Adverse Childhood Experiences and Trauma-Informed Care

**Special thanks to Amy Baker for information on ACEs and trauma informed care.

Adverse Childhood Experiences (ACEs) consist of a variety of untoward events and circumstances that many young people have faced growing up. They include abuse, neglect, hunger, poverty and household dysfunction, such as divorce or absentee parents for incarceration or other reasons.

Kaiser Permanente performed the largest study ever conducted on this subject, examining over 10 years of data on 17,000 people to determine the correlation between ACEs scores and adverse outcomes later in life. The ACEs screening consists of 10 questions.

The study found that ACEs are very common. This study found one in four people experienced two ACEs as children, and one in 16 experienced had four or more. ACEs are linked to increased smoking rates, COPD, mental health issues, and a number of other health conditions later in life. More information can be found at: You may wish to take this screening yourself to understand it better, and to know your own ACEs score.

Since this study was conducted, further research and experience have allowed a deeper understanding of the pathophysiology of childhood trauma (even mild trauma), what constitutes trauma and how it affects us all as we grow and develop into adulthood. 

There are ways that we are able to help break the cycle and intervene. In health care, we have the privilege of interacting with patients throughout their lifespan -- from the prenatal period to early childhood, adolescence and adulthood. These “touch points” with patients during their life spans allow us a unique opportunity to effect changes and potentially alter the course of their lives.

Understanding ACEs, how they can affect us and our patients, and how we can shift our response to people in a trauma-informed way, is the first step down this path. Here is a link the CDC website on ACEs:

Trauma-Informed Care

Trauma-Informed Care is a shift from wondering what is wrong with a person that would have them act the way they do to asking what happened to a person that would have them react the way they do. To be effective, providers must:

  • Understand that many current problems faced by the people we serve may be related to traumatic life experiences.
  • Know that people who have experienced traumatic life events are often very sensitive to situations that remind them of the people, places or things involved in their traumatic event.
  • Realize that these reminders, also known as triggers, may cause a person to relive the trauma and view our organization as a source of distress and not as a healing and welcoming environment.

Columbia Pacific CCO’s path toward trauma-informed care

Addressing adverse childhood events and moving toward trauma-informed care is one of our core initiatives. We strongly believe that addressing this during pregnancy and early childhood is a way to prevent poor health outcomes later in life. We will be reaching out to local clinics and organizations to schedule trainings this summer. 

We are partnering with our local hospitals and clinics to conduct in-depth trauma-informed care trainings. We are also helping pilot ACE screening at Columbia Memorial Hospital outpatient clinics in Clatsop County. This screening process is modeled after extensive experience at the Children’s Clinic in Portland.

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