The importance of Adverse Childhood Experiences in the patient journey

Physicians are problem solvers at heart, and when faced with gaps in the health care system many develop innovative approaches and solutions to fill those gaps and provide effective care to patients. We are heading in an exciting direction with the growth of multidisciplinary clinical networks and team based care that improve access and address complex patient needs. We have some outstanding examples, and I have been privileged to take part in several recent events working to establish and expand these communities of care.

Adverse Childhood Experiences (ACEs)

Last month, more than 600 energized, passionate and committed physicians, mental health experts, educators, academic researchers, First Nations members, criminal justice representatives, community agencies, health authorities, provincial government policy makers, politicians, youth and families attended the ACEs Summit: BC and Beyond. Adverse Childhood Experiences (ACEs) are stressful or traumatizing events experienced during childhood that cause neuropsychological changes which can become key factors in the development of a number of health problems later in life. ACEs awareness and understanding has significantly grown in BC due to the work of the Child and Youth Mental Health and Substance Use (CYMHSU) Collaborative – a project supported by the Shared Care Committee (a partnership of Doctors of BC and the BC government). The ACEs Summit built upon the work undertaken by a number of Local Action Teams which identified issues around ACEs awareness and prevention and developed programs to implement trauma-informed care in their communities.

My personal experience

My personal experience with incorporating questions about ACEs into my practice has been incredibly positive. Like many I was hesitant about opening this Pandora’s Box of my patients’ buried trauma and abuse – and not just because I already struggle to run my office on time. But what I learned was that asking the questions changes your relationship with patients. Asking “what happened to you?” changes the depth and tone of any future conversation. The number of patients of all ages who replied “nobody has ever asked me about this before” was amazing. Just by asking we validate the patient’s personal experience and remove some of the stigma that happens when people think these issues are so shameful that not even your doctor wants to hear about them. And identifying root causes is the first step towards healing.

Child and Youth Mental Health and Substance Use Collaborative (CYMHSU)

The CYMHSU collaborative’s innovative approach started with identifying a particular gap in care for a vulnerable patient community. It designs solutions by working from the ground up and focusing on patient and community needs. It crosses traditional boundaries by involving all the appropriate care providers – GPs, specialists, other health professionals, schools, and communities. It involves multiple ministries at the government level, and more importantly it involves patients and families in the program design. Another innovation was to develop a partnership with colleagues in Alberta who have led this work through the Alberta Family Wellness Initiative. The recent ACEs Summit brought key partners together to highlight the work here in BC, to learn from the work elsewhere in Canada and internationally, and to consider how best to move forward. The next challenge is how to sustain and expand on this work with the ending of the formal CYMHSU Collaborative. Our CYMHSU Community of Practice needs to be appropriately supported to be self-sustaining into the future. This is the next step, and I have no doubt given the incredible passion for the work evidenced at the Summit that we will succeed. Working together with all our partners is key as we use these learnings and principles to transform the entire health system in BC and work to develop other networks of care. 

To learn more about ACEs visit the Collaborative Toolbox here.