AAPCA1 & ACEs Aware
AAPCA1 is working with the California ACES AWARE initiative to provide California pediatricians with information they can use in their practice to screen for Adverse Childhood Experiences (ACEs) during well child visits. This initiative will help pediatricians support families by identifying stressors that can lead to developmental and behavioral problems in children, and are risk factors for adult onset chronic diseases.

Below are a stream of our ACEs highlights and articles thus far.

Pediatric Perspectives
The Value in Prevention and Early Intervention for ACEs

By Dr. Renee Wachtel MD, FAAP
A recent article by Barnes AJ et al (Ped Res 2020, Jan;87(2):362-370) reviews the data about childhood adverse experiences, which include abuse and maltreatment (physical, sexual, emotional/verbal); neglect (physical and emotional/psychological); and household dysfunction (parent mental illness; domestic violence; divorce or separation; incarceration; and alcohol or drug abuse) . The original ACEs study, which demonstrated the effect of ACEs upon chronic adult health conditions, also did not include other psychosocial factors that can increase health risk, such as immigration status, food insecurity, and the effects of the COVID 19 pandemic, to name a few. The 2016 US National Survey of Children’s Health estimates that 46% of all US children 0-17 years of age have experienced at least one ACE and 29.9% have experienced 2 or more ACES. Children who have experienced at least one ACE are at increased risk for chronic physical health problems during childhood and adolescence (e.g. obesity, chronic headaches) learning problems and developmental delays, and behavioral problems.
Staff Resiliency

How can we make pediatric care more rewarding to pediatricians? One answer is implementing trauma informed care with our patients and their families. And a part of this is developing resilience in ourselves and our staff, and developing Trauma Informed Primary Care. 

Trauma-Informed Primary Care lays the foundation for successful screening for Adverse Childhood Experiences (ACEs), improves patient outcomes, improves clinical decision making and enables us to build collaborative care networks.
"Invisible Scars" on PBS
Childhood trauma impacts millions of Americans, and its consequences can be devastating. Those experiencing high levels of trauma can see dramatically lower life expectancies, and the CDC estimates it accounts for billions of dollars in healthcare costs and lost productivity. A new series, “Invisible Scars: America’s Childhood Trauma Crisis" recently aired on PBS. A portion of the transcript is below. The full episode (10 minutes) can be found here:

The first episode of this PBS series focuses upon a hotel room in Oakland, California, which has been home to Iesha James and her sons for four months. It's close quarters for three growing boys, ages 15, 13, and 12. But they'd rather be here than return to their apartment, where a drive-by shooting in August upended their lives. Jeremiah, the oldest, was hit in the leg.
Why should Pediatricians screen for ACES in their patients?
Because Adverse Childhood Experiences (ACEs) are associated with the Toxic Stress Response.

Several decades of scientific research have identified the biological mechanisms by which early adversity leads to increased risk of negative health and social outcomes through the life course. Repeated or prolonged activation of a child’s stress response, without the buffering protections of trusted, nurturing caregivers and safe, stable environments, leads to long-term changes in the structure and functioning of the developing brain, metabolic, immune, and neuroendocrine responses, and even the way DNA is read and transcribed. This is known as the toxic stress response.  

These biological changes play an important role in the clinical progression from ACE exposure to negative short- and long-term health and social outcomes. Further, both the disrupted biology and the associated negative outcomes demonstrate a pattern of high rates of intergenerational transmission. Development of the toxic stress response is influenced by a combination of cumulative adversity, buffering or protective factors, and predisposing vulnerability.
Building Resiliency

As part of our ACES (Adverse Childhood Experiences) AWARE grant, we have established a “Think Tank” of 6 pediatricians who are meeting regularly to craft messages to our chapter members about ACES screening and trauma informed care. One of our Think Tank members, Deirdre Bernard-Pearl, MD, a pediatrician and Medical Director of Santa Rosa Community Health was recently featured in a statewide educational webinar. An excerpt of her interview is below:

An Interview with Dr. Bernard-Pearl from the ACES Aware Educational Series
September 30, 2020

Before you started ACE screening, what were some strategies or steps that you took to implement? And, what were some of the lessons you learned from this process?

Dr. Deirdre Bernard Pearl: Before we started ACE screening here at pediatrics, we decided to do a pretty extensive training of all of our staff. We definitely wanted to train our medical providers and our nurses, but we also felt it was really important that the whole clinic understand this initiative. 

The way we thought about it from the beginning is that the ACE screening it's really not like other screening questionnaires, it's kind of unique and it asks such personal information. We thought it would make a lot of sense if everyone understood why we were asking all of these very personal questions, and kind of get everybody on the same page. We looked at it as a shift in our culture because we were really shifting the way we were approaching primary care.

You can access the full webinar below: Assessing Readiness & Building Resilience in the Clinical Workforce: A Foundation for ACE Screening Integration
Parental and Provider Resources for ACEs
AAPCA1 and ACEs Aware Website
Our ACEs Aware and AAPCA1 webpage allows you to explore resources based on your comfortability with ACEs. We address a diverse array of topics ranging from trauma informed care, referrals, and toxic stress.
We look forward to communicating future ACEs initiatives with you and your practice! For more information on the ACEs initiative, visit our website here or contact projectcoordinator@aapca1.org.
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Your membership makes a difference for children in California, thank you!

The AAPCA1's ability to advocate on behalf of children is only as strong as the support we receive from our members. Encourage your colleagues to join today by visiting the AAPCA1 website.

Our mission is to promote the optimal health and development of children and
adolescents of Northern California in partnership with their families and communities, and to support the pediatricians who care for them.


President: Raelene Walker • Vice President: Nelson Branco
Secretary: Janice Kim • Treasurer: Nivedita More • Past President: John Takayama
Executive Director: Isra Uz-Zaman

California Chapter 1, American Academy of Pediatrics | www.aapca1.org | info@aapca1.org| 916-274-4173