Consideration of Personal Adverse Childhood Experiences during Implementation of Trauma-Informed Care Curriculum in Graduate Health Programs

Abstract

Context: Scientific findings of adverse childhood experiences (ACEs) and their lifelong graded relationship with leading causes of death are well established. Many health care practitioners, however, have yet to implement ACEs screening in clinical practice. Furthermore, ACEs screening and trauma-informed care (TIC) are not part of standard graduate-level training.

Objective: To 1) implement trauma-informed curriculum for multiple graduate health programs, 2) determine student understanding of and willingness to address ACEs, and 3) assess the relationship between students voluntarily evaluating their individual ACE Score and their attitude toward ACEs and TIC.

Design: Prospective study with pre- and postcurricular surveys (12-question digital survey administered before and after the curriculum) for 967 graduate students from 9 health professions programs at 2 campuses who received curriculum focused on ACEs and TIC.

Main outcome measures: Students' understanding of ACEs and TIC, their awareness of personal ACEs, and their willingness to incorporate TIC in practice.

Results: Among students who voluntarily completed an ACE questionnaire, there was statistical significance in familiarity with clinical and scientific findings of the ACE Study (p < 0.001) and familiarity with TIC (p < 0.02). A significant intercampus difference in the students' familiarity with the scientific and clinical findings of the ACE Study (p < 0.05) was found.

Conclusion: Students and future health care practitioners who voluntarily assess their ACE Score are significantly more likely to understand scientific and clinical findings of the ACE Study as well as TIC.

Figure 1.

Precurricular (Pre) and postcurricular (Post) survey responses of health professions students to the survey question, “How likely will you be to administer and assess an ACE questionnaire for your patients?” ACE = adverse childhood experiences.

Figure 2.

Precurricular (Pre) and postcurricular (Post) survey responses of health professions students to the survey question, “How confident are you in knowing what to do to help your patient after discussing his/her history of trauma?”

Figure 3.

Comparison of responses to survey questions between osteopathic medical students from both campuses (Pomona, CA, and Lebanon, OR) who assessed their own Adverse Childhood Experiences Score, with the major difference being that Lebanon-based students received a hard copy of the Adverse Childhood Experiences and Resilience/Stress questionnaires. The X-axis represents 7 of the survey questions. The Y-axis represents the mean of responses on an interval scale of 1 = unfamiliar, uncomfortable, unlikely, etc; 2 = somewhat familiar, somewhat comfortable, somewhat likely, etc; and 3 = extremely familiar, extremely comfortable, extremely likely, etc. For the self-assessment question, 1 = no; 2 = yes. ^a p < 0.05. ACEs = How familiar are you with the clinical and scientific findings of the Adverse Childhood Experiences Study?; Administer = How likely will you be to administer and assess an Adverse Childhood Experiences questionnaire on your patients?; Comfort = How comfortable are you discussing with your patient their personal history of physical, emotional, and sexual abuse?; Confident = How confident are you in knowing what to do to help your patient after discussing their history of trauma?; Importance = How important do you think it is for a patient’s medical record to include any history of physical, emotional, and sexual abuse?; Lebanon = Lebanon, OR, campus; Pomona = Pomona, CA, campus; Self-assessment = Have you completed an Adverse Childhood Experiences questionnaire in the past?; TIC = How familiar are you with Trauma-Informed Care?