How to get behavioral/mental health providers to authentically appreciate the effect of ACES on physical health and their role in communicating with physical health clinicians?

Correction:Mental Health

Hi Suzanne, The Harvard Center for the Developing Child recently released a new video that makes the connection between trauma and physical health very clear.  I hope this is useful. Karen

YouTube 5 min video: https://youtu.be/IipVaPKnjRk   

Link to website where video and  more info can be found: https://developingchild.harvard.edu/resources/how-early-childhood-experiences-affect-lifelong-health-and-learning/   

Thank you. This you tube is great!. The problem is behavioral / health  clinicians  are taught these concepts, and do not have the professional humility to understand that physical and  mental health clinicians need to communicate and work together to treat and prevent the effects of toxic stress. Mental health continues to function in a silo. They do not see that patients struggling with obesity, hypertension, substance abuse, etc need their mental and physical  health clinicians to work as a team to optimize health. (Integrated health systems like CCBHCs and Kaiser do this already)

Yes, sometimes mental and physical clinical providers get stuck in the old paradigm that falsely separated these two interrelated disciplines! When I was in nursing school (AA, BS, MN!) we did not look at the whole person, SDOH or other influences of wellbeing! Thanks for being a great champion!  Karen
The attached pdf can be found here: www.cdc.gov/vitalsigns/aces/index.html 

As a family doc I see the problem from the other end. Except for a goodly number of pediatricians, the medical profession, especially general internists, gynecologists and psychiatrists, are largely ignorant of the adult physical health impact of childhood maltreatment, never mind being familiar with trauma informed care. Thus I think it is up to non-physician therapists to appreciate this issue and recruit and lean on consulting physicians to respond to these needs in their clients. I have an (embargoed) review article awaiting publication on adult diseases correlated with child abuse and neglect and at the end of August will give a poster presentation on this issue at the IVAT Summit in San Diego. I have included a copy of my Powerpoint for your use.

Santa Clara County has a reputation for sophisticated child abuse programs. If there is any way I can help let me know.

Hi Suzanne,

As a family doc who retrained as a somatic psychotherapist I only learned about the subtle and pervasive meaning and presence of trauma in my new training. Even then, I found the links focused primarily on trauma as a mental health issue that is a risk factor for mental health conditions and that any potential links to chronic illness and other physical conditions were relegated to it implying it was "all in someone's head."

ie: there is a belief based on the mind body split that physical diseases have only physical causes

My own work has since been to explore and integrate research from the silos within different kinds of chronic illnesses and research and to present it for patients so they don't have to wait for medicine to catch up.

Similar to Jeffrey Gordon's comment above (I've seen some of your articles here such as the one about ACEs Screening and Academic Blinders and the terrific team you wrote with and happy to hear you have an article in publication) about spreading the word through therapists, my own work has been to give patients and interested health professionals tools and information so they can do the personal work of trauma healing to support their own healing and spread the word to their clinicians (to the ones who might be willing to listen).

One of my own areas has been to create fact sheets - such as an ACE Fact Sheet to Educate your Doctor, accompanied by detailed articles, summarizing ACEs science in chronic illness (attached).

I also appreciate Karen's reference to Shonkoff et al's work at the Harvard Center for the Developing Child, which is a great resource as are some of their published journal articles.

Changing the predominant view of mind/body as separate seems to be a process that requires all kinds of us to chip away at it from different angles and positions - thanks for posting Suzanne.

This is really interesting, Suzanne.  Being a primary care internist, I didn't realize that some behavioral health people don't see the connection.  I thought it was just us "physical health" people that didn't see the mind- body connection.  We are trying to work on that with our clinician education.  We are desperate to work with mental health and community people who can help use provide resources for our adult patients struggling with chronic illness and the burden of ACEs

Sometimes you have to do it at the "retail ' level  I use the "England and Wales" video on ACESTOHIGH as an intro.  I am also going to my professional society, The Community Development Society, with a presentation.

Thank you for your replies and support. Yes, in my county, behavioral/mental  health folks have theoretical ACEs  training, yet real life implementation of collaborative work flows does not happen. Primary care providers and mental health need to meet to work together and develop mutual respect to enhance  patient care. I hope that ACES Aware can develop more specific workflows and guidelines for mental health and physical health clinicians to promote a team approach to mitigating and preventing effects of adversity. ( My experience is that behavioral/mental  health and primary care work well together as a team at CCBHCs and Integrated systems like Kaiser. However, county behavioral health and some non-profit agencies have been broadly  condescending, disrespectful, and weaponize patient care  when primary care clinicians work to collaborate)