The ABCs of ACEs: Addressing the long-term health effects of Adverse Childhood Experiences


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6 comments

  1. Franklin Warsh

    It’s a laudable goal, but hazardous considering how stretched the system is for resources. Broaching the subject can reactivate or worsen the patient’s trauma-related symptoms. If the primary care provider isn’t trained or local treatment has a long wait list (if it’s available at all), there is the very real possibility of making the patient worse, full stop.

    • Martina Jelley

      We are working on training primary care providers on discussions of ACEs in adults health. There is a lot to do and much to be learned. But we cannot ignore the problem as if we are worried about opening Pandora’s box. The box is already opened and is manifested in poor health outcomes and dysfunctional behaviors. Helping patients acknowledge that is therapeutic, in and of itself. Disclosing the trauma to a trusted provider can be the first step to healing. If we wait until we have enough resources, we will never do it. In our population, more than a third of the patients have 5+ ACEs. We have to acknowledge that – to do otherwise would be malpractice.

  2. Mark Brady

    As is often the case, it’s what happens AFTER a trauma that can lead to adverse or beneficial outcomes. That also applies to screening for trauma – bringing up past suffering and offering little to effectively address it most often only adds to allostatic stress load.

  3. Colette

    Please don’t underestimate the power of just being heard. If we don’t allow survivors of trauma to be acknowledged we perpetuate their suffering. If we keep doing what we always do we will keep getting what we always get. Surely now is the time. Often trauma survivors believe they are deficit in some way, that what happened to them happened because they somehow deserved it. Trauma is when bad things happen to good people – to hear that from a first responder will help. Compassion and the ability to engage with someone who helps the person feel safe – most of us have that ability, don’t we?

  4. Francis Dwyer

    Very many years ago, I went to see my family doctor to admit that I was an alcoholic. A perceptive and gentle physician, he responded with, “Tell me about growing up Frank.” That was the beginning of a long journey towards sobriety and personal progress. The culmination is a memoir I will be forever grateful to this fine doctor, who for some weeks, gave me a half hour to unburden myself – at the end of his long office days. I was near to killing myself and his care saved me. Please keep spreading the word about the long-term effects of childhood abuse and trauma.

  5. Javed Alloo

    Thanks for raising this important issue, Max. Given the many ways that it affects a person’s health outcomes, the importance of knowing more about adverse childhood events (assessment and treatment options) is critical for all clinicians. It has likely influenced interactions of care for at least some of the patients most clinicians cared for in the past week, though we may not have been aware. But as others have commented, the readiness for a patient to explore the effect of their ACE needs to be the critical decision point about continuing with that conversation. Creating safety in the clinical relationship and ensuring continuity of care are pre-requisites to “opening the box”, else we risk re-traumatizing with unintentional abandonment and forcing the story to be retold over and over again. Supporting and strengthening coping skills are very different than exploring and (re)processing trauma; the former is something that many providers are capable of doing, while the latter is better done under the supervision of those with specialized trauma managed training.

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