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Post by phalange3 on Oct 13, 2016 0:07:38 GMT
Whereas, the Adverse Childhood Experiences (ACE) study found a strong relationship between childhood exposure to abuse or household dysfunction and multiple risk factors for leading causes of death in adults; and
Whereas, 85% of the brain is developed before the age of five; and
Whereas, child outcomes are strongly influenced by supportive parenting; and
Whereas, the integration of mental health into primary care is critical for successful outcomes; and
Whereas, once the practice has decided to address childhood trauma, the next step is to determine who should be identified and how; therefore be it
RESOLVED, that the Academy support legislation promoting the universal screening of patients and primary caregivers with ACE surveys as early as possible, starting at the newborn visit.
LEAD AUTHOR: Melanie Dubois, MD
CO-AUTHOR: Elizabeth Janofsky, MD
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Post by JSimkins on Oct 14, 2016 19:19:34 GMT
I am a big supporter of ACE screening and absolutely support this resolution in spirit, just unsure if "legislation" is the right term. Legislation would likely only be important for reimbursement if you want to go down that route. Incorporating the ACE screening tool into Bright Futures Guidelines may be a more specific, effective suggestion that emphasizes its importance to all pediatricians.
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Post by Christian Pulcini on Oct 15, 2016 10:53:30 GMT
I also agree with the resolution in spirit, but as the author mentions above the legislation portion may be difficult to navigate. If it was simply cut out and stated "the Academy promote the universal screening...". If the author desires the reimbursement piece however, this would be important to mention and I would suggest "the Academy promote the universal screening..." "and investigate reimbursement options for such screening".
Further, there is some momentum to move away from screening for ACEs and instead providing universal education. The thought is that universal education is more patient-sensitive and promotes conversation between care providers and patients, rather than another screen performed that may not be utilized. This is food for thought on the topic.
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Post by jwschreiber on Oct 16, 2016 20:11:52 GMT
I think there is a lot on bright futures for ACES, I wonder if the funding piece again might be the way to go, maybe this can allow us to have longer visits to better assess for these risks
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Post by marcial on Oct 19, 2016 13:55:20 GMT
I also agree that it should be included in our already established well visit guidelines, it would be very hard to argue that it is added value on top of the normal well visit, but we have ASQ, lead questionnaire, phq9, etc on most of those visits already and those all fall within the reimbursement of the well visit as far as i know. I'm not sure medicaid or other insurance would cough up more money for this one in particular.
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zarah
New Member
Posts: 12 
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Post by zarah on Oct 20, 2016 17:47:10 GMT
What evidence is there that these screenings are beneficial? I think ACEs are super important and underrecognized but I'm reluctant to require all pediatricians to screen for them at every well child check if we don't have a good way to respond to the results.
I also agree that legislation is not the way to handle this, if we think it is important it should be part of our standard of care, and there should be robust AAP policy, and we should advocate for appropriate reimbursement for doing so, but I really don't think the legislature should dictate what we do or do not include in a standard well child visit.
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Post by Ryan Hassan on Oct 21, 2016 0:39:58 GMT
I agree with Zarah. As part of the new SOPT advocacy campaign, Partnering for Resilience, one of the issues we will be covering is the evidence on screening for ACEs, and there is still wide debate as to whether it is useful or not. Certainly we should screen for risk factors and be prepared to address ACEs, but universal education may be a better approach than universal screening.
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Post by Trey on Oct 21, 2016 23:38:33 GMT
I agree that screening should be done but also agree that some evidence would be helpful. I also agree with "legislate" being bit too strong. Looking back at the statement on Poverty, we should approach this in a way to encourage a potential policy statement on screening for ACE if research supports this. I do remember mixed reactions to the poverty statement. No one disagreed it was good, but people felt like they were being asked already to do too much at short visits and this could be repeated with such a resolution.
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Post by Sarah on Oct 21, 2016 23:51:46 GMT
I would vote to amend this to change this for the Academy to provide education on ACE's.
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Post by Alex on Oct 22, 2016 5:17:41 GMT
There are no validated screens for ACEs at this time. I would not have AAP advocate for legislation requiring screening when we don't have evidence based tools to perform an appropriate screening. I think the AAP needs to continue educating and working on resources for patients and their providers to establish resilience. I think the other adverse events resolution is better suited at this time
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