Sounds good, Kathy. Let me know when a practice begins using ACEs. I'd love to do a post about it.
That's exciting that Dr. Felitti will be at the conference. Very interesting about how you're using dialogue education. I hope you post the conference in the events section!
Cheers, Jane
I want to make sure folks saw Jane's book review on 'Blind to Betrayal." This book is co-authored by Dr. Jennifer Freyd. Some of you may remember her history:
"As an adult in the early 1990s, Freyd privately accused her father of abusing her during her childhood. Her parents co-founded the False Memory Syndrome Foundation to dispute Freyd's claims and the claims of others who they allege may have recovered false memories of childhood abuse in therapy.[12]"http://en.wikipedia.org/wiki/Jennifer_Freyd
Her work is amazing. Needless to say she understands this subject matter on a visceral level.
Chris,
Can you post a link to Jane's review?
Thanks,
Kathy
I rarely see my g.p. I do see my psychiatrist every few months or so. I would hope if I brought up ACE's that he would have a good bit of familiarity with the term. He and I have certainly talked about my own ACE's but I don't believe we've used that language per se…at least I hadn't as I only recently learned the term. I'm just grateful that there is a widening body of research and knowledge concerning how ACE's shape our entire lives all the way to the cellular level.
So many of my patients complain about the quick, unidirectional nature of visits to the doctor. It is easy for me, because as a psychotherapist I have an hour to listen. Physicians do not, and personally I always feel this. So, opening up a discussion about early abuse is going to be fraught with limitations. How can it occur with greater sensitivity toward the patient and where the physician isn't overwhelmed by crossing that threshold? I don't have any answers necessarily, but I wonder if a more straight forward resiliency test could help. The one I found doesn't show how to score it, and is probably meant to be used to facilitate discussion, but what if there was a score that could help a person identify where their resiliency is supporting them and how it might be lacking, and what they might need to focus upon? Is there anything out there like this? For example, my score might be 8 out of 12, and it could recommend that I need a stronger support system, or that I would benefit from more physical activity or something along those lines. It could offer resources online to learn more.
When I administered health care systems, I was working towards a multi pronged approach. Health care is only one entry portal for healing from ACE's and schools, juvenile social programs, non-profits like Big Brothers and Big Sisters, among others, can contribute to identifying ACE victims.
For health care and physicians, I believe that through an algorithm combining a variety of information sources can be devised to detect levels of trauma in patients (Dr. Felitti recommends a questionnaire, and I agree with this approach). Then I would advise that Physicians discuss 3 items with the patient: (1) that the level of ACE's might contribute to higher levels of disease in the patient; (2) that a variety of behaviors (Negative, Neutral and Positive in impact) might have developed in the patient as a response to their higher levels of ACE's; and (3) referral to a comprehensive program designed to help heal from the trauma. I visited Cherokee Health Systems (CHS) in Tennessee years ago while searching for models that dealt with behavioral issues. CHS has Behavioral Health Specialists (BHS) and MD's working together as a team. If they detect behavioral issues, the MD hands the patient off to the BHS immediately and helps the client deal with immediate issues and helps develop a longer term strategy for address those issues. I added a nutritional specialist to the model I advocate to address issues that might be corrected by supplementation. There are a number that can be assisted or corrected by nutrition. Good question.
I'm torn on that. On the one hand, it's the only way to star the change toward trauma informed. On the other hand, it's a waste of time. The odds of a doctor even bringing up stress are 3%, based on a JAMA study, let alone ACEs. They are limited in their time, and then they are sending people away from their services and prescriptions to someone else's. If the doc themselves are stressed, then they aren't going to want to bring it up, and given what I know about it, vs. what the doctor might know (I will brashly assert it's akin to their level of knowledge of nutrition), I feel that I'm far safer keeping my vulnerabilities to myself.
An effective strategy might be to make sure you bring up stress and ask if they know the about ACE, and then drop it. It at least brings light to the bigger issues facing their practices and might start that tide turning. I have to admit, that I don't go to the doc unless something is demonstrably wrong, like my broken foot.
I'd want the doctor to be receptive and listen, not argue with me about it. I'd want him/her to ask clarifying questions about it and use active listening.
If I told my doctor, I'd want him to...
1) Validate.
2) Normalize ACEs.
3) Remind me that ACEs are not a death sentence, there is hope.
4) Build capacity in protective factors and evidence-based practices I can implement in my life to heal.
5) Follow up at next appointment.
