauma-Informed Care

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By Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD

Tags: Detailing Visits, Evidence Based Medicine, Pediatrics, Primary Care

​As we’ve jumped right into 2022 programming, our team at NaRCAD continues to support detailing efforts that improve outcomes for vulnerable populations, recognizing that patient needs are complex and often informed by social determinants of health. One critical topic for which we’ve developed resources focuses on detailing to improve patient health as informed by both adverse and positive childhood experiences. We’re seeing an increased need from our community members to support detailing efforts related to this critical topic. We partnered with the National Association of County and City Health Officials (NACCHO), Centers for Disease Control and Prevention (CDC), and consultants from Brigham and Women’s Hospital and Tufts Medical Center over the past two years to develop academic detailing materials for clinicians working with both adults and children. 

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​The CDC defines adverse childhood experiences (ACEs) as traumatic events that occur in childhood, including abuse, neglect, and family dysfunction. These events are linked to poor health outcomes in adulthood like chronic health problems, mental health conditions, and substance use. When considering the impact of environment on health, the CDC notes that children are likely to flourish when they have safe, nurturing relationships. These supportive settings create the opportunity for positive childhood experiences (PCEs). PCEs can mitigate the effects of ACEs and toxic stress, promote healing from traumatic events, and foster healthy development and learning in children.

Encouraging clinicians to consider both ACEs and PCEs is a natural fit for clinical outreach educators. There are many reasons that clinicians may not be prepared to have conversations with patients about childhood experiences. Perhaps the clinician doesn’t have a behavioral health provider to consult within their practice, so they don’t know who to turn to if a patient discloses a traumatic experience. A detailer can encourage a clinician to explore this concern, as well as provide a list of local behavioral health providers in the community. 

​Another barrier may be that clinicians could feel hesitant to approach discussions related to trauma, or may not have the skills to do so with sensitivity. In this case, detailers can offer tools that illustrate supportive language that creates a safe environment for patients to share their experiences. Supporting clinicians in using evidence-based tools to build trust with their patients signals that it’s not only okay to talk to patients about this sensitive topic; it’s vital for clinicians to lead these conversations in order to ascertain their patients’ needs and promote patient-centered decision making.   

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A detailer can encourage clinicians to adopt new behaviors through specific key messages, including asking clinicians to take the following steps to support adult patients:

• Ask patients general questions about trauma such as, “have you had any life experiences that you feel have impacted your health and well-being?”
• Use supportive language with patients who disclose trauma or ACEs to help build resilience such as, “thank you for sharing that with me. Have you talked about this before?”
• Document patient responses and communicate patient-identified strengths to the care team. Avoid documenting the details of the trauma itself and focus on the impact the trauma has had on the patient’s health and well-being.
• Create a plan in collaboration with the patient that encourages self-advocacy.

When clinicians are supporting pediatric patients, detailers can deliver this set of evidence-based key messages, encouraging clinicians to:

• Identify positive experiences and strengths of the patient by asking questions such as, “which adult(s) besides your parents is/are important part(s) of your life?” or “who could you call to help if there was an emergency?”
• Ask about social determinants of health. Understanding how family and community environments impact growth potential helps to improve health outcomes. Questions can address:
  • housing security
  • food security
  • transportation needs
  • utility needs
  • interpersonal safety
  • employment
  • family and community support
  • education
  • mental health
• Use a screening tool to evaluate potential ACEs if indicated. Formal questionnaires provide a structured way to identify adverse and positive childhood experiences, but routine screening for all patients is not currently recommended.
• Evaluate ACE screens based on the child’s current health. If abuse, neglect, or family disruption is going on, there may be an immediate need to intervene. If the child is safe, provide resources to the family and patient.
• Explore collaborative interventions with patients and families. Effective problem-solving of ACE challenges can foster and encourage post-traumatic growth.

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With evidence-based tools, successful AD interventions related to ACEs can result in multi-faceted support for patients, such as stronger connections with community resources, mental health supports, and more trusting relationships between clinicians and their patients.
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We hope to continue to explore this important and complex topic together as a community. If your program is currently working on an ACEs or PCEs AD campaign, or is interested in starting one, please reach out to us so we can support the development of your programming. We always love collaborating and learning more about the important work that you’re doing, and we hope to continue to build our resources and create toolkits in support of complex topics such as these that intersect with other behavioral health and prevention-focused AD campaigns.

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