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Welcome to this edition of AMC.

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Tell you how I got better. I'm glad to be

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here, but a mission

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to. Well, I think that we're, we're talking, we're gonna

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talk about everybody's Arkansas is

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the 2nd highest prescriber.

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Welcome to AFMC TV. I'm Robin Ledbetter.

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Thank you for joining us. Today I have with me Doctor

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Chad Rogers. He's the chief medical officer

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here at AFMC.

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Thanks for being here, Doctor Rogers. Thanks for having me.

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So we're talking about ACEs.

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Tell us what that is.

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Yes, so you hear people talking a

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lot more. About ACEs. It stands for adverse

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Child Experiences, which can can include

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a lot of

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things, um, but most primarily you kind

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of think about

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experiences that children have usually in the first couple

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of years of life,

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typically between 0 to 5, but especially

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0 to 3 being a big development

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all the time. So they're very intense

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or stressful experiences that happen to children

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at a very early age. They kind of had

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a huge impact on their development or their

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growth or their mental health. They kind of have

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persisted in adulthood.

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So we know from years of

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study about adverse childhood experiences and

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what causes them causes them. There's the original

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CDC study, uh, which you can look

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up online, uh, the adverse Childhood Experiences

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study, that people can learn that there's 10.

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They're kind of commonly talked about and some of them

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are things like you traditionally think about like abuse

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and trauma or maybe

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homelessness and stuff like that, but there's a whole bucket

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of sort of household dysfunction of

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things that happen to people that sometimes you don't

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realize um

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were not

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uh not normal, but they, they really

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are kind of normalized in our culture, things like

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a parent having a drug use problem,

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maybe having a parent that's incarcerated.

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Um, so those are, those are seeing,

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you know, someone in your family treated violently. They kind of

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have an impact on you at a very early age. Again,

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they were very intense that you kind of felt were threatening.

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They kind of impacted your overall

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kind of trajectory through life. And so

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there's the 10 that are described, but there's really hundreds

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that you could, so it's really sort of some

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event that that you kind of perceived

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yourself to be a great danger where you felt

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threatened either maybe physically or

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emotionally or spiritually or whether it was

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like, you know, a nutrition thing.

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Um, that you kind of carry on. And we know that

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people who had the more adverse childhood experiences

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you have, the more likely you are to

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have difficulty with your physical health, but

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also your mental health. So it can really

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have long term consequences and we just

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kind of continually get more information and

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more uh researches. Down about

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the impact of these and they're not

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uncommon. So a lot of us have experienced

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something

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that um sort of kind of shaped us, um,

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whether it's for the good or the bad.

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uh, but we now know the research of why

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that happens and why that happens within the brain

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and within the body with stress hormones and

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and things like that. So, um, people

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are beginning to talk about those things a lot

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more. And as a result of talking about them and

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knowing about them, we're also researching about how they

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happen and then how we can prevent them.

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So that's really kind of the whole encompassing.

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Uh, idea around knowing

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and learning and addressing adverse childhood

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experiences, and they are critical

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and identifying them in pediatric care,

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right? So it's a very good time to identify

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them when kids are early on. There's some things

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that we just can't prevent. I mean, we've all lived

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life. We know sometimes, you know,

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bad things happen.

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But, uh, by identifying them very early

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on, we may be able to make some interventions,

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um, early on that maybe help a family

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kind of prevent maybe making it worse or

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maybe making or maybe addressing it

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specifically to kind of help the child. The other

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thing is that we know that resilience is really

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important. So kind of looking at people's strengths and

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what are the things that kind of give them hope and joy

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for the future, and we can kind of help

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also bring those in because those are the things that kind of help

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protect people. And we know that those

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adult child in

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kind of healthy,

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protective

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relationships are the kind of fundamental thing

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that protects children from the impact of adverse

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childhood experiences.

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So, um, that's also kind of

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something that we can begin to address early on if we can identify

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who are your resilience factors, what are the positive

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experiences that you're having at home in the school and your

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community so that we can help kind of

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prevent the, the effects of adverse childhood

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experiences.

