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Treat the Family; Treat the Child

Children who grow up with adverse childhood experiences are more likely to suffer from chronic health conditions, anxiety disorders, substance abuse and early deaths, studies have shown.

And they often unwittingly pass it on to their own children later in life.

Beginning with benchmark research by Kaiser Permanente in California in the mid-1990s, the phenomenon is now widely understood to be a contributing factor in a wide range of psychosocial problems, according to the Centers for Disease Control and Prevention.

“We now know that poor nurturing or toxic stress can … disrupt developmental biology,” said Dr. Aaron Lopata, Chief Medical Officer of HRSA’s Maternal and Childhood Health Bureau (MCHB), in a recent national webcast. “We also know that early intervention can improve a child’s life chances for success.”

“Intractable social and economic problems” can arise later in life
for children raised in unstable homes, says Dr. Aaron Lopata.

Lopata introduced a panel of experts who said at-risk parents – including teen parents – do better at raising their infants when behavioral health is included for the whole family as a routine part of primary care.

The SAMHSA-HRSA Center for Integrated Health Solutions is looking to build integrated behavioral health and primary care systems of care across generations.

“Outcomes for teen parents are not as dire as we once thought,” said Dr. Kristine Schmitz of the Children’s National Health System in Washington, D.C., which provides mental health, legal aid and school retention help to stabilize struggling young families.

When tethered to a single interdisciplinary care team by text, phone, email and regular visits,  such parents are less likely to dropout or neglect to use birth control; more likely to maintain their babies’ vaccination schedules and doctor visits;  and much better informed on how to avoid the pitfalls of their own traumatic upbringings, Schmitz said.

The key to this approach, said Lopata of MCHB, is that parents and child are treated as a single, interdependent, family unit – rather than a collection of disconnected individuals.

Frontline experience: From left, Dr. Kristine Schmitz, Dr. Susanna McColley and Dr. Rahil Briggs
have seen similar results in Washington, D.C., Chicago and New York. Children do better
when parents are offered behavioral health services in an integrated care environment.

It’s a crucial distinction, said Dr. Susanna McColley of Northwestern University’s Feinberg School of Medicine and Lurie Children’s Hospital of Chicago, because most parents see their children’s providers far more often than they do their own – assuming they even have one.

As a concrete example, McColley said, fully a quarter of the nation’s cigarette smokers are in regular contact with pediatricians through well-child visits. And they’re more likely to quit for the sake of their child’s health than their own.

Nine out of 10 smokers start before age 18, she said, and children of parents who smoke are more vulnerable to taking up the habit – which remains the number one preventable cause of death in the U.S.

“What’s predictable is preventable,” said Dr. Rahil Briggs, Director of Pediatric Behavioral Health Services at Montefiore Medical Group in the Bronx.

Because so much of parental lifestyle and behavior has major effects on the developing child, “the child isn’t the only patient here.” Rather, the whole family needs to be treated simultaneously.

CDC Risk Pyramid:  As a child accumulates adverse life experiences,
his or her chances of illness and early death increase.

“What we’re really trying to do is get in there early,” Briggs said, preferably four months before birth, to screen parents for traumatic events in their own lives and get them into counseling before their child is born.

Anxiety disorders, for example, are among the most common for survivors of multiple Adverse Childhood Experiences – and could translate into a child who has trouble learning, leading to persistent gaps in educational attainment and eventually “intractable social and economic problems” potentially lasting a lifetime, Lopata said.

Watch the archived webcast.

Download the presentation slides.

There will be a follow-on webcast on Monday, June 6, at 2 pm (EDT) for grantees looking to add behavioral health to their practices. Panelists will discuss coding, billing and reimbursement options to a variety of third-party payers. Register here.

Learn more about Adverse Childhood Experiences.

Date Last Reviewed:  April 2017