Good Health Starts With Smart Screening

Imagine if a few quick questions at your child’s next check-up could unlock the door to your child having improved success in school and work, stronger personal relationships, and a healthier, happier, longer life. What if those few questions could save your child from a heightened risk of addiction, disease, and premature death? You’d leap at the chance, right?

Opinion_Feature_ImageCalifornia today has the opportunity to do this for our poorest and most vulnerable children. Senate Bill 1466, now on the Governor’s desk and awaiting his signature, would ensure that screening for trauma is incorporated into comprehensive screenings that are part of the Early and Periodic Screening Diagnosis and Treatment (EPSDT) benefit, which provides comprehensive and preventive health care services for children who are under 21 and enrolled in Medi-Cal. This simple measure has the potential to radically improve children’s lives.

Sometimes practice lags behind science. SB 1466 will help us catch up. Over the past 20 years, research has shown that trauma from adverse childhood experiences (ACEs) is a key determinant of health, social, and economic well-being. ACEs include physical, sexual, and psychological abuse, neglect, domestic violence against a child’s mother, and substance abuse, mental illness, or incarceration of a household member. A landmark study of ACEs, published in 1998, and dozens more studies since then have demonstrated that exposure to ACEs is remarkably common and can lead to dramatically increased risk of poor health and life outcomes.

The examples are too many to list, but here are a few: with childhood exposure to multiple ACEs comes a greater likelihood of stroke, heart disease, chronic lung disease, liver disease, cancer, diabetes, autoimmune disease, depression, suicide, alcoholism, substance abuse, obesity, and sexually transmitted diseases. With exposure to six or more ACEs, a child can be expected to die 20 years earlier than if she had not had any ACEs.

ACEs are also tied to lower academic and job performance. This is not surprising. Trauma causes children’s bodies to switch into “fight or flight” mode – an emergency response system that can save lives in the moment, such as when it prompts us to duck or run when we hear shots fired, but one that can cause lasting harm when the “fight or flight” response is triggered so often that the system stays on. The resulting high level of stress hormones becomes toxic and has a cascading effect, leading to changes in the structure and functioning of children’s brains, which in turn can cause problems in areas like learning, memory, and regulation of emotion.

The good news is that none of this is a foregone conclusion. There are evidence-based and promising interventions that can interrupt, reduce, and even reverse the effects of trauma and toxic shock. These include educating and supporting parents and other caregivers so they can better understand and nurture children and help them feel safe and secure.

As with virtually every other aspect of health, screening is an indispensible first step for addressing trauma. Screening is how health care providers, from pediatricians to eye doctors and dentists, ascertain when further monitoring or treatment is needed and when it’s not. The same is true with trauma. A handful of questions can unveil a history or symptoms of trauma and allow a trained provider to quickly determine if a child should undergo a more thorough assessment and possibly receive services. Emerging problems can be identified, treated, and healed, and further trauma can be prevented.

Acting early can save us from spending exponentially more down the road. More than money, we can save lives and help today’s children grow into healthier, happier, better educated, productive, stable adults, who will in turn be able to make a better future for their children. But despite childhood trauma’s unparalleled role in shaping long-term health and longevity, screening for trauma in children is haphazard at best and more often altogether absent. For the sake of our children, let’s be smarter and make this screening the norm. With the Governor’s signature on SB 1466, California can take this small but ultimately life-saving step forward.

Robin Goldfaden is a staff attorney with the Youth Law Center.

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