La Jolla pediatric office to pilot new childhood trauma screening, citing importance during COVID-19

Dr. Wendy Hunter of the La Jolla office of Children’s Primary Care Medical Group
Dr. Wendy Hunter of the La Jolla office of Children’s Primary Care Medical Group says adverse childhood experiences, or ACEs, can have long-term negative health effects.

A La Jolla pediatric office is one of a select few to pilot a new screening and treatment program for adverse childhood experiences, known as ACEs, as a way to lessen the possible long-term negative health effects associated with them.

Through an initiative known as ACEs Aware, a first-of-its-kind effort led by the California surgeon general’s office and the Department of Health Care Services to cut ACEs and related stress in half in one generation, the screening evaluates children and adults for ACEs involving abuse, neglect and household dysfunction by age 18. When providers screen for ACEs, they can determine the likelihood that a patient is at an increased health risk. Once identified, providers can treat and improve care, possibly reducing long-term health costs.

Starting in October, the La Jolla office of Children’s Primary Care Medical Group at 7300 Girard Ave. will use the Pediatric ACEs and Related Life-events Screener (PEARLS), which looks at potentially traumatic events occurring before 18, as part of the well-child checkup.

“We look for ACEs that we know contribute to diseases in humans,” said Dr. Wendy Hunter of CPCMG La Jolla. “We found with this tool, about two-thirds of people in California will have experienced at least one adverse event. One in 10 will have four or more identified by the screen. Having four or more correlates with things like asthma, heart attacks and a lot of organic diseases. Those with four or more are 37 times more likely to commit suicide.”

And in the time of COVID-19, pediatricians are seeing children who are experiencing “drastic” changes to their daily routines that could increase their exposure to ACEs, Hunter said.

“We’re seeing a big rise in things like domestic violence and child abuse, parents losing jobs and losing housing as a result of COVID, so we think this is a good time to talk about this,” she said. “Drastic things are happening to families and children, like not being able to go to school, losing social relationships and losing the connection to healthy adults other than their parents.”

Dr. Pradeep Gidwani, ACEs medical director for California Chapter 3 of the American Academy of Pediatrics, said the connection between traumatic childhood events — either witnessed or experienced — and health consequences as an adult is a biological function.

“Trauma in general can be thought of as an experience that overwhelms one’s system and ability to cope … or integrate the emotions associated with that experience,” he said. “What makes childhood trauma a little different is it can be internalized when anything endangers the life of the child or someone close to the child. Children internalize the stress of domestic abuse, even when it doesn’t happen to them but to a parent. They can have a lifelong effect.

“In the ACE study, they looked at abuse, neglect and household dysfunction as trauma and toxic stress. Toxic stress is frequent, strong and prolonged. It changes the body’s stress response to be more permanent and at a higher state of scanning for threat. Now that we look at it from this angle, a child whose system is turned up leads to changes in the brain and the nervous system, hormonal system and immune system. That puts you at risk for these other health factors.”

Hunter said the office will screen children at kindergarten entry age, middle school entry age and high school entry age. The screen is a series of 10 questions about the patients’ childhood — what they experienced or witnessed — and can be asked to the parent or child, depending on age.

“We also hope to intervene early because we know if you give them mitigating factors, that can protect them against diseases,” Hunter said. “We know having good relationships with an adult of any kind, exercise, sleep and addressing mental health issues, even if you have more than four ACEs, those things improve your health outcome.”

Gidwani said that “when we get staff comfortable with doing the screening in their office … and once they find the concerns, we can look at how to connect families to resources. When someone has trauma, you might think they would want to seek mental health, but that is not always the case. With trauma, they may have created a maladaptive coping mechanism, nor do they want to revisit the trauma. We have to take a trauma-informed approach to our work. That means helping the family know they are safe and their experience will have an impact on their lives, and we can help.”

“The ACE score by itself isn’t destiny,” he added. “It’s a risk factor, and risk factors can be mitigated by protective factors. By screening at the clinic in La Jolla, we are asking questions that don’t normally get asked, but by asking, we have the chance to change their health outcomes.”

Hunter said she is trying to get the word out about protective factors that can help mitigate ACEs and their long-term effects and help children thrive during the pandemic.

“Give kids something to look forward to, like pizza outside together on Fridays, that is future-oriented,” she said. “And for every age, have a new hobby or project or goal, something to work toward, because when you achieve a goal, it’s very powerful in terms of mental health, and a lot of us have stopped trying to achieve new goals. Things like continuing family dinner is very protective right now to help against these adverse events we are all experiencing.” ◆