CCMS Medicine Fall 2017 - 14

www.CHESTERCMS.org

Creating a Trauma Informed Community
continued from page 13
mentally ill parent can leave permanent, physical "fingerprints"
on our brains. Explaining how our biography becomes our
biology, Donna Jackson Nakazawa's Childhood Disrupted [6]
confirms the link between adverse childhood experiences and
adult illnesses such as heart disease, autoimmune disease, and
cancer. Her pathophysiology research findings which might
account for the ACE-related outcomes include: decreases in gray
matter volume and density of neuron connections, increased
levels of stress hormones, increased inflammatory cytokines,
epigenetic changes affecting stress response genes, the impact
of gene variants affecting serotonin and cortisol, and reduced
generation of new neurons in the hippocampus.

sources of toxic or traumatic stress. When evaluating children
with problematic behavior (or behavioral disorders), they may
be able to provide more accurate and effective assessment and
treatment by considering the possibility of past trauma as an
etiological agent. Improved standardized assessments are needed
for evaluation and treatment; however, there are preventive
measures and targeted therapeutic interventions that can
enhance our abilities to address emotional dysregulation. Healthcare providers, including pediatricians who regularly make
contact with families of infants and young children long before
school enrollments, can promote parenting programs, maternal-
infant-child home visits and early interventions, as well as:

Realizing the far-reaching health and social consequences of
CM, the question becomes, What can we do to underscore the
importance of preventing maltreatment as a strategy to promote
health and prevent disease across the lifespan?

* model the dyadic interaction involving facial, vocal and
gaze behaviors that should be visible between parent and
child such as smiling and cooing

The most important preventative measure we can take doesn't
require certification, and it can't be prescribed. It is as essential as
nutrition and clean water, and wearing a seatbelt.
The primary prevention strategy for child maltreatment
is the powerful healing role of a Safe, Stable, and Nurturing
Relationship (SSNR).
The World Health Organization (W.H.O.) [7], The National
Center for Injury Prevention and Control and the CDC [8] all
point to the role of Safe, Stable, and Nurturing Relationships
(SSNRs) as a primary prevention strategy for child maltreatment
and propose that this strategy can lessen the detrimental effect of
child maltreatment even after it has occurred.

* strengthen therapeutic relationships by building trust with
parents, to work together to help their children
* build confidence by accentuating parental strengths
* incorporate a caregiver-focused health risk assessment
instrument or postpartum checkup as part of well-child
visits, such as the Maternal Depression Screening
(http://www.sadag.org/images/brochures/edinburghscale.pdf);
ACE Questionnaire (https://acestoohigh.com/got-your-acescore/) or the ACE International Questionnaire (ACE-IQ)
(http://www.who.int/ violence_injury_prevention/violence/
activities/ adverse_childhood_experiences/questionnaire.pdf )
* refer trauma-surviving parents to trauma-specific
psychotherapy
* incorporate food insecurity questions into office visits
* educate parents on issues such as feeding, sleeping, toxic
stress, positive discipline strategies and building resiliency in
children.
An increasing number of possibilities exist in the broad
spectrum of SSNR practices already being developed, such as
public education efforts to change social norms and behaviors,
parenting programs, maternal-infant-child home visitation
and early intervention, and neighborhood activities that
engage parents and whole families, as well as changes in public
policy that support the family unit. The take-home lesson for
physicians is simple yet profound: "Health outcomes from
positive experiences may be just as important as toxic outcomes
from adverse experiences. SSNRs may promote one and prevent
the other." [9]

So what is the preventative role of the child health-care
professional?
Pediatricians, family doctors, home visiting nurses, social
workers, teachers, guidance counselors and other mental health
professionals should understand that presentations of attention
deficits, emotional dysregulation, and oppositional behaviors
may have their roots in early abuse, most often neglect and other

1 4 C H E S T E R C O U N T Y M e d i c i n e | FA L L 2 0 1 7

Adverse events and protective factors experienced together
have the potential to foster resilience. Ultimately, the attainment
of successful outcomes requires that we all act as advocates for
our children, as protagonists of social change in the collective
life of a community, by modeling the care, the attention and
commitment to influencing the child as well as the parent
toward the optimum health and welfare of both immediate and
future generations.
http://www.sadag.org/images/brochures/edinburghscale.pdf https://www.acestoohigh.com/got-your-ace-score/ https://www.acestoohigh.com/got-your-ace-score/ http://www.who.int/violence_injury_prevention/violence/activities/adverse_childhood_experiences/questionnaire.pdf
CCMS Medicine Fall 2017

Table of Contents for the Digital Edition of CCMS Medicine Fall 2017
