PHILADELPHIA — Screening for adverse childhood events, such as child abuse or household dysfunction, in adults within a primary care setting may identify who is likely to pass along the same adverse events to their children — especially mothers — according to a recent presentation at the annual meeting of the American Association of Nurse Practitioners.
This process is especially important because children who experience adverse childhood events (ACEs) have a difficult time with memory, emotion regulation, attention and building relationships because of impaired neurodevelopment. A direct correlation has also been noted with an increased chance of health-risk behaviors in adulthood that heighten the risk of sexually transmitted infections (STIs), depression, obesity or smoking. Additionally, exposure to these events in childhood increases the risk for stroke, cancer, diabetes and other chronic conditions.
“I started this study thinking that if we can identify ACEs in parents, we may be able to identify who is at risk to pass them on to the next generation,” Sandy Schilling, MSN, FNP-C. ARNP, said in an interview with Infectious Diseases in Children. “There is some growing evidence that when a mother has experienced these events, she’s significantly likely to pass them on to the next generation through epigenetics and through environmental exposure.”
Although screening for ACEs in practice can be done, many practitioners do not go through the process. According to Schilling, pediatricians across the country have developed pediatric-focused screening tools that can be used with families. By screening for these events, proper community resources can be referred that aim to build resilience.
To observe the number of practitioners who understand the impact of ACEs and trauma-informed care (TIC), Schilling administered a questionnaire and interviews in which the participants answered questions pertaining to pre- and post-ACE knowledge and TIC implementation.
Of the 14 nurse practitioners who were included in the study, 93% had previously heard of ACEs, but only 36% had heard of TIC. With the education provided in the study, the level of knowledge of ACEs increased from 29% to 100%. A notable increase in the knowledge of TIC was also observed (21% to 71%). Regarding screening for ACEs, the practitioners’ comfort level rose from 21% to 64%.
“ACEs are really a complex risk factor and environmental exposure in childhood that can impact physical and mental health,” Schilling said. “We have some direct correlations between increased risk and increased number of events, but there are also people who have high event scores who don’t have health-risk behaviors or chronic diseases.”
Schilling said that this may be because they had a safe, nurturing environment away from the home in which a child’s flight-or-fight response could stop, giving them a better chance of neurological development.
Schilling S, et al. Trauma informed care: Adverse childhood experiences screening in primary care. Presented at: American Association of Nurse Practitioners National Conference; June 20-25, 2017; Philadelphia.
Disclosure: Infectious Diseases in Children was unable to confirm financial disclosures prior to publication.