Table 3 Proposed clinical implications of reviewed findings
From: Biological embedding of childhood adversity: from physiological mechanisms to clinical implications
Practitioner activity | Recommendations | Recommended resources |
|---|---|---|
Understanding disease etiology and risk | Consider how ELA contributes to a patient’s risk of common health problems, e.g.: • Mental health disorders: Depression, anxiety, substance use disorders, post-traumatic stress disorder, psychosis • Cardiovascular disease: Ischemic heart disease, hypertension, atherosclerosis • Metabolic pathology: Obesity, type 2 diabetes, dyslipidemia, metabolic syndrome • Neoplasm: Breast, liver, lung cancers | Results of major epidemiological studies assessing health effects of ELA [1,2,3,4,5,6] Further reading suggested throughout |
Screening | • Screen for ELA history • Assess social service and protection needs • Consider ELA history when assessing risk and screening for ELA-related diseases or developmental needs | Adverse Childhood Experiences Questionnaire [1] WHO Adverse Childhood Experiences International Questionnaire [104] American Academy of Pediatrics Resilience Project Clinical Screening Tools [105] |
Intervention | General practice Provide access to: • Mental healthcare • Early prevention and treatment for other ELA-related diseases • Social services and poverty alleviation • Violence response and prevention interventions Pediatric practice • Family and caregiver support programs • Early development interventions • Services to prevent or respond to ELA exposures, including child protection services | WHO Preventing Child Maltreatment guide [106] WHO mhGAP Intervention Guide [107] Interventions resources to support healthy child development from Frontiers of Innovation – Center on the Developing Child at Harvard University [108] |
Transforming care models | Adopt best-practices from “medical home models” to support ELA-exposed patients, including strategies promoting: • Patient- and family-centered wraparound care • Cultural competency • Enhanced access and follow-up | National Center for Medical Home Implementation Tools & Resources [109] |
Advocacy | Incorporate evidence on ELA into advocacy relating to: • Access to mental health services • Poverty alleviation, criminal justice reform, and violence prevention • Fair parental leave and high-quality child care • Immigration and refugee policies protecting children and families | WHO guidance package on Advocacy for Mental Health [110] United Nations Children’s Fund policy advocacy and children's rights tools [111] Children’s Defense Fund policy campaign resources [112] |