Early Childhood Trauma Got A Priority in California Recently.

As the first state in the U.S., California screened for adverse childhood experiences (ACEs) on 1st January 2020. Some early life hardships like neglect, abuse and poverty can affect the children's life with many health issues in their later life. The study is vast research as it provides other data besides being a public health initiative. State officials are hoping to lessen the adverse effects of early life complexities half times within a generation. Some critics think that the screening can not show many health benefits on its own. Instead, it will provoke the people to demand more facilities from the state that it can not cope up.  

The $160 million worth project was completed to monitor 7 million children. A Californian health service, known as Medi-Cal, funded this spending from its insurance for low-income people. For monitoring the children with ACEs under 18, the study provided 2 hours of online training for the health care providers. As a part of the research, the team set up a questionnaire containing ten categories of ACEs. Children's guardians or teenagers themselves provided answers in this study. The researchers asked them about neglect, violence, and substance abuse- questions. Some questions may include, "Have you ever felt unsupported, unloved and/or unprotected?" or "Has your child ever seen or heard a parent/caregiver being screamed at, sworn at, insulted or humiliated by another adult?"

When the provider finds out children with a worrying score, he has some other steps to follow. It is his responsibility to provide that child with information about helpful resources. The resources include housing assistance or food stamps. He should also highlight the facts of how stress and trauma harm the child's body and brain's development. In unusual cases, he can also refer the child to specialists like the psychologists.

Nadine Burke Harris is the Surgeon General, California and a significant contributor to this initiative. She says about the children with alarmingly high scores, "The overwhelming body of data … tells us that early detection and early intervention improves outcomes. We have the science to act."

Harris also remarks that the worst stress can have the worst effect. That is, the children will have lifelong ill-health in the future as a consequence. An early study by Kaiser Permanente's researchers completed back in 1998 shows that 9500 adults with high scored ACEs are with terrible complexities. They have increased alcohol drinking, depression, drug addiction, and suicide attempts. Their levels were four to twelve times higher than those of adults without ACE's. Another study regarding ACEs done on 17,000 people shows that people with ACE's die 20 years earlier than the people without it. The early death of the people is a concerning threat. To minimize deaths for ACE's, the initiative also pays the adults so that they take part in the screening. After that, the doctors help the adults to remove their stress and stop addiction as well. 

Aric Prather says how ACEs affect adults' health is "pretty indisputable." He is serving the University of California, San Francisco (UCSF) as a psychologist. Some other experts are also in the belief that the California screen can bring about some unintended consequences. According to David Finkelhor, acting as the Crimes against Children Research Center at the University of New Hampshire, Durham believes that state laws are necessary so that the providers can report neglect and child abuse. He is also worried about the screening. He says, "Screening could tremendously increase the number of minor or unnecessary referrals to the child protection system."

The reports are not significant enough, according to Burke Harris, but the state needs further monitoring on them. She says, "We take those concerns seriously."

Finkelhor depicts that some ACEs screen not only failed in showing benefits but also caused harm. The providers did not consider many important aspects like domestic violence on women and their impact on children's health or life. The next step to help the children with high ACEs score is also scant. Finkelhor says, "It's not clear to me that [we should treat] a kid who was abused 5 or 6 years ago but didn't have symptoms or problems."

As a pediatrician from the UCSF, Dayna Long is working on 550 families' new screening. She is running a clinical trial on them so that she can find out some interventions that work. Children with an effective caregiver are more sustainable to ACEs' adverse effects. So, she believes that caregivers need better supports. Some essential services like food and shelter, medication, including proper counselling and instructions, can reduce children's trauma.

But all the supports the affected people need can not be provided by California yet. According to Prather, if all the victims of ACEs need support from the specialists, they will face immense pressure in dealing with them. The screening program is a gateway for the researchers to study why many people are adaptive to ACEs and what are the effects on the brain and body. Long says, "My hope is that as we start to generate data as a state, there's an investment in both the quality and rigour of science so that we can continue to drive policy. Ultimately, we want to be able to look across the generations and ask, 'How did we do?'"

The ambitious initiative took much money from the state and question arises, "Does it worth that much?" The answer depends on its effectiveness, and Burke Harris confirms it by measuring the money. She and her team showed us an example of a total of $10.5 billion spent by the Californians to fight ACEs in 2013. They reported it in PLOS ONE. If the expenditure on this reduces, the initiative is successful, she believes.