There is a well-established causative relationship between Adverse Childhood Experiences (ACE’s) and pathology. Despite strong supporting evidence, some healthcare workers are unaware of how deep this relationship is. I conducted an educational session surrounding ACEs targeting healthcare workers in an attempt to contextualize the relationship between ACE’s and consequent disease.https://scholarworks.uvm.edu/fmclerk/1431/thumbnail.jp

Konstantinopoulos, Nektarios

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University of VermontScholarWorks @ UVMFamily Medicine Clerkship Student Projects Larner College of Medicine2018ACE’s Contextualization for Healthcare WorkersNektarios KonstantinopoulosLarner College of MedicineFollow this and additional works at: https://scholarworks.uvm.edu/fmclerkPart of the Community Health and Preventive Medicine Commons, Medical EducationCommons, Other Public Health Commons, Primary Care Commons, Psychological Phenomenaand Processes Commons, and the Public Health Education and Promotion CommonsThis Book is brought to you for free and open access by the Larner College of Medicine at ScholarWorks @ UVM. It has been accepted for inclusion inFamily Medicine Clerkship Student Projects by an authorized administrator of ScholarWorks @ UVM. For more information, please contactdonna.omalley@uvm.edu.Recommended CitationKonstantinopoulos, Nektarios, "ACE’s Contextualization for Healthcare Workers" (2018). Family Medicine Clerkship Student Projects.368.https://scholarworks.uvm.edu/fmclerk/368ACE’s Contextualization for Healthcare WorkersNektarios KonstantinopoulosMay 2018Dr. Carl Flynn1The impact of Adverse Childhood Experiences (ACE’s) on health, both pediatric and adult, continues to be supported by research. Despite the increasing preponderance of research, many healthcare workers are unfamiliar with how robust this connection is. The hope is that as healthcare workers begin to understand this connection they will be able to utilize that information to creatively find solutions in reducing the impact ACE’s have on health outcomes. 2It would be challenging to estimate the impact of ACE’s, both financially and in terms or morbidity and mortality, on the US healthcare system. ACE’s has been definitely associated with depression, obesity, smoking, and excessive alcohol use: these are risk factors for some of the most costly diseases3In a rural environment, the already fundamental role of Primary Care Providers (PCPs) is further intensified because of a limited availability of resources. PCPs are frequently required to handle complex cases. Their trusted role among community members enable them to facilitate patient commitment to treatments under challenging circumstances. Even given this phenomena, PCPs and their staff feel that more could be done to structure practices to manage patients with complex problems, often with psychiatric comorbity, and educate patients about the relationship between ACE’s and adult disease.Summary of interview conducted with Carl Flynn, MD and Michelle Ayotte, RN.4I conducted an educational session with staff members of a Federally Qualified Health Center about the current evidence connecting ACE’s and health impacts. Additionally, I attempted to articulate evidence-based strategies for improving interactions complex patients with a likely history of ACE’s. 5Obtaining useful information following the interview was of negligible value because of a relatively small sample size and that respondents may have felt obligated to respond positively. Despite these detractors, attendees stated explicitly they felt better informed and were able to connect this information past and current patients. Additionally, attendees felt the information in session enabled them to empathize with patients better. 6There is a wide range of potential ways to evaluate the educational session’s effectiveness ranging from standard surveys to standardized patient evaluations. Potentially, more importantly would be to here providers experiences and insights following exposure to the information regarding the association between ACE’s and disease.7The potential for future interventions is diverse. Though evidence defining the relationship between ACE’s and pathology is more than two decades old, research continues to be performed that discovers new relationships. One of the most exciting areas for research would be to evaluate the efficacy of various interventions. 