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Joe Parks, MD

Medical Director, National Council for Behavioral Health

The Pandemic Illustrates How Important it is to Understand and Address ACEs

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The COVID-19 pandemic has had a devastating effect on the health and welfare of so many people, and it seems no one is immune from the fear, isolation or economic anxiety caused by this historic public health crisis.

The mental health of young people represents a unique concern that requires attention.

In a recent survey conducted by the Centers for Disease Control and Prevention (CDC), 63% of 18- to-24-year-olds reported symptoms of anxiety or depression, with 25% reporting increased substance use to deal with that stress and 25% saying they had seriously considered suicide.

One year into the ACEs Aware grant, a state-led initiative under California Surgeon General Nadine Burke Harris, MD, we know more than ever about the impact of adverse childhood experiences (ACEs) and toxic stress on young people.

We know ACEs describe 10 categories of adversities in three domains – abuse, neglect and household challenges – experienced by the time a person reaches 18 years old.

We know 62% of California residents have experienced at least one ACE and 16% have experienced four or more ACEs, using 2011-2017 Behavioral Risk Factor Surveillance System (BRFSS) data.

And we know ACEs can present life-long implications for a person’s health and welfare.

Perhaps more importantly, we also know how important it is for clinicians to treat ACEs and toxic stress as early as possible because it can present life-long implications for a person’s health and welfare. If medical professionals are unable to diagnose and treat conditions that surface at an early age, children are likely to suffer from them throughout their lives.

“What the data tells us is that early detection and early intervention improves outcomes,” Dr. Burke Harris said in a recent interview.

That’s because ACEs and toxic stress can change the way the brain develops and functions, contributing to increased risk of chronic diseases – including diabetes, cancer and stroke – as well as substance use, suicide and other injury and violence-related outcomes.

“Because children’s brains and bodies are still developing, the impact of the adversity and the trauma that they are experiencing … as a result of the pandemic has an outsized effect on their development,” Dr. Burke Harris said. “It actually can impact brain development and increase the risk for long-term mental health and physical health.”

Many states are beginning to make progress in efforts to raise awareness, improve treatment and improve clinical outcomes.

Last year, the National Council provided detailed guidance on trauma-informed care in primary care settings, emphasizing the importance of screening for trauma.

A new report released by the California surgeon general, Roadmap for Resilience: The California Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress and Health, urges communities to improve the health of young people by engaging numerous resources in a community – health care, public health, social services, early childhood, education and justice.

So much great work is being done to understand ACEs and implement strategies to help those affected by trauma. But the pandemic serves as a cruel reminder that our work must continue if we hope to make a difference in people’s lives.

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