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And what should pediatricians and family doctors

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be looking for when screening? Is

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that something that happens during routine visits?

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Right, so it depends on the practice you go

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to. And so people will have different every practice

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is probably a little bit different about how they look for them.

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I think number one, being aware

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of them,

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uh, kind of helps you kind of shape because sometimes

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you have something going on with the family that you just

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can't quite figure it out and it's like, oh, they're dealing with homelessness

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or oh they're dealing with the fact that. You

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know, the dad is incarcerated and the mother

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has some mental health issues. So knowing that the impact

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of those,

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so, and there's not like there are

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some screening tools for children, um,

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but most of the studies that have been done with screening

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have been done with adults.

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Uh, but again, I think it depends on

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your practice style and how you want to address them. They tend

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to be very personal, so sometimes they're very hard

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questions to ask. And there are also maybe

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be questions that people are afraid to ask because they don't

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have a solution to.

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But I think just having the awareness

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about, um, you know, the impact of ACEs

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and also knowing about what the sort of the

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percentage of ACEs are in your,

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in your community. So if you know that a lot of people

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experience poverty, uh, then you

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know that there's a lot of families that are dealing

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with adverse childhood experiences. So,

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um, there's lots of opportunities to screen, but

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you sometimes it's hard to do something that you

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don't know about. So that's where screen and there's other ways

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to screen like maternal depression

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or social determinants of. Health, a lot

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of things that we kind of talked about before,

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uh, they kind of give you some idea and some

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insight to how that's impacting their lives.

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And how would a physician even approach that

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screening? Right. So I think at times

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I think it takes a time because I think

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it takes time for people to kind of trust you

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and be able to tell you things like if, if you walked

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into my office and I was like asked you a

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very personal question, it could feel

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sort of violating and aggressive

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and may actually re-traumatize you.

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So I think it's something that kind of happens

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in a very trusted relationship either whether that's

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with your, your primary care provider

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or your mental health provider, and over

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time these things kind of come out. So it doesn't really even

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need to be a one-time event, you know, you may learn

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things about people over time, especially as they

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feel safe with you and are able to share

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with you. And what screening

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tools do you recommend for assessing

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ACEs in pediatric populations? Is there

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a specific tool that everyone should

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use? There, there's some good standardized tools.

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I think Pearls is the one that I'm using the most

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commonly. It's for young children and for, uh,

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teens.

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Um, these are all screeners

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that are available online.

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Uh, the original ACI screener is actually

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used in adults and not in children, so there's some

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things that you don't want to use, but someone shouldn't

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use a screening tool unless they really had some training

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and evaluation and know the validity of

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that that screening tool and also

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to be prepared for the responses to those.

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Those tools. So there's a lot of things that

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are available.

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Sometimes just a general like good social

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history of talking to someone about, you know, divorce

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in the family or or mental health

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issues about other family members are good ways to kind

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of, kind of elicit those, um,

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adverse childhood experiences, but also,

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you know, other screening tools also

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look for elements of adverse

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childhood experiences and they sort of add up, you

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know, um, when you're, when you begin

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screening or looking or asking people.

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And what does it mean to practice

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trauma-informed care in a pediatric

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or even a primary care setting?

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So trauma informed care is again being aware,

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realizing the impact of adverse childhood experiences,

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knowing their prevalence in your community

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and sort of how they impact families and

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kind of tailoring your approach to knowing how

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to respond to someone.

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Um, who has had, so making your

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place a very welcoming place, making it a place

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where people feel safe,

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uh, making it a place where there's not a

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lot of barriers,

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um, to a kind of routine,

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um, procedures within the

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office. So it gets down to really kind of the basic

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operations of the office as well,

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um, how people make appointments, how people

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are followed up, that they're not left out

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hanging in the cold with any follow

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up about referrals or medications.

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So those are all things that you kind of think about

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around and making your your

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practice kind of a more trauma formed

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practice so you don't re-traumatize people. But

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I think the big element is you really create that

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safe space for people.

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And does

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ACE's awareness extend beyond

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the clinic? Is this something that goes into schools,

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communities?

