Migraine and Trauma-Informed Care: A Review of the Literature and Recommendations for Clinical Practice and Research.

IntroductionTraining health professionals for the skills and capacity to respond adequately to children and adults who have been exposed to adverse childhood experiences is recognized as an essential need in health care. Accessible opportunities to educate physicians and physician-trainees are limited.MethodsFour computer-based e-modules were created focusing on addressing childhood adversity and implementing trauma-informed care in the pediatric primary care setting. These childhood adversity and trauma-informed care (CA-TIC) e-modules were designed as an individualized, self-directed experience to allow for distance learning with flexibility to be embedded into existing coursework. To foster an engaging learning environment, we narrated the modules, prioritized images, and included the opportunity for participant interaction via multiple-choice and short-answer questions. Twenty-eight pediatric residents, two medical students, four attending physicians, and one fellow at Children's National Hospital completed the e-modules.ResultsOverall, participants rated the CA-TIC e-modules 4.6 (SD = 0.5) out of 5 for design and quality. Using paired t tests and Wilcoxon signed rank tests, we found statistically significant score increases from presession to postsession for participants' knowledge, attitudes, practice, and confidence related to CA-TIC. The most commonly cited learning points and practice changes included asking about trauma in practice and the seven C's of resilience.DiscussionA trauma-informed, strengths-based approach to care can assist health care providers in mitigating the link between adversity and related poor health outcomes. The CA-TIC e-modules provide an opportunity to train health professionals using an innovative, self-directed, and low-resource mechanism.

A large body of evidence links exposure to childhood trauma with negative health outcomes. Training future physicians to recognize and respond to trauma is paramount, and engaging medical students in the preclinical years affords the opportunity to foster the development of a trauma-informed lens that can then be solidified during clinical clerkships. We developed and implemented a 4-hour trauma-informed care (TIC) symposium for 179 second-year medical students at the George Washington University School of Medicine and Health Sciences during the Patients, Populations, and Systems course. The symposium included three interactive didactic sessions focusing on the connection between trauma and health and TIC principles. A facilitated small-group discussion allowed students to apply TIC principles to a patient case, followed by reflection and evaluation. The overall rating of the TIC symposium was 4 out of 5. Strengths included integration of a small-group case with discussion on application of TIC in practice, experience of the lecturers and small-group facilitators, and review of research relating adversity to specific health outcomes. Suggestions for improvement included incorporating role-play and standardized patients. Content analysis of student reflections mapped to the domains of physician competency. A 4-hour symposium can affect student knowledge and understanding of TIC. Teaching TIC presents an opportunity to prepare medical students for a career in medicine through cultivation of required physician competencies. Next steps include enhanced opportunities to practice TIC and follow-up analysis of participants to determine behavior change during clinical years.

Despite prevalent trauma exposure among patients seeking health care, as well as widespread frameworks for enacting trauma-informed care, the uptake of trauma-informed practices such as trauma screening and referral among health-care providers remains relatively low. The current study sought to assess the roles of health-care providers’ personal histories of adverse childhood experiences (ACEs) and personal beliefs in the just-world hypothesis in understanding their attitudes toward trauma-informed care. Advanced practice graduate nursing students (N = 180; M age = 34.6 years) completed a self-reported survey assessing their personal history of ACEs, global belief in a just world, and attitudes related to trauma-informed care. Results indicated the relation between providers’ ACEs and attitudes toward trauma-informed care was fully mediated by their beliefs in a just world, such that providers reporting higher ACEs scores also report greater endorsement of attitudes consistent with trauma-informed care due to less belief in a just world. Implications for both health-care providers’ themselves and cultural shifts necessary for provision of trauma-informed health care are discussed.

