ACEs - Adverse Childhood Experiences

I was assigned some courses on ACEs and there was a great TED talk on the subject. Here are links to what I was to use in preparation for answering the questions below. I highly recommend the training, it was great!

• TED Talk - Nadine Burke Harris
  
• ACEs Training Modules
  

The questions were simple, and were meant to be a basic reflection of learning posted in a group discussion. 

Discuss your thoughts about what you have learned about ACE's. Did you know anything about them before this week's assignments?

I did know about ACEs before completing this week's assignment(s), and I have always felt very fortunate to have had a childhood that resulted in the score I have for ACEs. I first learned about ACEs in 2016 when my sister in law was completing her third master's degree - yep third. She is a Vice Principal now, but was initially a special education teacher, then a grade school principal in a school district filled with kids from socioeconomically challenged homes. The average ACE scores for the kids in her elementary school was seven. Seven!! 

She was discussing it with me in 2016, and I had not heard of ACEs before, that I recall. What she shared with me, and learning about ACEs, inspired me to learn as much as I could about SDOH. I eventually went on to write my master's thesis with a focus on teaching nursing students about SDOH, and for my capstone I developed a curriculum for nursing students to learn about SDOH and I addressed ACEs and the correlation between SDOH and ACE scores throughout the curriculum.

If so, did you learn anything new?

I actually did learn something new this go-around. I did not realize that the ACEs are strongly considered preventable - I mean - I guess maybe cynically speaking, I did not feel empowered to succeed in preventing most ACEs. According to Centers for Disease Control and Prevention [CDC] (2023), "...we must understand and address the factors that put people at risk for or protect them from violence. Creating and sustaining safe, stable, nurturing relationships and environments for all children and families can prevent ACEs and help all children reach their full potential" (para. 13). 

Who knew? "...can prevent ACEs..." I certainly didn't know. 

How will what you learned affect how your provide care for your pediatric patients? 

I suppose this new awareness entreats me to gather as much information as I can about school, community, government, and private resources that I can share with pediatric patients and their parents/caregivers, when I recognize signs of ACEs in my patients.

According to the Cleveland Clinic (2023), signs of an adverse childhood event can include:

• • Fear of other people
  • Difficulty sleeping or frequent nightmares
  • Bedwetting
  • Changes to their mood
  • Difficulty showing affection towards friends or family
  • Avoiding situations or events that relate to a traumatic experience
  • Difficulty learning in school

But what are the warning signs before an ACE occurs?

There aren't really warning signs, as much as there are common risk factors. The Cleveland Clinic (2023, para. 9) indicates the common risk factors for ACEs include:

• • children assigned female at birth
  • minority racial or ethnic groups 
  • children with socioeconomic challenges
  • children of caregivers who experience stress
  • children who have family members/friends with substance use disorder or other mental health condition

And although "ACEs are common across all populations," (CDC, 2021, para. 13), I will be more likely to help prevent ACEs for my patients if I:

• • maintain awareness of the most common risk factors
  • identify the risk factors during my assessment of the patient
  • intervene to extirpate the risks I can identify 

What I learned from this assignment, will strongly impact my practice moving forward, and ultimately benefit the patients that are in my care.  

References

Centers for Disease Control and Prevention (CDC). (2023, June 29). Fast facts: Preventing adverse childhood experiences. Violence Prevention. https://www.cdc.gov/violenceprevention/aces/fastfact.htmlLinks to an external site. 

Centers for Disease Control and Prevention. (2021, April 6). About the CDC-Kaiser ace study. Violence Prevention. https://www.cdc.gov/violenceprevention/aces/about.htmlLinks to an external site. 

Cleveland Clinic. (2023, April 4). Adverse childhood experiences (aces) & childhood trauma. Cleveland Clinic. https://my.clevelandclinic.org/health/symptoms/24875-adverse-childhood-experiences-ace

Championing for Providers in Rural Areas

How can we champion for more providers in rural areas and expand the network of access?

We need to get the word out that Nurse Practitioners (NPs) are trained to practice medicine, and are highly advanced in the practice of nursing. This combination enables the NP to provide a high level of care unmatched by other disciplines. So I believe it first begins with policies that allow nursing at all levels to practice to their full scope, and advanced practice nurses to practice medicine, also to the full scope of their training and capabilities.

The patients needing care in these rural areas, are typically older, in worse health, and have lower incomes than those in urban areas. Many don't understand what NPs are capable of, what they are trained for. They don't understand the "whole iceberg" approach to care that NPs provide versus the "tip of the iceberg" care generally provided by Medical Doctors and Doctors of Osteopathic medicine. Many MD and DO direct their care on or at the illness, not with or for the patient. A response to disease or abnormalities, rather than prevention of the disease and acute management.   

The current AMA campaign (n.d.) #FightingforDocs doesn't really help the matter either. This campaign is spreading the idea that NPs are not equipped, trained, or experienced enough to provide Primary Care or lead a healthcare team. The AMA has been preaching about "preventing scope creep" which fosters further mistrust in these rural areas, effectively grooming the population to feel they are getting less than optimal care when being treated by an NP versus MD or DO. I do believe that not all MD, DO, or NP fit into the “typicals” I am discussing, but generally speaking about these disciplines…well, this is my opinion.

Finally, limited access to programs of study and local, advanced training programs for nurses who are currently practicing in rural areas, may be a result of faculty shortages, community support, or financial limitations that coincide with a current state of economy. Increasing that training access and quality would enable those already living rurally, to continue practicing in their locale, at an advanced level. 

Reference

American Medical Association (AMA). (n.d.). AMA recovery plan for America's physicians: Fighting scope creep. American Medical Association. Retrieved November 11, 2022, from https://www.ama-assn.org/amaone/ama-recovery-plan-america-s-physicians-fighting-scope-creep