Q&A: Screening For Childhood Trauma in Ohio To Address Toxic Stress

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All children in California’s version of Medicaid, called Medi-Cal, will now be screened for traumatic events known as adverse childhood experiences, or ACEs.

Starting this year, when those kids visit the doctor they will be asked about difficult topics such abuse, neglect, and household dysfunction.

Nationally, health experts have begun to focus on ACES to determine if kids are suffering from toxic stress. Several research studies suggest early adversity creates toxic, prolonged stress, which affects kids’ brains and bodies.

If children and teens are screened for these adversities and the problems are addressed early, health experts says it may prevent toxic stress from creating serious health issues later in life.

Morning Edition host Amy Eddings spoke with ideastream health reporter Marlene Harris-Taylor about what Ohio health officials are doing to bring trauma out of the closet.

It’s not surprising that California is leading on screening for ACEs because the Surgeon General of the state, Dr. Nadine Burke Harris, has been advocating for this for years. But why now? What happened to trigger this move?

Starting Jan. 1, California now provides a way for doctors to get paid for screening patients. Doctors will receive a $29 reimbursement for each patient screened and for providing what’s called an ACEs score to determine if intervention is needed.

Dr. Burke Harris spoke in Cleveland at a City Club forum in March. She said the science is clear that early intervention improves outcomes for kids.

Children are especially sensitive to repeated activation of the stress response because their brains and bodies are just developing, and exposure to adversity in childhood affects what we call the developmental trajectory. It affects the way that subsequent systems develop, not only children's developing brains, but also their developing immune systems, hormonal systems, and even the way their DNA is read and transcribed,” she said.

So what about here in Ohio? What steps are health officials taking to look for signs of toxic stress in kids?

I spoke with Maureen Corcoran, Director of the Ohio Department of Medicaid. She and Ohio Gov. Mike DeWine have taken steps to tweak an existing program for primary care doctors who are already treating low-income children on Medicaid. It’s called Comprehensive Primary Care or CPC. The doctors in the CPC practices get extra money each month to screen kids for many different health issues, she said.

“In return for that money, they have to do one of several things. One of those options for those screenings is ACEs,” Corcoran said.

About 225,000 kids are enrolled in the state's CPC program, out of the some two million who are enrolled in Ohio Medicaid overall, she said.

The state is currently not tracking how many of those kids have been screened for ACEs, Medicaid officials said, and there is also no data available about the follow-up with kids who had high ACEs scores.

What should health officials do, for example, if they find out there are addiction issues in a home creating trauma for a child?

There really is no consensus right now in the medical community on what the right interventions are and which would be most effective. There are ongoing studies on the best ways to help families build resilience and reduce stress.

So what about kids who are not on Medicaid?

There are some programs across the state, in Columbus and Cincinnati and here in Cleveland. University Hospitals and the mental health agency OhioGuidestone are in the midst of a pilot program where kids up to six years old and pregnant mothers who visit the UH Rainbow Babies & Children’s hospital are being screened and referred for follow-up services. UH professor of pediatrics, Dr. Alissa Huth-Bocks, heads that program and said they spent nearly a year just getting prepared to start the screening process.

“That involved a lot of conversations, a lot of trainings and onsite consultation and support to staff and providers who work at the Rainbow center so that everybody felt ready to proceed to screening patients,” Huth-Bocks said.

When patients do report serious adversities, the doctors at Rainbow Babies are able to connect them with appropriate resources. “We have onsite mental health specialists who are able to meet with patients either right then and there in live time or at a later time when it's convenient for the patient,” she said.

There are about 15 months left in the pilot and one of the most important things they are trying to figure out is how to pay for all this in the future.  The pilot is funded by a short-term grant. Screening, and especially the follow-up services, are very expensive, said Huth-Bocks

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