“In my mind, Immokalee is not just a clinical
training site for our medical students anymore,”
Reyes said. “Immokalee is an academic health
mental illness, alcohol or drug abuse and an ACE score of six (again, compared to those
separation from a parent. with zero) died, on average, 20 years earlier.
The study found that two-thirds of
As a result of the study, the American
center – we have service, we have research and participants, who were mostly middle-class, Academy of Pediatrics (AAP) acknowledged
we have teaching.” white, college-educated and with good health childhood stress as a barrier to good health.
insurance (all worked for Kaiser Permanente),
The ACE of pain
The Adverse Childhood Experiences (ACE)
survey was developed for a 1998 Centers for
Disease Control and Prevention and Kaiser
“The AAP said it’s important to be screening
had experienced at least one type of severe for it. What they didn’t say is how you’re
childhood trauma. Most had two or more. supposed to do that,” Reyes said. “So what we’re
The higher their ACE score, the higher their risk
doing is implementing a way for that to happen.
of mental, physical and social problems as an adult. “We want to show how it’s possible to do
People with four or more (compared to those what the AAP is saying in a busy physician’s
Permanente study of more than 17,000 adults with zero) were twice as likely to smoke, seven primary-care office where they already have to
measuring 10 types of childhood adversity and times more likely to become an alcoholic, 10 ask about 10 different things. They don’t have
five types of family dysfunction. Adversity times more likely to use illegal drugs and 12 the time, the nurses don’t have the time. That’s
including sexual, physical and mental abuse. times more likely to attempt suicide. Those with called implementation research.”
Dysfunction including domestic violence,
Workers head to the fields shortly after 5 a.m.
Many leave small children at home in the care
of older siblings or other relatives or friends.
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