Target Audience

This activity has been designed to meet the educational needs of nurses, physicians, and other health and legal professionals involved in the treatment and care of victims of sexual assault and domestic violence.

Statement of Need/Program Overview

The need for this session has been established through a review of peer‐reviewed literature and media coverage. The Adverse Childhood Experiences (ACE) Study is a long term, in‐depth, epidemiologic analysis of over 17,000 middle‐aged, middle‐class Americans, matching their current health status against 10 categories of adverse childhood experiences that occurred on average a half‐century earlier.

This ongoing collaborative effort by Kaiser Permanente and the CDC found that: adverse childhood experiences are surprisingly common although typically concealed, and are overwhelmingly unrecognized in medical practice; they still have a profound effect 50 years later, now transformed from life experience into organic disease and mental illness; and that adverse life experiences in childhood are the main determinant of the health and social well‐being of the nation.

The Adverse Childhood Experiences Study thus has direct and important relevance to the practice of pediatrics as well as to adult medicine. Its findings indicate that many of our most common public health and adult medical problems are the result of events and experiences present but not recognized in childhood. The ACE Study challenges as needlessly superficial our current conceptions of depression and addiction, showing them to have a very strong dose‐response relationship to antecedent life experiences, particularly during childhood. The implications for pediatrics and primary care medical practice of this comprehensive study are profound and suggest the need for a paradigm shift in primary care medicine from our symptomreactive mode to the more comprehensive biopsychosocial approach that was originally proposed but never attained. Although the need for change is great, and its benefits demonstrated in a related 125,000 adult patient study, resistance to this change is major, and largely comes from us.

Educational Objectives

After completing this activity, the participant should be better able to:

• Describe the high prevalence of adverse childhood experiences even in clearly middle class populations.
• Discuss the long‐term consequences of these childhood experiences a half‐century later.
• Discuss the significant Public Health Paradox wherein the conventional 'problem' represents an unconsciously chosen 'solution' by the individual.

Faculty

Vincent J. Felitti, MD

co-Principal Investigator of the Adverse Childhood Experiences (ACE) Study, Kaiser Permanente, San Diego, CA Clinical Professor of Medicine at the University of California

Vincent J. Felitti, MD, is co-Principal Investigator of the Adverse Childhood Experiences (ACE) Study, ongoing collaborative research between the Kaiser Permanente Medical Care Program and the Centers for Disease Control. A 1962 graduate of the Johns Hopkins Medical School, Dr. Felitti is an internist who started as an infectious disease physician in 1968 at Kaiser Permanente in San Diego and then in 1975 founded the Department of Preventive Medicine; he served as the Chief of Preventive Medicine until 2001. Under Dr. Felitti’s leadership over the years, the Department provided comprehensive, biopsychosocial medical evaluation to assess the health risks and disease burden of over one million individual adults, one-by-one. Major health-risk abatement programs were developed for obesity, smoking, and stress, as well as population-based screening for the genetic disease, Hemochromatosis. Dr. Felitti is Clinical Professor of Medicine at the University of California and a Fellow of The American College of Physicians.