adverse childhood experiences and practice: informing services in pediatric medical settings
TRANSCRIPT
Adverse Childhood Experiences and
Practice: Informing Services In Pediatric
Medical SettingsDeandra Clark, MDKim Conant, LPN
Kristine Hobbs, LMSWRamkumar Jayagopalan, MD
SC Children’s Trust Conference, September 18, 2015
Who are We? Where Did We Come From?
Why are We Here Today?
Agenda
• Why SEEK?• Dr. Ramkumar Jayagopalan, Carolina Pediatrics, Columbia
• How to SEEK?• Kristine Hobbs, Mental Health Integration Coordinator, QTIP
• What if ‘they’ don’t want to SEEK?• Dr. Deandra Clark, AnMed health Children’s Healthcare Center
• What if you SEEK and FIND?• Kim Conant, Special Care Needs Coordinator, Palmetto Pediatric
and Adolescent Clinic
• Discussion
Why SEEK?Dr. Ramkumar Jayagopalan
TRAUMA INFORMED
CARE Ramkumar Jayagopalan
WHAT IS TRAUMA ?
TOXIC STRESS
Emotional stress.• Positive stress- helps guide growth
• Tolerable stress- not helpful but no permanent damage
• Traumatic stress / Toxic stress
TOXIC STRESS
• Extreme, frequent, extended activation of the stress response, without the buffering presence of a supportive adult.
• Neglect, abuse, extreme poverty, family violence, substance abuse, and parental health problems.
• These are examples of Adverse Childhood Events ( ACEs).
WHY ADDRESS TOXIC STRESS?
Adverse Childhood Experiences ( ACE ) study• Attention problems, oppositional behavior,
emotional dysregulation, sleep problems, toileting problems, anger, anxiety and depression- directly related to childhood adversity.
• High risk for adverse health outcomes as an adult- cardiovascular, cancers, asthma, depression and autoimmune diseases.
• High risk behaviors like alcohol and drug addiction.• Enormous financial and personal cost.
ACE PYRAMID
WHAT TOXIC STRESS DOES ?
TOXIC STRESS
EPIGENETIC CHANGES
BRAIN DEVELOPME
NTMALADAPTIVE BEHAVIOR
ADVERSE HEALTH
OUTCOMES
TRAUMA EPIDEMIC
• 68% of all kids have had at least one PTE (potentially traumatizing event).
• More than half of these kids have had more than two PTEs.
• Strong link between exposure to PTEs in childhood and long term somatic and emotional health outcomes.
WHAT CAN PEDIATRICIANS DO?
• Identify traumatized children.
• Screening for consequences of trauma.
• Effective interventions for treatment.
• Create a trauma sensitive office culture.
How to screen for trauma?
• Open ended or direct questioningSince the last time I saw your child ( you), has anything really
scary or upsetting happened to your child or anyone in the family?
• Standardized screening tools SWYC- Survey of Wellbeing of Young Children One screen for developmental, emotional , mental health and family risk factors ( Age 0-5). SEEK PTSD- RI TSC- C Ideally should be done at all well child visits.
How to identify trauma symptoms ?
• Change in bodily functions- sleep, eating and toileting.
• Change in behavior- detachment, aggression, anxiety, fantasy.
• Impaired development and learning.
TRAUMA SCREENING PROTOCOL
SCREEN FOR TRAUMA
POSITIVE
SCREEN FOR PTSD SYMPTOMS
NEGATIVE
KEEP SCREENING
FOR SYMPTOMS
POSITIVE- MILD10-20
COUNSELING/
EDUCATION
POSITIVE- SEVERE
PTSD> 20
REFER EBTs
NEGATIVE
RESCREEN EVERY WELL CHECK OR IF
INDICATED
PTSD REACTION
INDEX
How to respond?
Affirmation• HELP – Hope, Empathy, Language,
Patience.• Provide education materials.