8• Bowers, K., et al. (2018). Maternal distress and hair cortisol in pregnancy among women with elevated adverse childhood experiences. Psychoneuroendocrinology. 18(95), 145-48.• Bright, MA, et al. (2015). Adverse Childhood Experiences and Dental Health in Children and Adolescents. Community Dentistry and Oral Epidemiology. 43(3), 193-9.• Broksy, BS. (2016). Early Childhood Environment and Genetic Interactions: the Diathesis for Suicidal Behavior. Current Psychiatry Reports. 18(9), 86.• Chapman, D., et al. (2004). Adverse Childhood Experiences and the Risk of Depressive Disorders in Adulthood. Journal of Affective Disorders. 82(2), 217-25.• Cloitre, M., et al. (2009). A Developmental Approach to Complex PTSD: Childhood and Adult Cumulative Trauma as Predictors of Symptom Complexity. Journal of Traumatic Stress. 22(5), 399-408.• Dietz, PM, et al. (1999). Unintended pregnancy among adult women exposed to abuse or household dysfunction during their childhood. JAMA 282(14), 1359-64.• Dube, S., et al. (2001). Childhood Abuse, Household Dysfunction, and the Risk of Attempted Suicide Throughout the Life Span: findings from the Adverse Childhood Experiences Study. JAMA. 286(24), 3089-96.• Exley, D., et al. (2015). Adverse childhood experience and asthma onset: a systematic review. European Respiratory Review. 24(136), 299-305.• Felitti, VJ., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American Journal of Preventative Medicine. 14(4), 245-58.• Ford, J., et al. (2013). Clinical Significance of a Proposed Developmental Trauma Disorder Diagnosis: Results of an International Survey of Clinicians. Journal of Clinical Psychiatry. 74(8), 841-849.• Gibb, B., et al. (2007). Childhood Emotional, Physical, and Sexual Abuse, and Diagnoses of Depressive and Anxiety Disorders in Adult Psychiatric Patients. Depression and Anxiety. 24(4), 256-63.• Iniquez, KC., et al. (2016). Adverse Childhood Experiences and Health in Adulthood in a Rural Population-Based Sample. Clinical Medical Research. 14(3-4), 126-37.• Kestila, L., et al. (2008). Childhood and Current Determinants of Heavy Drinking in Early Adulthood. Alcohol and Alcoholism. 43(4), 460-69.• Le-Scherban, F., et al. (2018). Intergenerational Associations of Parent Adverse Childhood Experiences and Child Health Outcomes. Pediatrics. 141(6).• Rieser, S., et al. (2014). Adverse Childhood Experiences and Health Anxiety in Adulthood. Child Abuse & Neglect. 38(3), 407-13.• Sachs-Erichsoon, N., et al. (2016). In my end is my beginning: developmental trajectories of adverse childhood experiences to late-life suicide. Aging and Mental Health. 20(2), 139-65.• Van der Kolk, B. A. (2005). Developmental Trauma Disorder: Toward a rational diagnosis for children with complex trauma histories. Psychiatric Annals. 35(5), 401-408.• Van der Kolk, B. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York: Penguin, 2015. Print9•• Written Project:• Students are required to submit a 10-slide PowerPoint summarizing their communityproject at the end of their clerkship. The first nine slides should summarize thecommunity project and should be uploaded to ScholarWorks separately from page 10.Slide 10 will state the following: Thank you for agreeing to be interviewed. Thisproject is a requirement for the Family Medicine clerkship. It will be stored on theDana Library ScholarWorks website. Your name will be attached to your interviewand you may be cited directly or indirectly in subsequent unpublished orpublished work. The interviewer affirms that he/she has explained the nature andpurpose of this project. The interviewee affirms that he/she has consented to thisinterview.• Yes __X___ / No _____• If not consenting as above: please add the interviewee names here for thedepartment of Family Medicine information only.• Name: ______________________________________________________________• If you received informed consent, please upload page 10 as a separate documententitled: “Name of Project/Interview Consent Form”. If an informed consent was notreceived, please do not upload the consent page to ScholarWorks. However, youshould include the consent page when submitting your PowerPoint to the FamilyMedicine Department.10

ACE’s Contextualization for Healthcare Workers

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ACE’s Contextualization for Healthcare Workers

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