ACE Year End Updates: Part Two

My last blog focused on the transitions we are undertaking organizationally and strategically to best serve the current and future needs of the Michigan ACE Initiative. It is our hope that you will see the value of these changes in the very near term. As we end the year, it is also worthwhile to capture some of the more recent events, publications, and discussions taking place on ACEs. First, some publications that you may have seen in the past weeks:

  1. The first installment in Rochelle Riley’s series about how trauma and toxic environments impact how children learn. This article, which was published Dec. 14, describes the trauma of children in Wayne county and efforts by Children’s Trauma Assessment Center (CTAC) housed on the campus of Western Michigan University to assess and work with children who have experienced ACEs. We are pleased to work with representatives from CTAC and have them represented on our steering committee and have staff as Master Trainers. Their work is exemplary but there is so much more to do as the article establishes.
  2. A story in Bridge Magazine highlighting the gap in ACEs and the role of physicians and other providers. This is an excellent review of ACEs and the challenges facing the provider community in being trained to look for ACEs and to have the tools to do so. The work of Dr. Teresa Holtrop, one of our Master Trainers, with funding from the Michigan Health Endowment Fund, is highlighted as well as efforts on the West Side of Michigan, particularly with Muskegon HealthWest who were involved in our first cohort of Master Training. This story also includes a link to the ACEs scoring “quiz” for readers to take—a point that we will discuss later in this blog.
  3. The release by the Centers for Disease Control, CDC that updates the conclusions of the original ACE Study in Vital Signs. The national data and links to various current resources and references should be on everyone’s desk to continue our adherence to the study and results. Many funding sources would find this database valuable when coupled with local efforts on awareness and interventions.
  4. Finally, we were alerted to a new study by the Michigan Association for Infant Mental Health Association (Thank you Sheryl Goldberg—ACE Steering Committee Member). This study was included in the recent newsletter of the World Association for Infant Mental Health and is entitled: “Asking about Adverse Childhood Experiences  (ACEs) in Prenatal and Pediatric Primary Care: A Narrative Review and Critique.” This study raises real questions facing clinicians and others in health care regarding using ACE screening tools without being prepared for results. Further training by providers is one of the recommendations.

These are just some of the more recent articles. For those who track the work of Dr. Nadine Burke-Harris, who is now the Surgeon General for California, will find a number of policy recommendations taking place in that state. Dr. Christina Bethell, (Our ACE Conference Keynoter) is working with Dr. Burke Harris on this effort as well. This includes policy on screening all children and provider funding and education. A simple Google search will take you to the more recent happenings due to her efforts.

Policy

While we believe we can learn much from others across the nation and worldwide on ACEs, we also believe that we need to stand up a Michigan position on ACEs. To that end we have worked with the Michigan Legislature to introduce and adopt concurrent resolutions regarding a declaration that ACE is a critical health care issue in Michigan.

Our champions for this effort include Sen. Curt Vanderwall and Rep. Hank Vaupel—both Chairs of Health Policy in the Senate and House, respectively. These resolutions have passed the house of origin and are now in committees in the opposite House or Senate—waiting for final action that we expect before their spring 2020 break.

A study group, housed at Michigan State University, and funded by the Michigan Health Endowment Fund, has been providing issue content discussion for key lawmakers for the past two years. Their next session will focus exclusively on ACEs and representatives of the Michigan ACE Initiative have been asked to coordinate the presentation. These events on by invitation only to members and staff of the Health Policy and Appropriations committees and key Administrative officials. Our presentation has now been organized and will take place in January. Thanks to Master Trainers:  Dr. Furhut Jannsen,, Joe Thomas, J. Munley, and Nicki Britten for their willingness to be part of the presentation and to Justin Fast of Public Sector Consultants for his involvement. We expect this will assist in moving the resolutions forward and providing to key lawmakers a stronger sense of ACEs and current initiatives taking place across the state.

It is very helpful when presentations are made locally or discussions take place individually with lawmakers that a reference to your being part of the Michigan ACE Initiative take place—this helps lawmakers with understanding the message we provide with the information they hear locally.

Caveats on ACEs History quiz

I wanted to end this blog with just a few comments on the use of the ACE history “quiz”—the 10-question document. As you will recall there was ample discussion in the Master Training regarding the use of this questionnaire. While it provides “self-awareness,” an important element in any intervention—its major use is for history for adults and for population-based analysis and not for individual clinical use as it is not a “diagnostic tool.”  This is why we are having significant work underway by the Pediatric community and others regarding not only the preferred screening tool, but also protocol for its use.

I think we all want to retain fidelity to the original study and results and do not want to inadvertently cause confusion and inappropriate use of the ACE score. We know ACEs are a population-based approach and are at the heart of what is now the movement in social determinants of health. The clinical use of ACEs will be determined by further study and testing by those closest to the patient and individuals and we should take our lead from them. Our work will remain in furthering awareness, creating supportive coalitions, and appropriate interventions to counter the effects of trauma and toxic stress. That is a big enough agenda.

My hope for all is a restful and happy holiday season as we take up the efforts and raise our “bar” in the coming year.