The Journal of the Arkansas Medical Society Issue 5 Volume 115 | Page 12

EDITORIAL PANEL: Chad T. Rodgers, MD, FAAP | Elena M. Davis, MD, MPH | William L. Mason, MD | Michael Moody, MD | Pramod K. Nelluri, MD | J. Gary Wheeler, MD, MPS
Trauma-Informed Care Needed to
Combat ACEs
JANIE GINOCCHIO, MPA, AND DAPHNE GAULDEN, MPA, MPH
A
rkansas has the highest
percentage of children with
at least one adverse child-
hood experience (ACE), nearly 56
percent compared to an average of
46 percent of children nationally. As
many as one in seven children in the
state have experienced three or more
ACEs. 1 According to the 2016 Behav-
ioral Risk Factor Surveillance System
survey, 60 percent of Arkansas adults
have experienced at least one ACE.
In a quarter of Arkansas counties,
more than 20 percent of adults have
experienced four or more ACEs. 2
Research shows that ACEs increase
the long-term risks for smoking, alco-
holism, drug abuse, depression, heart
and liver disease, and a dozen other
illnesses and unhealthy behaviors. In
the seminal 1998 ACE Study funded
by Kaiser Permanente and the Cen-
ters for Disease Control and Preven-
tion, Vincent Felitti and his colleagues
first identified ACEs. They noted that
the mental and/or physical trauma
caused by ACEs falls into three
categories: abuse (physical, sexual or
emotional), neglect and household
dysfunction, which includes divorce,
parental incarceration, substance
abuse, mental illness or exposure to
domestic violence. 3
Most people surveyed in the ACE
Study were white, college-educated
and middle-aged people who scored
from zero to 10 based on the number
of ACEs each had. When researchers
compared respondents’ ACE scores
with health insurance claims, they
found those people with ACEs were
more likely to experience negative
health effects. 4 For example, an ACE
score of six is associated with a lifes-
pan shortened by 20 years. A person
with an ACE score of four is 400 per-
cent more likely to develop chronic
obstructive pulmonary disease. 3
Subsequent ACE surveys with
more diverse populations mirrored
these results. The surveys examined
the role that economic and commu-
nity factors such as poverty and vio-
lence have as ACEs and the protective
factors that have the greatest impact
on health outcomes. 5
The current understanding is that
ACEs activate a child’s stress response
system and are a form of develop-
mental trauma. Without protective
factors such as a secure attachment
to a parent or other adult, the stress
response becomes chronic or toxic,
which in turn affects the develop-
ment of the brain and other organs.
Experiencing the mental trauma
108 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY
of severe ACEs may cause patients to
have difficulty trusting others, includ-
ing health care professionals. They
may be uncomfortable in a health
care setting, which can lead them
to be noncompliant with physician
directives.6 Efforts to restrict or
prohibit unhealthy coping mecha-
nisms such as smoking can escalate
feelings of distrust and resistance to
medical advice.
Considering that some of Arkan-
sas’ most serious health concerns can
be linked to individual and commu-
nity-level trauma, there is a need for
well-trained individuals to champion
and implement trauma-informed
care (TIC) approaches in communi-
ty-based settings.
TIC is a way of providing services
by which health care and human ser-
vice providers recognize, understand
and respond to the effects of mental
and emotional trauma in the lives of
patients. TIC views the presenting
problems as potential symptoms
of maladaptive coping. Providers
who use TIC can better understand
how early trauma shapes a person’s
fundamental belief about the world
and affects lifelong psychological
functioning.
According to the Substance Abuse
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