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Adverse Childhood Experiences (ACEs) are multiple sources of maltreatment and household dysfunction with tremendous impact on health. A trauma-informed (TI) approach is preferred when working with patients with ACEs. The Professional ACEs-Informed Training for Health© (PATH©) educational program and simulation experience using standardized patients (SP) was developed to help healthcare professionals address ACEs with adults. PATH© is a 3–4 hour curriculum comprised of lecture and discussion, video-based demonstration, simulation experience, and debriefing. It was first developed for primary care (PC) residents in family medicine and internal medicine, and subsequently modified for occupational therapy (OT) and physical therapy (PT) students. This study evaluates a preliminary dataset focusing on PATH© skills of PC residents and OT and PT students during simulation. Recordings of 53 learner-SP encounters from 15 OT and PT students and 38 PC residents were coded using standardized behavioral codes. A subset of ten recordings of PC residents who participated in simulations in the first and fourth year of the training program allowed for evaluation of training outcomes over time. Results showed that medical residents and OT and PT students demonstrated skills during SP encounters congruent with TI training on addressing ACEs with adults, particularly in explaining ACEs, demonstrating empathy, collaborative treatment planning, and stigma reduction. PC residents showed both positive and negative changes in PATH©-specific skills from year 1 to 4 of the training program. This study supports the PATH© model and simulation-based training in preparing clinicians to address ACEs with adults and provides insight into further curriculum improvement. [ABSTRACT FROM AUTHOR]

Objective: The primary care office is an ideal setting to identify and address adverse childhood experiences, which is a strong predictor of chronic health outcomes and morbidity. This study sought to understand the experiences of primary care from the perspective of patients who experienced trauma. Method: Purposive sampling was used to select eligible and interested participants who identify a high adverse childhood experience score at a residency-based community health center, which offers integrated behavioral health services in primary care. Semistructured in-depth interviews conducted by doctoral-level behavioral health clinicians were audio-recorded, transcribed, and analyzed thematically. Results: Subjects (n = 6) described aspects of medical setting, including removal of clothing or physical touch, that trigger their past trauma, which often resulted in maladaptive stress responses. Subjects also reported sensing when their complexity resulted in negative interpersonal dynamics between team members, and they described fearing abandonment from their team during these heightened stress states. The behavioral health clinician on the health care team served as an advocate, enhanced trust, and allowed for increased continuity and access to care. Conclusions: Given the role of adverse childhood experiences in health outcomes and the results of this study, incorporating a trauma-informed approach is essential to treating patients with adverse childhood experiences. We propose that integrating mental health professionals into primary care settings better serves patients with trauma histories. [ABSTRACT FROM AUTHOR]

Adverse childhood experiences (ACEs) are 10 categories of childhood abuse and maltreatment, which have a dose–response relationship with common adult health concerns seen in primary care including health risk behaviors, chronic disease, and mental illness. Many of the ACEs-associated biopsychosocial risk factors are modifiable. However, physicians may not address these issues for fear of opening “Pandora’s Box”, that is, a source of extensive problems for which they are not sufficiently prepared with training, resources, or time. Residents need training in how to conduct trauma-focused conversations within the limited scope of an office visit. To address this need, a 4-hour simulation and video-based training program was developed for primary care residents about how to conduct brief interventions connecting their patients’ current health concerns with their experiences of ACEs. Resident participants have evaluated this program as preparatory for real-life encounters and as being designed to allow for educational mastery. This article describes a workshop presenting this training program which was given at the 37th Annual Behavioral Science Forum in Family Medicine. Five skills targeted in the program were presented and a demonstration was made of the components, that is, didactics, provider and patient videos, simulated patient encounters, trainee feedback, and facilitated discussion that encompasses targeted skills, clinical implementation, and self-care. Companion tools were shared, including the syllabus, evaluation rubric, and provider and patient resources. Participants practiced trainee feedback and discussed the challenges in implementation. [ABSTRACT FROM AUTHOR]