Anticipatory guidance
In-office treatments:• Self care- good sleep, exercise…• Focused breathing and relaxation
techniques- pin wheel ?
Refer for treatment.• PCIT• TF- CBT• Know what are the evidence based
treatments available.• Know your community trauma resources.
SO WHY DO IT ?
• That is what pediatricians do!
And……..
You would look cool !
RESOURCES
AAP Healthy Foster Care America
www.aap.org/fostercare
National Child Traumatic Stress Network
www.nctsn.org
Child Trauma Academy
www.childtrauma.org
Project BEST ( Bringing Evidence Supported mental health Treatments. )
www.musc.edu/ncvc
How to SEEK?Kristine Hobbs
• Trauma Informed Care• Why pediatricians?• Why SC?
• Tools available• Resources for Pediatricians• Resources for Families• Next Steps…
“From the time of its inception as a recognized specialty of medicine, the field of pediatrics has attached great significance to both the process of child development and the social/ environmental context in which it unfolds.”
http://www.pediatricsdigest.mobi/content/129/1/e224.full
Why Pediatricians…
http://childlaw.sc.edu/JointCommittee/2013%20Annual%20Report%20JCLCC.pdf
Why South Carolina?
Last year (2012)… • 1,087,000 children living in South Carolina• SC ranked 43rd in the nation by the Annie E. Casey
Foundation in overall child well-being• 490,000 children lived in some officially measured
degree of poverty • 583,000 children were on Medicaid• 25,400 children were the subject of a child
maltreatment investigation• 3,800 children lived in foster care• 17,000 cases of delinquency were referred to the
family courts• 93,000 children received special education services• 57% of students received subsidized school meals to
access adequate nutrition• 25% of students who start school will not graduate
with peers
http://childlaw.sc.edu/JointCommittee/2013%20Annual%20Report%20JCLCC.pdf
“The Safe Environment for Every Kid (SEEK) model …address prevalent psychosocial problems:• parental
depression• substance abuse• major stress• intimate partner
violence• food insecurity• discipline
challenges”
http://theinstitute.umaryland.edu/seek/
One Tool….
Resources for You and Your Families
http://theinstitute.umaryland.edu/seek/seek_parenthandouts.cfm
Next Steps…Poison Control #Smoke Detector – Fire DepartmentQUIT LineDSS – SNAP; local food banks; free & reduced lunchParent supports; churches, community, child care center; First Steps; Home visitors; social support networks; Military resourcesPersonal support network, DMH, private therapist EAP at workDepression – same as above; include doctorDomestic violence – manned across stateSubstance – fast track through DAODAS using their SBIRT contacts….
SEEK CHEAT SHEET – Lexington County SEEK Topic
Resource Ideas
Phone Number Website
Poison Control
National Hotline Number
1-800-222-1222
Smoke Detector
Local Fire Department
803-785-8343 http://www.lex-co.sc.gov/departments/DeptAH/emergencymanagement/Pages/index.aspx
Tobacco Smoke
SC DHEC QUITLine
1-800-QUIT NOW https://www.scdhec.gov/health/chcdp/tobacco/quit-for-keeps/
Food Needs
SC DSSLocal Food Bank
DSS - 1-(800)-616-1309We Care Center – Chapin--(803) 345-3244Sharing God’s Love, Irmo--(803) 732-3188Harvest Hope Food Bank, Cayce--(803) 794-1627LICS – Lexington Interfaith Community Services, Lexington (803) 957-6656
https://dss.sc.gov/content/customers/food/foodstamp/foodstampcalc.aspxhttps://dss.sc.gov/Scmapp/default.aspxhttp://chapin_sc.suntopia.org/food_pantries.php
Parenting Support
First StepsHome VisitorsChurchesParenting Groups
Saxe Gotha Presbyterian Church - Respite Care for children with special needs and their siblings - 3rd Saturday of each month – 4:30- 7:30Ginny Aldinger 803.629.5212
http://www.acswebnetworks.com/saxegotha/article229636.htm
Extreme StressDown, Depressed or Hopeless
Hotline NumberLocal DMHTherapists EAP programs Church/Community affiliated groups
Lexington County Mental Health Center – 803-359-7206Suicide & Crisis Hotline1-800-999-9999Family Service Center (803) 733-5450
http://www.state.sc.us/dmh/lccmhc/ www.fsconline.org
Interpersonal Violence
Domestic Violence HotlineLocal Resources
National Domestic Violence Hotline800-799-7233Sistercare, IncPhone: 803-926-0505; Hotline: 1-800-637-7606
http://sistercare.com/
Drugs or Alcohol
Local DAODAS Center
LRADAC(803) 726-9400;
http://www.lradac.org/
What if they don’t want to SEEK?
