Addressing Childhood Trauma in Orange County, NY

Rachel Milone, Fall 2019 2Gen Scholar

Adverse Childhood Experiences (ACEs) encompass a wide range of traumatic experiences that children may be exposed to during development. These experiences include physical and emotional abuse, neglect, exposure to mental illness, and household violence. In 1995, Kaiser Permanente initiated the first study of the effects of childhood trauma on later-life health and well-being. The results were astonishing, finding that ACEs are extremely common across all walks of life and that their effects are profound. The greater the number of ACEs a person is exposed to, the greater their risk of negative outcomes. The lasting impacts of early adversity include increased prevalence of mental illness, chronic illness, infectious disease, risky behaviors, and decreased educational opportunities and income.

This semester, Project 2Gen partnered with Cornell Cooperative Extension Orange county to support the county’s Resilience Project. Educating the public and raising ACE awareness are central to this work as it takes a multifaceted approach to treating and preventing ACEs in Orange county.  My partner Rohit and I contributed to this work by reviewing Orange County pediatricians’ approach to treating trauma in their patients.

After educating ourselves on the findings of ACE research and the mission of the Resilience Project, we contacted pediatricians in Orange County. We asked pediatricians a variety of questions regarding their current ACE knowledge and their practices for treating trauma. Although we asked the same set of questions in each interview, every doctor’s perspective was quite different. Surprisingly, we found that many pediatricians were not aware of current ACE research. And pediatricians that were ACE informed took it upon themselves to learn. But pediatricians were open and interested in current ACE research and all were treating trauma in their patients in some way. Based on our findings, we suggested ways that pediatricians in Orange County could improve their approach to treating trauma.

Over the course of the project, it was amazing to speak with pediatricians both previously involved in the Resilience project and outside of it. We saw a desire to improve the lives of patients in every single pediatrician we talked with. To me, this was heartwarming and motivated me to push forward in this project. Unfortunately, a common theme arose among all pediatricians we contacted. Although pediatricians wanted to treat and prevent trauma in all their patients, they simply did not have the time. Many physicians explained that they often can only spend 15 minutes with each patient, which barely leaves enough time to address the aliment the patient came in for. We suspect that this time constraint is not unique to Orange County pediatricians, but is a problem many providers face.

Once the biggest obstacle for Orange County pediatricians treating and preventing ACEs was identified, my partner and I faced a big obstacle ourselves. How could we improve these pediatricians’ approach to treating trauma when they have such limited time? A multitude of the interventions we had researched seemed valuable, but were simply not feasible.  After much deliberation and innovation, we decided to recommend some unintrusive interventions. We suggested compiling a list of local behavioral services to make referrals easier for physicians and created a document for physicians that outlined the current ACE research and offered some ways for the physicians to learn more. We choose both of these interventions to suggest because they seem to be helpful and feasible for physicians to incorporate given their constraints.

For me, throughout this project I have become extremely interested in research-practice partnerships and hope to continue this type of research in the future. I hope I can follow up on our research and assess how effective our suggestions were. Further research should be conducted on a larger scale to determine how providers in general should include practices for treating and preventing trauma in their already full schedules.