SU 4312 The AAP s policy statement on childhood
The AAP’s policy statement on childhood adversities is a call to the pediatric SU 4312 to apply the knowledge toward developmental screening in clinical practice. It is a movement to increase education around childhood adversity as a public health crisis and to build trauma-informed care into pediatric clinics (American Academy of Pediatrics, 2012a). Most importantly, the AAP Policy Statement summarizes the research documenting that childhood adversities are relevant within a biomedical model: early life trauma can disrupt healthy biopsychosocial development in children. Despite the science, the adoption of universal ACEs screening in pediatric care setting is still under development.
For example, data collected through the 2013 American Academy of Pediatrics Periodic Survey exclusively among non-trainee physicians practicing general pediatrics indicated that only 11% reported some or strong familiarity with or knowledge of the ACE study (Kerker et al., 2016). Three-quarters of the pediatricians surveyed had no familiarity with the ACE Study. For pediatricians who reported conducting ACEs screening, their attitudes and beliefs predicted this practice. Pediatricians were more likely to screen for ACEs if they believed they could influence parenting behaviors, and they were also more likely to screen for ACEs if they believed that social-emotional development is within the bounds of pediatric care (Kerker et al., 2016). Thus, despite the movement towards addressing childhood adversities in pediatric settings, universal ACEs screening is still not “widespread” and is in its infancy. The study indicates that pediatricians are cautious about screening for ACEs; their decisions rely on their own beliefs and attitudes about whether they themselves should take the role of specifically addressing parenting and the social-emotional development of their patient population. Additional studies among healthcare workforce attitudes and knowledge about ACEs utilizing an emic view can provide the field with a more thorough understanding about their perceptions regarding ACEs screening.
Cautious action The intergenerational cycle of adverse childhood experiences requires a paradigm shift: healing and recovery in adult survivors (tertiary prevention) must be understood as a critical step to primary and secondary prevention of the exposures in children and adolescents (Dube & Rishi, 2017; Dube et al., 2013). Finkelhor’s argument about cautions with respect to “widespread” ACEs screening is an acceptable argument. To take it one step further, we need to exercise caution, but also heed the call to action as required by ethical public health practice. The Principles of the Ethical Practice of Public Health (Public Health Leadership Society, 2002), is a guideline to our field that reminds us that we have a duty and obligation to serve and protect populations. Under these Principles is included an excerpt on the Values and Beliefs Underlying the Code and the Basis for Action as quoted verbatim from the document. (https://www.apha.org/∼/media/files/pdf/membergroups/ethics_brochure.ashx). In addition, The Public Health Ethics Code also provides guidelines about the importance of research to increase our knowledge about a problem and to identify the potential solutions; a point that Finkelhor raises as well. Most importantly, community participation and engagement are key critical components, as outline in the CDC-Military initiative and the survey of pediatricians (Kerker et al., 2016; Robinson et al., 2008).
Trauma informed care: a promising practice that utilizes ACEs screening data In 2014, Substance Abuse Mental Health Services Administration (SAMHSA) released Tip 57: Trauma-Informed Care (TIC) In Behavioral Health (Substance Abuse and Mental Health Services Administration, 2014), partially informed by the ACEs science. The underlying principles include: realizing that trauma is widespread; recognizing symptoms of trauma; responding without further escalation and re-traumatization.