Tagged With "Viewpoint"

Recently a family doc published a "Viewpoint" in the Journal of the American Medical Association suggesting restraint and caution in using the ACEs screening tool (Campbell TL. Viewpoint, Screening for Adverse Childhood Experiences (ACEs) in Primary Care: A Cautionary Note , JAMA Published Online: May 28, 2020, doi:10.1001/jama.2020.4365) because (1) there were no evidenced based treatments, (2) asking the questions would offend patients and parents, and (3) risk of labeling people with such...

No we should not be asking these ACEs in the Peds office. I don’t think that any of our patients should have their name, DOB, medicaid number and a billing code sent to the state documenting 4 or more or less than 4 ACEs. This HAS A REAL POSSIBILITY of misuse. We took an OATH to do no harm and this could cause real harm. Also your second “expert” is Dr. Nemeroff. He has been a real proponent for psychotropic use in kids. That right there is a red flag to me.

Jeoffry, I share your frustrations. I give credit to JAMA for publishing several articles, over the last six months, on ACEs, but am disappointed they didn't see the value of printing your letter. No doubt all of us, who have been bitten by the ACEs bug, have multiple stories of disappointment in how others don't "get it". (Last year, I submitted a Point of View paper to JAMA, describing my experience in addressing ACEs with my patients, and it was denied.) My frustration now, as in those...

Jeoffry, Although I have concerns about required screening for ACEs in a society and medical culture that has little understanding of trauma, still commonly believes the only effects of trauma are psychological, often tells individuals with “functional” diseases, mental health conditions, low income or who are discriminated against that it’s all in their heads, does not provide health insurance and mental health treatment for all – I believe it is important to move forward because of all...

Ms Mead I am so grateful for your heartfelt comments. It must have taken a lot of thought and energy to put together such an extensive essay. Your intimate passion and concern come through and I share it. I am glad you found a way (in spite of personal circumstances) to put your wisdom and caring to use. I would riff of your desire to see our society become "more trauma informed" to say I honestly think we live in a relatively brutal and unjust, selfish and violent society. Child abuse is...

Thank you for being so concerned and so passionate. As an advocate for good medicine and good therapy and for helping traumatized kids, I recognize some of your concerns, but others, in my experience, are not as significant as you think. (1) There is a lot of family violence, We have to do everything we can to prevent it and to treat its effects. (2) CYW is definitely not the government, Dr. BH may be part of government now but I see that as a great success in changing public policy to deal...

I can see this information used to discriminate against disadvantaged people. Pediatricians should not be collecting scores that can be used in a harmful way against children or parents. You are basically asking a parent to put a number on the chart associated with their name that represents the "parental risk factors" for child abuse and neglect that we all know about from the various medical textbooks we use. I was looking at Zitelli and the ACE questions are listed in the section as...

Billing Codes Directly Associated with a Score Less than 4 or 4 or more.: DHCS Operational Implementation Element Description\ Payment Effective Date January 1, 2020 Attest to Completing Training By July 1, 2020 Target Population Children and adults up to 65 Provider Types Almost all Rate $29 HCPCS Codes • G9919: ACEs score of 4 or greater, high risk • Screening performed – result indicates patient at high risk for toxic stress; education and interventions (as necessary) provided • G9920:...

Is it Social Justice to take disadvantaged kids (or any kids) and to collect their Name, DOB, Medicaid Number and a Billing Code representing 4 or more ACES or Less than 4 ACES and send that information to the state? Can you tell me Jeff please; is that your idea of Social Justice? It is not my idea of Social Justice and all I have seen from the California community is getting a score - nothing about how to talk to parents about the score or anything.... Just GET THAT SCORE DOCTOR. This does...

Re: Medical Authorities with Academic Blinders look the other Way: Reject ACES

But, Alas, pediatricians are medical clinicians, not police. If they did not ask about language skills they may never uncover a hearing problem that could be treated. If they do not ask about home environment, they may overlook abuse -which they have the responsibility and skills to treat.This is not prejudice, punishment or stigmatization but caring outreach and risk assessment in the vast majority of circumstances.

You are correct.

You DO NOT NEED AN ACE SCORE to get a psychosocial history. You do not need to put a family at risk to do a psychosocial history and provide services to patients. I know. I have been doing it for 20 years. All this score can be used for when put in the medical record is to harm children, parents and families. If I were forced to get this score, I would tell all my patients that the government is forcing me to ask you questions that could put you at risk for having your children removed from...