California is right to focus on adverse childhood experiences. Other states should follow

It’s time to change the conversation in health care. Rather than asking, “What is wrong with this person?” medical professionals might ask, “What happened to this person?”

California Surgeon General Nadine Burke Harris and an increasing number of practitioners are changing the conversation because they recognize that trauma early in life—child separation, racism, neglect, abuse or poverty, for instance—can manifest itself years later with devastating consequences.

Dr. Burke Harris, a pediatrician, hopes to reduce the effects of toxic stress and adverse childhood experiences, also known as ACEs, by 50% in one generation. 

To achieve that goal, Dr. Burke Harris announced in June that practitioners throughout California will adopt trauma-informed primary care by expanding trauma screening and training for Medi-Cal professionals.

Trauma-informed primary care has its roots in a collaboration that began in 1995 between Kaiser Permanente and the U.S. Centers for Disease Control and Prevention. Researchers assessed more than 17,000 individuals to determine the psychological impact of adverse childhood experiences during the first 18 years of life.

Major findings from that initial study showed a strong correlation between adverse childhood experiences early in one’s life and illness later in life.

People who experienced a combination of four types of adverse childhood events had a 240 percent greater risk of hepatitis, were 250 percent more likely to have a sexually transmitted disease and were 390 percent more likely to have pulmonary disease.

There was also a link between ACEs and risky behaviors leading to diminished health. People who experienced an adverse childhood event were twice as likely to use tobacco products, seven times more likely to misuse alcohol, 10 times more likely to have injected street drugs and 12 times more likely to have attempted suicide.

Dr. Burke Harris said during a 2014 TED Talk:

• We now understand better than we ever have before how exposure to early adversity affects the developing brains and bodies of children. When we understand the mechanism of a disease, when we know not only which pathways are disrupted, but how, then as doctors it is our job to use this science for prevention and treatment… This is treatable. This is beatable. The single-most important thing that we need today is the courage to look at this problem in the face and say, ‘This is real, and this is all of us.’

With this bold move, California is leading the nation in creating a health care model that recognizes mental wellness cannot be separated from physical health, a model every state in the nation must adopt.

Integrating trauma-informed care into primary care will require a fundamental change in the established health care model. 

The National Council for Behavioral Health is supporting adoption of trauma-informed primary care through the development of easy-to-use tools and implementation strategies contained in a new resource, Fostering Resilience and Recovery: A Change Package for Advancing Trauma-informed Primary Care. 

This carefully developed change package offers the latest guidance on screening for trauma, suggests trauma services and offers steps for the organizational changes necessary as practitioners embrace this shift in integrated care and was developed with the financial support of Kaiser Permanente.

California must not stand alone in its commitment to trauma-informed primary care. Every state should look to California as their North Star and embrace trauma-informed care as the norm,  not the exception.

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Chuck Ingoglia is the president and chief executive officer of the National Council for Behavioral Health, ChuckI@thenationalcouncil.org. He wrote this commentary for CalMatters.

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