Jeffrey Brenner on Adverse Childhood Experiences [4 min - University of Pennsylvania]

Good Morning, Colleagues,

When the Claremont Graduate University, School for Information Systems and Technology presented Dr. Vince Felitti to our symposium, "Innovations for Patient Empowerment" in Pasadena, CA (November 2012), we overheard several physicians questioning of the appropriateness of pursuing Adverse Childhood Experiences with patients.  Their reluctance to scanning a potential ACE event may have been an aversion to disruptive outcomes - that is, adverse time management outcomes.  Two concerns cited then were mentioned here by Dr. Brenner - the possibility that the health plans have established time or unit standards for overall productivity performance in primary care visits and the consequences of an inadequacy of mental health resources to manage the huge burden that must be carried by these individuals.  One legislative thought for policy development might be to establish an ACE Score as a uniform measuring tool implemented at a particularly important system-assessment time (at the beginning of puberty or for persons being released from incarceration).  These screenings should be documented for future reference.  Perhaps this type of legislative development could arise from the Medical Directors and Chief Operating Officers of Foster Care Systems in municipal (social welfare and criminal justice) Probation and Correctional systems.  In this realm, the "System" is managing parental duty - to be the "institutional parent for an otherwise parentless child - or socialization of a person who, as a result of a possible criminal-oriented environment or the feedback from those who have not yet made the right choices -  has resulted in the wrong choices.  Crafting solutions that provide good choices must occur when the support team fully understands and appreciates the emotional and psychological dynamics impacting young people.  The appropriately designed multi-disciplinary team will one day be  assembled to test the right assessment tools - targeted at the right environmental and cultural dynamics - adjusted for rural versus urban lifestyles - and targeted for various age/technology interfaces.  Perhaps, demands for "best practices" in youth development cause us to rethink relying on physicians in asking what happened to you as an individual - for fear they might find themselves faced with legal proceedings for incest in progress, or unfamiliar with the statutory obligations of documenting a rape that may have occurred two or four our six years ago.  The issue of Adverse Childhood Experiences also provides insights into the changes that have been occurring in communities throughout America.  The viewing of "Paper Tigers" shown in San Diego in October brought into clear focus the importance of "evidenced based" parenting.  Clearly, relying on past practices or historical trends of the 1960's and 1970's  may not be the most appropriate tools and techniques in today's world.  The  United States was uplifted with the personal freedoms that arose from diminished communities fighting Jim Crow which could envision more access to employment, housing, education for African American and Hispanic American communities and gender-related portals opened to combat gender bias.  But there were no cell phones, no laptop computers, no social media networks and wireless Internet did not support the freedom riders.  The songs sung over rolling hills in Selma,  Birmingham,  Chicago,  Brooklyn and Los Angeles should now come into harmony. The "latchkey children" who fended for themselves until Y2K.  The early-on computers, which promoted young people to travel into far and strange - and sometimes destructive - places. Porno was everywhere.  Obviously, they were not sufficiently well supervised. But we didn't know any better.  The sexual freedoms and the impact of HIV/AIDS of the 1980's and 90's became the disruptions of the 2000's - where large and small communities provided a complete rewrite to drug abuse standards, sexual permissiveness and dietary standards.  Public health professionals tracked health disparities for the major chronic diseases but few clinics demonstrated major improvement in many of the growing chronic diseases.  So here we stand - November 2015. We stood that post - and we are going to Stand this Next One. We Must Repost the Watch. We need New Soldiers. Providers who actually know the patient - and/or read the history.   Findings which were published 15 years ago should be sorted out, dispersed based on culture and community, and made viable into the current world. The struggles for improved access in the1970's were mentally, spiritually and physically uplifting.  Today, however, we see different pockets of poverty and isolation emerging.  We should learn to listen, to love each other, to respect each others experiences and not judge the victims for whatever adverse circumstances may induce a common presentation.  One size, however, does not fit all.

Film at 11:00

Paul B. Simms