Scientific findings of adverse childhood experiences (ACEs) and their lifelong graded relationship with leading causes of death are well established. Many health care practitioners, however, have yet to implement ACEs screening in clinical practice. Furthermore, ACEs screening and trauma-informed care (TIC) are not part of standard graduate-level training. To 1) implement trauma-informed curriculum for multiple graduate health programs, 2) determine student understanding of and willingness to address ACEs, and 3) assess the relationship between students voluntarily evaluating their individual ACE Score and their attitude toward ACEs and TIC. Prospective study with pre- and postcurricular surveys (12-question digital survey administered before and after the curriculum) for 967 graduate students from 9 health professions programs at 2 campuses who received curriculum focused on ACEs and TIC. Students' understanding of ACEs and TIC, their awareness of personal ACEs, and their willingness to incorporate TIC in practice. Among students who voluntarily completed an ACE questionnaire, there was statistical significance in familiarity with clinical and scientific findings of the ACE Study (p < 0.001) and familiarity with TIC (p < 0.02). A significant intercampus difference in the students' familiarity with the scientific and clinical findings of the ACE Study (p < 0.05) was found. Students and future health care practitioners who voluntarily assess their ACE Score are significantly more likely to understand scientific and clinical findings of the ACE Study as well as TIC.

BackgroundTrauma is an emotional response to distressing events where coping and subsequent recovery are absent. Adverse Childhood Experiences (ACEs) are traumas, occurring before the age of 18 years, such as child abuse or neglect, caregiver instability, and household dysfunction. Sixty-four percent of the U.S. population report experiencing at least one ACE, with over 1 billion children experiencing abuse and neglect annually worldwide. Chronic exposure to stressful circumstances or multiple traumatic events has negative physiologic impacts. Persons who experience 3 or more ACEs in childhood are at greater risk of poor mental health outcomes and may be more likely to engage in high-risk behaviors, predisposing them to long-term health impacts, such as metabolic diseases, anxiety, depression, substance use, and chronic pain. Trauma informed care (TIC) is a recommended approach to healthcare delivery across professions, especially when a trauma history is suspected. This commentary aims to increase awareness of the impact of ACEs on health outcomes and introduce TIC concepts as they may apply to chiropractic care for adults with a history of ACEs.DiscussionThis commentary reviews an introductory model (4R's: realize, recognize, respond, resist re-traumatization) as one TIC framework used by healthcare practitioners. Prior trauma can lessen trust, alter perceptions of physical touch, and hands-on examinations and chiropractic treatments may trigger stress responses. Using TIC after appropriate training, includes referrals to multidisciplinary providers to address trauma-related concerns outside the scope of chiropractic, and screening for ACEs if deemed appropriate. Creating safe spaces, communicating clearly, avoiding victimizing language, explaining procedures, asking for consent before physical contact, and giving patients choice and control in their own care may avoid triggering prior traumas.ConclusionGiven the high worldwide prevalence of persons experiencing 3 or more ACEs, TIC principles are practical adaptations to chiropractic care for use with many patient populations. As TIC and ACEs are emerging concepts within chiropractic, students and practitioners are encouraged to undertake additional training to better understand these complex and sensitive topics. Exploratory research on the incidence, presentation, and impacts of various trauma types, including ACEs, to support adoption of TIC in chiropractic settings is essential.

Background/Objective:Children with multiple Adverse Childhood Experiences (ACEs) have been shown to be at greater risk for chronic health conditions. Providing Trauma-Informed Care (TIC) to children with ACEs has been linked to better downstream health outcomes. Out-of-school time (OST) programs, such as Boys and Girls Clubs (BGC), can play an important role in supporting children with ACEs. Currently, BGC of Tippecanoe County does not require staff or volunteers to participate in training on ACEs or TIC. This study aims to determine the number of ACEs that children at BGC experience, and subsequently if training for staff and volunteers should be required. Methods:An anonymous survey was developed using a template from ACEs Aware. The survey included ten ACEs questions and nine Related Life Events questions (considered additional ACEs in this study). An optional demographics section was also included. Caregivers of children at BGC were asked to participate. Staff and volunteers were also surveyed regarding their history of training in TIC. Results:A total of 64 surveys were distributed to parents and 52 were completed (81.3% response rate). Of the completed surveys, the mean number of ACEs experienced per child was 4.6, the median was 3, and the mode was 2. The maximum number of ACEs experienced by a child was 14. Fifty percent of the staff and volunteers surveyed (n = 18) had no formal TIC training. Further data analysis is still in progress. Conclusion and Potential Impact:Children who attend BGC may experience on average a higher number of ACEs than the general population. Requiring training on ACEs and TIC for staff and volunteers may help better identify and respond to child behaviors linked to ACEs. Helping children feel safe and empowered through TIC provided at OST programs may have a positive impact on their physical and social health.

