Lawmakers are finalizing legislation that would create a public health program that would screen adults for exposure to childhood trauma and educate clinicians about the impact of childhood psychological damage on overall health.
Rep. George Till, D-Jericho, a physician and the primary sponsor of the legislation, said new evidence supporting the connection between childhood trauma and health complications later in life has been revelatory for his practice.
“Most folks in medicine are unaware of the impact these childhood experiences have on long-term health,” he said.
The bill, H.762, still in draft form, is designed to expand trauma informed care, which is based on studies that show childhood abuse and neglect are connected to risk factors for fatal diseases and substance abuse later in life.
The legislation would incorporate the use of what is known as the Adverse Childhood Experiences questionnaire into the work of community health teams involved in Vermont’s Blueprint for Health. The bill also calls for the study and implementation interventions to identify children who have, or are at risk of experiencing, abuse or neglect.
The health care committee spent time Thursday ironing out the bill’s language and scope, but did not bring it to a vote.
It must pass Friday, the final day before the crossover deadline when all bills must come out of committee in order to be considered in this biennium.
Community health teams coordinate the care of patients with chronic conditions or who are at risk of developing a chronic condition.
Trauma informed care dovetails with the Blueprint’s mission to improve preventive care as a method to lower system-wide health care costs, Till said.
The ACE questionnaire is a set of 10 questions designed to measure a person’s exposure to childhood traumas and access their corresponding risk for health complications.
Five of the questions are personal and pertain to whether the subject was verbally, physically or sexually abused, and the other five pertain to whether family members were abused, had substance abuse issues or spent time in prison.
Each type of trauma counts as one, and the number of different traumas experienced are totaled up to give an individual their ACE score.
Studies show someone with an ACE score six has a life expectancy that is 20 years shorter than average, Till said, and even with a score of two a person is twice as likely to suffer from rheumatic diseases such as arthritis.
A Vermont Department of Health study found that 58 percent of people have a score of one and 14 percent have score of four or more.
“At four you really start to see health effects,” Till said. A score of four corresponds to higher rates of depression, suicide and IV drug use, he said.
Higher scores have also been connected to liver, lung and heart disease.
Clinicians participating in the Blueprint would train staff to administer an ACE questionnaire and incorporate the results into preventive care. Two community health teams would participate in a pilot program and would hire a family wellness coach to help prevent childhood trauma.
Another pilot would require the Vermont Department of Health to provide training in trauma informed care to nurses or mental health workers in primary schools.
The department would also be required to designate a director to oversee, develop, coordinate and implement trauma based care initiatives.
Dr. Harry Chen, commissioner of the Department of Health, expressed concern that the bill does not contain an appropriation to fund its initiatives.
“These are significant activities that are not in our current budget or scope of work,” Chen said in an email.
Lawmakers believe they’ve found a way around that by including language that the activities called for in the bill would only be required if they could be completed with existing funding sources.
The bill recommends curriculum around trauma informed care be expanded at the University of Vermont nursing and medical schools, which have already begun to teach such practices.
It would also require the Vermont Board of Medical Practice and the state medical society to develop and distribute educational materials on trauma informed care.
The Department of Mental Health would deliver progress reports to the Green Mountain Care Board, which has members focusing on similar initiatives related to population health.
Trauma informed care is an important issue given the compelling data, Chen said, but “we have a considerable science gap as to the upstream interventions that make a difference in the outcome.”
Mental health clinician also expressed concern in earlier testimony before the committee about the appropriateness of nurses and doctors asking questions that are typically posed by psychologists or psychiatrists.
