9 responses to “ACEs (Adverse Childhood Experiences): One Family Physician’s Experience”

  1. Though I work from this perspective I was delighted to read her article and how she transformed her approach and practice and began to screen every client. If this were the standard we’d be much further ahead in patient care excellence. I want all my students to read this article!

  2. Thank you, Dr. Ali, for your insights and for sharing some of your own personal journey. So much of this remains missing in medical practice (and medical training, and medical culture). I am grateful for the resources you’ve shared here and tips on how you’ve implemented this. I hope these practices can become more widespread.

  3. All physicians should have to learn about social services, social structure, cultural & social conceptualizations on normal, healthy, abnormal, and unhealthy. More than that, they should be taught to be much more critical evaluators rather than a cut-and-copy version of their predecessor. Courses in Anthropology and Sociology ought to help with that. The truth is: biology, medicine, and health care have all been so convoluted with the social world that understanding how each is “intertwined” is “essential”.

  4. I am so excited to read this!

    I am an Occupational Therapist working on a mental health outreach team. I am so happy to hear about your thoughtful self reflections that have lead to the change in your practice.

    I am proud to say, trauma informed practice is the becoming the norm in OT mental health practice.

    I can provide too many examples of clients dismissed by medical professionals simply because they are utilizing the only tools (substance use, self harm, frequent ER presentations, etc etc) they have to cope with extraordinary feelings surrounding trauma. Learning how to self soothe and regulate emotions in a positive manner is part of a healthy childhood. It is no wonder people with disrupted childhoods have learned maladaptive coping mechanisms… often simply to survive.

    I have had experience working at a federal halfway house, a place where unfortunately Indigenous people were extremely overrepresented. Reading many of the “offender’s history, while many of their crimes were truly awful, every single time their childhood history was more difficult to read.

    Finally, as a survivor of childhood abuse, I have experienced the first hand dismissal of my mental and physical suffering. It was only until I connected with doctors who understand TIP was I able to heal. I was lucky. Because of two fantastic doctors who are well versed in TIP and knowledge of ACEs, I was able to become healthy. I was able to finish my masters in occupational therapy, instead of being a “drain” on the system. Instead, I am actively contributing as a health professional dedicated to propagate the message you have so elegantly discussed.

  5. Working in a wealthy part of Vancouver I’m always struck by how prevalent childhood trauma and parenting dysfunction is. I was delighted to read how the author came across this body of research and the direct impact it had on her daily practice from her chair. I particularly like the way she screens all her patients with a questionnaire. If we all read this and changed our practice we would be light years ahead in clinical excellence. Thank you

  6. Mental health, family dysfunction, substance abuse etc are the visible tip of the iceberg. ACE’s are often the hidden, underlying part. Knowledge and understanding of ACE’s seems crucial to effective treatment and solving of these problems.

  7. Hi Dr. Ali,

    Thank you so much for writing this post! I am not usually one to comment in this way, but I really felt compelled to do so after reading this pearl. I am new to practice as of July, and had been directed to Nadine Burke-Harris’s book a few months prior. I also implemented ACE questionnaires at new patient visits and have had a very similar experience – no one is surprised when I explain the rationale, people are very supportive, and often grateful. (Coincidentally I have the exact same set up as you – laminated sheets with a wax pen, and I log the number in the “risks” portion of my CPP).

    Again, thanks for sharing!

  8. Thank you for highlighting this valuable aspect to integrated care Dr. Ali. I appreciate that you point out how trauma may impact anyone, and is not reserved for marginalized populations.
    It truly takes a team approach to provide holistic care for patients. Counsellors and social workers play a vital role in helping patients work through trauma, as well as a number of other difficult mental health concerns that directly impact physical and overall health. It is often social workers or counsellors who do the bulk of trauma care, as many physicians are not trained, nor do they have the time to provide patients with the depth of care needed to support patients with the impact from ACE’s. Trauma is complex and the effects are far reaching – and this is exactly what counsellors and social workers are trained to help with. We are all working to improve the quality of life for the patients we work with.

  9. Wonderful post! I have been aware of ACE for years, working in the downtown eastside and in mental health where the ACE scores are routinely elevated – especially in the 1st nations population, and this knowledge has informed my practice, but I do not have scores on my charts. I admire your systematizing it – with the laminated sheets – and I can’t agree more that the score should be on all patients charts.
    Such important work you have done – your patients are very lucky to have you.
    I now plan to get the score on all my charts too.
    Thanks so much

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