American College of Preventive Medicine (ACPM) Recommends against Pediatric ACE Screening

Craig McEwen 10/15/2210:57 AM

A just-published article reports that the American College of Preventive Medicine (ACPM) recommends against pediatric ACE screening but strongly supports continuing surveillance of ACEs along with protective factors in the population as a way to identify public health and other policies that can prevent adversity and toxic stress. Their report highlights Dr. Robert Anda’s (and colleagues) commentary that notes that ACE scores are neither a diagnostic tool nor predictive at the individual level (https://pubmed.ncbi.nlm.nih.gov/32222260/).

ACPM’s review of research indicated that there is “a potential benefit of screening for ACEs, if effective interventions exist, but they do not offer strong and consistent evidence that screening reduces the consequences of ACEs.” Further, the research suggests that “Interventions to enhance protective factors and prevent and mitigate the consequences of ACEs and other childhood adversity are promising and require further implementation and research.”

ACPM also makes other recommendations, such as: “All healthcare teams should receive training about the impact of childhood experiences on health across the lifespan and must have protocols and systems in place which support evidence-based trauma-informed, resiliency-informed, healing-centered care, and referral for other indicated behavioral and social services, such as perinatal home visiting and parenting programs for those who are at risk for or have experienced trauma.”

Sherin, et al., “Recommendations for Population-Based Applications of the Adverse Childhood Experiences Study: Position Statement by the American College of Preventive Medicine.” AJPM Focus at https://www.sciencedirect.com/...ii/S2773065422000372.

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Jeoffry GordonMember

@Mike Flaningam posted:
In reading the ACPM report, I feel like the headline here on the PACEs site is a bit misleading. Yes, they recommend against ACE screening, but they do seem to provide fuel for advancing PACEs awareness within the health care system.
That said, I definitely share Jeoffry's frustration on how the medical establishment is way too focused on having studies that meet strict evidence-based guidelines. And in this report, the authors probably feel like they are being supportive of addressing PACEs, but to those of us who "get it", their tepid report is deflating. To the non-PACEs aware reader who glances at the abstract (though trust me, essentially no docs are perusing ACPM's journal), their take-home message is that there looks to be some relevance to PACEs, but more studies are needed. Then they're quickly flipping the page to the next article. What the ACPM should be doing is clearly saying, "Hey, this is big, paradigm shifting stuff that everyone in health care, including all physicians, needs to be aware of", They also should then provide the reader with links where people can go to learn more, and not just expect that the burned out physician will have any idea on how to raise their awareness.
Ultimately, while the bulk of ACPM's recommendations are to mostly push PACEs, it doesn't feel like it.

You know on the surface I could agree with you, but if you go a bit deeper: It is a bit trying to solve a clinical problem ignoring the rules of trauma informed care. First you ask "What's wrong? What do you need? How can I help?"

One does not engage by criticizing, pointing out faults, and generally concluding you fell short and your behavior and attitude could even be harmful or dangerous!

10/25/223:37 PM

Mike FlaningamMember

In reading the ACPM report, I feel like the headline here on the PACEs site is a bit misleading. Yes, they recommend against ACE screening, but they do seem to provide fuel for advancing PACEs awareness within the health care system.

That said, I definitely share Jeoffry's frustration on how the medical establishment is way too focused on having studies that meet strict evidence-based guidelines. And in this report, the authors probably feel like they are being supportive of addressing PACEs, but to those of us who "get it", their tepid report is deflating. To the non-PACEs aware reader who glances at the abstract (though trust me, essentially no docs are perusing ACPM's journal), their take-home message is that there looks to be some relevance to PACEs, but more studies are needed. Then they're quickly flipping the page to the next article. What the ACPM should be doing is clearly saying, "Hey, this is big, paradigm shifting stuff that everyone in health care, including all physicians, needs to be aware of", They also should then provide the reader with links where people can go to learn more, and not just expect that the burned out physician will have any idea on how to raise their awareness.

Ultimately, while the bulk of ACPM's recommendations are to mostly push PACEs, it doesn't feel like it.

10/18/2212:09 PM

Jeoffry GordonMember

The ACPM continues the high-minded academic tradition of castigating clinical research that does not meet precise research standards developed for biochemical pathophysiology and its treatment. In doing so it creates barriers to needed and overdue clinical intervention in a major behavioral pandemic with huge consequences for individual health and society. This policy statement impedes, impairs and delays attention to ACES, PACES, childhood abuse and neglect in the clinic as well as omits the opportunity to emphasize the ongoing under funding of epidemiological research of the problem (for instance only $40 million a year in the NIH), the lack of clinical training in most medical school and residencies for physicians, the general absence of policy concern for childhood maltreatment by most profession medical societies and the overall societal abandonment of policy support for mental health parity. Not all illnesses are easily treated by pills or surgery. The complexities of the impact of adverse childhood experiences need added attention, not nay saying. This is an arrogant knife in the back!