ACEs & TIROH

Adverse Childhood Experiences and Trauma-Informed Resilience-Oriented Healthcare

What are ACEs?

Adverse Childhood Experiences (ACEs) and toxic stress are public health crises. ACEs are stressful or traumatic events experienced by age eighteen, identified in the landmark Centers for Disease Control and Prevention (CDC) and Kaiser Permanente (KP) Adverse Childhood Experiences Study, to be strongly associated with increased health and social risks. Early detection and intervention can help prevent or reduce the health risks associated with ACEs.

Trauma-Informed, Resilience-Oriented Healthcare (TIROH) is an organizational culture, structure, and treatment framework built on understanding, recognizing, and responding to all kinds of trauma and places focus on protective, resilience-oriented approaches to the entire organization. Adopting TIROH practices can improve patient engagement, treatment adherence, and health outcomes, as well as provider and staff wellness.

CAFP’s Commitment to ACEs & TIROH

CAFP is deeply committed to the work of TIROH. Our 2022-2024 strategic plan goals and educational activities are testament to our understanding that family physicians need to learn about the profound impact of ACEs and toxic stress on health. As more family physicians include ACEs and TIROH in their regular clinical routines, more patients and their families will benefit.

The third of our four Strategic Goals is Prioritize Justice Through Diversity, Equity and Inclusion. While many of the objectives and strategies under this goal relate to TIROH, the most relevant is objective 3.6, Apply a Trauma-informed Lens in All Our Work. Strategies under 3.6 include, Educate members about the components of trauma-informed care (TIC) and Identify TIC goals and components of applying a trauma
informed lens.

We aim to educate and transform both our 10,000+ physician members and ourselves –the staff of CAFP – in order to best incorporate TIROH principles throughout the fabric of CAFP.

ACEs Aware Provider Engagement Pilot Program

CAFP deepens our work through a partnership with the UCLA-UCSF ACEs Aware Family Resilience Network (UCAAN). Our shared goal is significant growth in ACEs-TIROH awareness throughout California family medicine. This is achieved through a multi-pronged approach including live presentations and workshops, practice inquiry groups, magazine articles, online discussion groups, and more.

ACEs, Toxic Stress and Patient Education: A Performance Improvement Project

This Performance Improvement project was launched in 2023 and has been refreshed and relaunched for 2025. It is designed to improve patient and physician ACEs awareness and patient education, and to study the impact of educational materials on patients’ understanding of ACEs’ health impacts. Participating physicians survey patients, distribute educational materials, analyze survey data, and reflect on resulting practice improvement.

Results from 2023 indicated that raising awareness of ACEs and toxic stress did not significantly burden physicians and increased patient understanding of ACEs as a healthcare issue.

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Workplace Training – Trauma Informed Tips

You can bring TIROH to your clinic, office or group through this workshop series, supported by CAFP and created by Origins Training. The TIPS series is designed to be delivered by a local champion to introduce or reinforce a trauma-informed lens in your organization. Each workshop in the series is organized around a trauma-informed principle and offers three practical tips for bringing that principle to life.

The program includes materials supporting seven interactive workshops (virtual or live) with email follow-up, plus facilitator guides.

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Family Medicine Initiative on Trauma-Informed Care (FIT)

This peer-to-peer learning initiative was funded by the Office of the California Surgeon General, the Department of Health Care services, and ACES Aware. Now concluded, it raised awareness about Adverse Childhood Experiences (ACEs).

CAFP organized a series of regionally-based, peer-to-peer learning workshops concerning ACEs screening rationale and methods, followed by peer-to-peer discussion groups on best practices, overcoming barriers to care, and practice approaches for this new screening tool. Participants addressed trauma-informed communication techniques, building a patient’s resiliency, and a trauma-informed physical exam.

Education On-Demand

Activities available 24/7 include:

Key Insights into a Trauma-Informed Approach to Care
From Trauma to Healing: For Our Patients, Our Communities, and Ourselves
Fundamentals of Adverse Childhood Experiences (ACEs) Screening and Response

Access Content Here

TEDTalk: Nadine Burke Harris

How childhood trauma affects health across a lifetime

Childhood trauma isn’t something you just get over as you grow up. Pediatrician Nadine Burke Harris, former Surgeon General of California, explains that the repeated stress of abuse, neglect and parents struggling with mental health or substance abuse issues has real, tangible effects on the development of the brain. This unfolds across a lifetime, to the point where those who’ve experienced high levels of trauma are at triple the risk for heart disease and lung cancer. An impassioned plea for pediatric medicine to confront the prevention and treatment of trauma, head-on.

Watch Here