Dr. Deandra Clark
Parent Cover Sheet - AnMed
Dear Parents, The American Academy of Pediatrics recommends the use of screening tools at every Well Child Check/physical for your child. These screening tools include screens for post-partum depression, developmental delays, Autism, depression and mental health issues, and economic hardships. Today’s questionnaire is the “Safe Environment for every Kid.” It asks some personal questions. It’s aim is to strengthen families, support parents, and improve children’s health, development, and safety. The reason we use these screens in this office is to identify issues where we can offer assistance and referrals if needed. To that aim, attached is a list of resources in Anderson that help with issues addressed in this questionnaire. Our goal is always to provide you the best care possible. We thank you for your willingness to help us provide that care.
Thank you,Your Care Team
AnMed’s Food
Pantry Resource
List
ANDERSON Family ResourcesTopic Phone Number Website
Poison Control
1-800-222-1222
Need a Smoke Detector?
210 McGee Road(864) 260-4016
www.acfire.org
Ready to Quit Smoking?
1-800-QUIT-NOW www.scdhec.gov/health/chcdp/tobacco/quit-for-keeps/
Food Needs?
DSS- 1-800-616-1309Salvation Army --(864) 225-7381New Life Philadelphia Center -- (864) 224-4052Good Neighbor Cupboard -- (864) 224-1701Anderson Interfaith Ministries -- (864) 226-2273
https://dss.sc.gov/content/customers/food/foodstamp/index.aspxhttps://dss.sc.gov/Scmapp/default.aspxhttp://anderson_sc.suntopia.org/food_pantries.php
Supports for parenting?
National Parent Helpline1-855-427-2736 (M-F 7a-4p)Family Connections1104 Ella St. -- (864)231-8100Email: [email protected] Alliance on Mental Health (NAMI)1 (800) 950-NAMI (6264)
http://scfirststeps.org/anderson/http://www.familyconnectionsc.orghttp://www.nami.org
Feeling Down, Depressed or Stressed?
Anderson-Oconee-Pickens County Mental Health Center200 McGee Road -- (864) 260-2220 Suicide &Crisis Hotline1-800-999-9999
www.aopmentalhealth.org
Interpersonal Violence?
National Domestic Violence Hotline 1-800-799-7233National Child Abuse Hotline1-800-4-a-Child (1-800-422-4453Safe Harbor --(864) 467-1177hotline- 1-800-291-2139
WomensHealth.gov www.safeharborsc.org
Ready to cut down on substance use?
Anderson/Oconee Behavioral Health Services226 McGee Road(864) 260-4168
http://www.aobhs.org
For more ideas contact the United WayPhone #211 or www.211.org
Anderson Family
Resource List
What if you SEEK and Find?
Kim Conant, LPN
Sumter County Family’
s Resourc
e List
Kershaw County Family
Resource List
H HopeE EmpathyL2 Language
LoyaltyP3 Permission
PartnershipPlan
HELP
SEEK Log – Little River
Discussion Question:
How can we work together in our
communities to address toxic stressors for kids
and families?