ObjectivesAdverse Childhood Experiences (ACEs) were first described by Felitti in 1998 which documented the link between childhood abuse and household dysfunction and long term morbidity and mortality.1 Only in more...

Trauma-Informed Care in Child Health Systems.

382 A Survey of Exposure to Community Violence and Adverse Childhood Experiences in Emergency Department Patients

Olivia, a 13-year-old neurologically intact patient with cerebral palsy, arrived from a routine abdominal procedure screaming in pain. The medical team was baffled as to why she experienced such agony despite receiving copious doses of morphine. We spoke with her adoptive parents to obtain more history. They revealed long-standing physical and sexual abuse before Olivia’s adoption 6 years ago and noted extreme distress to all medical procedures and prolonged surgical healing time. Although her parents hoped to give her a better life and ensure she received appropriate care for her condition, they felt helpless that Olivia was at risk for retraumatization (reexperiencing posttraumatic symptoms from her original traumas) each time she came to the hospital. The amplification of pain and delayed medical recovery secondary to a history of psychological trauma and adverse childhood experiences (ACEs) is well recognized.1–3 Health care institutions are aware of the need for the integration of trauma-informed care into practice, yet they struggle to find the right approach. Although screening for ACEs has been widely adopted as a trauma-informed practice, there are multiple concerns with ACEs screening, including operating from a deficit- versus strength-based model, risk for traumatization from screening, and limited follow-up resources.4 ACEs scores also do not fully capture trauma and posttraumatic stress symptoms, which may be better predictors of negative outcomes than ACEs alone. Many organizations have now implemented the Substance Abuse and Mental Health Services Administration guidelines of educating clinicians on realizing …

The findings on the relationship between adverse childhood experiences (ACEs) and outcomes in adulthood cover a wide subject area. In order to understand the results of ACE studies and plan adequate measures, the role of social work should not be disregarded. This paper studies the topic of ACEs, positive childhood experiences and the association with the subjective experience of poverty, which has rarely been addressed, but is relevant to social work. The research was based on simple and extended ACE questionnaires and was conducted amongst the adult population of Slovenia (n = 4939). The results found that adverse material position is associated with a higher amount of adverse and a lower amount of positive childhood experiences (on average, people with adverse material position have 3.43 ACEs and 7.77 positive experiences, while those with better material position have only 1.75 ACEs and 9.82 positive experiences). Social work needs to provide measures on a systemic level to improve the material position of families and to develop programmes based on the poverty aware paradigm to support partnership and interparental relationships in order to decrease the incidence of ACE. In addition, people need adequate support (e.g. trauma-informed care) when recovering from ACE and to enhance their resilience.

AimsAdverse childhood experiences (ACE’s) encompass many traumatic events occurring in early years (0-17years) including, but not limited to, childhood abuse and household dysfunction. It’s known that ACE’s can increase the...

Adverse Childhood Experiences and Trauma-Informed Care.

Adverse Childhood Experiences and Trauma-Informed Care in Rehabilitation Clinical Practice

Childhood trauma is widespread and contributes to clinical, behavioral, and social health consequences. Despite more than 2 decades of research from the Centers for Disease Control and Prevention-Kaiser Adverse Childhood Experiences (ACEs) Study, ACEs science is still not fully integrated into medical school curricula. Therefore, we conducted a pilot study to assess the level of awareness about ACEs and trauma-informed care (TIC) curricula among medical students. A cross-sectional study was conducted at the Medical College of Georgia using a sample of convenience. Enrolled first-, second-, and third-year students were invited to complete a survey during the Spring 2020 semester. A total of 194 students responded to specific questions about training on and knowledge of ACEs and principles of TIC. The majority of students (80%) indicated they heard of the ACEs Study, and 70% reported they received information about ACEs. Regarding TIC, findings indicated less knowledge on cultural context related to stress and trauma. In addition, first-year students were less likely to know about TIC principles than third-year students. This preliminary study is the first of its kind in the state of Georgia, where recent surveillance data indicate that 60% of adults have experienced at least one ACE. Given that ACEs are widespread, effective educational practices to increase knowledge about ACEs science, and skills to carry out TIC practices may benefit future practicing physicians by introducing ACEs in the first-year curriculum.