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So anyone who works with children,

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especially people who have traditionally worked with children for long

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periods of time, have known that there's,

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you know, that the impact of trauma on

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children. Um, so, but I think,

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you know, anybody who kind of directly works with

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children in some sort of service that school

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or social services or um

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or like a after school program

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needs to be aware of adverse childhood experiences,

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how it's impacting children. I think a lot of times you're

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like, where the question when it

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kind of goes off in your mind is like, what's

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wrong with this child? And the

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times you need to be thinking, oh, what

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happened to this child? You know, what are the things that this

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child has experienced?

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So by having that awareness,

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um, and again, also appreciating the

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fact that trusted relationship with adults that we

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have that we have a role as adults to

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create those kind of protective relationships

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with children to help guide them through those

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stressful situations. So it's, you know,

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also kind of having that awareness.

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Are there community-based interventions or

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partnerships that have proven especially effective?

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Right, so there's several therapies and modalities

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that are gonna use again, it's kind of tailored to

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the um.

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Um, the patient, but patient-child

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interaction,

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interactive PCIT therapy, there,

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um, it's, it's something that people are well trained

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on. It's a great thing for, uh,

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it takes kind of an adult and the child

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to the child's care provider to kind

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of do these therapies that kind of

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help kind of with emotional regulation

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and kind of identifying trauma and triggers,

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uh, but there's other like kind of. Behavioral therapy is

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another thing that's commonly used, uh, but

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you'll see a lot of different modalities.

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Um there's things that are kind of well accepted

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and safe,

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um, I think, you know, UAMS and our best have

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a lot of good resources,

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uh, for providing

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resources to providers who are well trained in the area

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of trauma, and they're doing things that are sort of

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generally accepted as being evidence-based

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and having good

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Uh, good outcomes.

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And what are some innovative approaches? Are there

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promising research developments that you've seen

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recently? Yeah, so there's just kind of

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there's this ever growing kind of body of knowledge

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again, we're able to like do it down to the really

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kind of good research to kind of see the

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impact of imaging on the brain

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and stuff like that. But I think the one thing

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is, you know, really training

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and working with adults to realize how they interact

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with children is very important and that they

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create. Um, that protective relationship.

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And I think that that's, you know, sort of the thing that we

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see helping children learn how to emotionally regulate,

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which is really a skill that's kind of

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hard to come at because sometimes when you get a child

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is kind of

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escalated and upset, then you find

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yourself being escalated upset and that really doesn't

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kind of help bring the child down. Recognizing

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that all behaviors have a meaning, so

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even even bad behavior is sort of an adaptive

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behavior, so recognizing that that's,

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um. And I hate to even use the word bad

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because the child's just responding to their environment the way that

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they've learned or know how they're teaching

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children how what are safe ways, what are good

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ways to kind of respond to stress. So

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there's a lot of good research, a lot of good

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tools are becoming more and more available,

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um, to, uh, people who work

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with kids in order to address, um,

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these things.

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And before we go, what should our

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the healthcare community, if they want to learn more

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resources training.

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Where do they go? Yeah, you know, I think the CDC

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has really had a really good, um,

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a lot of resources that people have gone to and used.

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Uh, I think there's a lot of local resources that you

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went to AFMC houses a lot of resources

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on our website about adverse childhood

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experiences

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that they get to go to. There's also, uh, numerous

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conferences, not just nationally, but

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also locally.

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Uh, we're getting ready for our adverse Childhood

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experiences summit coming up in a couple of weeks. So it's sort of

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that angel.

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Visit to kind of look at some different areas

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of what's going on with adverse childhood experiences

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because it is really a rapidly changing field.

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Well, Doctor Rogers, thank you so much for talking about

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this important information and to find out

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more about the ACEs conference, they

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can check out our website. Yeah, they can go AMC.org

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or even if

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you just Google adverse childhood experiences

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and AFMC should come up as a summit,

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but um it's there on our webpage.

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Thank you so much for being here today.

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And that's it for AFMC TV. Have a great

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day and thanks for watching.