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FINAL PROJECT

Is Your Child Resilient? Assessing for Adverse Childhood Events and


Resiliency
Module Description
While the Adverse Childhood Events study, which describes the deleterious effects
of toxic stress on long-term health, was published in 1998, the incorporation of
questions regarding these risk factors during well child checks remains inconsistent.
This module trains residents to incorporate screening for adverse childhood events
into their care for continuity patients. It also trains residents to incorporate
anticipatory guidance into discussions with parents of children who have
experienced adverse events so the parents can foster resiliency in their children.
This interactive module begins by garnering resident interest in the topic by having
them complete an online ACE quiz to obtain their own personal ACE score. It
continues by having the resident complete the resiliency quiz and evaluating the
results. The resident then works in an authentic learning environment by giving a
quiz of both the ACE and resiliency surveys to one of their own continuity patients
with a chronic health condition. This provides an opportunity for the resident to
discuss the impact of adverse events both on current health and on health in the
future. Because the resident will be providing education and counseling to parents
on how to foster resiliency in their child, this task requires the resident to have a
solid understanding of the material at a deep level. After the clinical encounter, the
resident will reflect on how the ACE study will influence his/her future practice.
Participants
The participants in this module are PGY-1 categorical pediatric residents in a
community program in Kansas with 5 residents per class. The setting is the
Community Rotation, a required 4-week experience in which residents learn about
advocacy and community engagement. There is at most one resident on the
rotation at a time. Resident learning needs include the requirement that the
information is considered applicable to their training in becoming a pediatrician and
that it is relevant to their routine clinical work. Because of resident time
constraints, the training must also be efficient.
Curriculum Goal
The goal for this module is for residents to become aware of the results of the
Adverse Childhood Events study, including implications for patient care, and to use
that information to inform their clinical practice.
Objectives
By the end of this module, residents will do the following:

1.) Evaluate their own personal ACE score and resiliency score and reflect on
how adverse childhood events and resiliency factors have influenced their
lives.
2.) Help one of their continuity patients with a chronic medical condition
complete the ACE and resiliency quizzes during clinic, and analyze the
results to determine possible implications on the future health of the child.
3.) Discuss with the parents and child during continuity clinic the associations
between the scores and risks of future health impairments.
4.) Advise parents during continuity clinic on how they can foster resiliency in
their children.
5.) Reflect on how the results of the ACE study will impact their care for their
patients in the clinic, and 75% of residents will plan to ask their patients
with chronic medical conditions about their adverse childhood events and
resiliency.
Timeline
Topic
Introduction

Pre-Encounter

Patient
Encounter

Details
Review of objectives
Resident will watch
the video
Understanding Toxic
Stress and
Resilience
Resident will read
Dowd, DE. (2014)
Adverse Childhood
Experiences and the
Lifelong
Consequences of
Trauma. Retrieved
from the Trauma
Guide by the
American Academy
of Pediatrics.
Resident personal
evaluation and
reflection
Resident will
download the ACE
score app if they
have an Android,
iTunes or Kindle
Resident will have a
patient complete

Format
Faculty with
resident
meeting

Time
25 minutes

Resident will
complete the
ACE and
resiliency
quizzes in paper
form
Resident will
evaluate their
scores and
reflect on its
influence
Resident will
meet with
faculty to
discuss
reflection

30 minutes

Resident will
meet with a

45 minutes

Post-Encounter

Debrief

the ACE and


resiliency quizzes
either electronically
or in paper format
Resident will
analyze the results
Resident will discuss
implications with
parents and patient
Resident will advise
parents on ways to
foster resiliency
Resident will reflect
on how the ACE
study will influence
their care of
patients in the
continuity clinic
Resident will discuss
their reflection with
faculty advisor

patient with a
chronic health
problem during
their continuity
clinic

Resident will
write a
reflection after
clinic

30 minutes

Resident will
meet with
faculty advisor

20 minutes

Strategy
Residents will download the ACE score app if they have an Android, Kindle, or
iTunes. It is available from iTunes at https://itunes.apple.com/us/itunes-u/adversechildhood-experiences/id518635725?mt=10# It is available for Androids and the
Kindle, as described at https://acestoohigh.com/2013/10/18/want-your-ace-scorenow-theres-an-app-for-that/ I anticipate that in the future, more and more devices
will have apps that provide the ACE quiz in the future.
Copyright/Ethical Concerns
In order to prevent concerns regarding copyrights, I will only use open-source
materials. I will make any graphics myself. If there is a plan for publishing results,
IRB approval will be obtained prior to implementation, and all information will be deidentified. The topics discussed during this module are personal, and all personal
information shared by residents will be kept in strict confidence between the
resident and the faculty member.
Artifacts
1. Here is a link to a screencast with an organizer on the ACE study.
2. Please see the link to the Jeopardy game.
3. Please see below for the rubric.

Rubric
Category:

Proficient

Satisfactory

Analysis of
personal ACE and
resiliency scores

Resident takes the


ACE and resiliency
quizzes and tallies
the score.
Resident writes a
reflection with
deep insights into
how both the
adverse events
and resiliency
factors have made
an impact on
his/her personal
life.
Resident prints off
an ACE quiz and
resiliency quiz and
provides them with
a pen to the family.
Resident provides
the family with
time to complete
the quizzes.
Resident asks
follow-up questions
to clarify answers.
Analyzes the
information to
determine
implications on
future care.
Resident
demonstrates an
understanding of
the effects of toxic
stress on a childs
brain and is able to
explain that to a
parent in a clear
way. Resident
discusses this

Resident takes the


ACE and resiliency
quizzes but
reflection on the
results is cursory.

Analysis of patient
ACE and resiliency
scores

Advises parents on
implications of ACE
and resiliency
scores, and
provides
anticipatory
guidance on how to
foster resiliency in
the child

Needs
Improvement
Resident completes
the ACE and
resiliency quizzes
but does not
reflect on the
scores.

Resident has the


family find the
quizzes online on
their own,
complete them and
then the family
reports the results
to him/her.
Resident simply
looks at the score
rather than asking
needed follow-up
questions.

Resident does not


complete the task.

Resident makes
family aware of the
resources available
to families and
describes what
individuals can do
to foster resiliency
in children, but
does not
personalize the

Resident is unable
to explain the
connection
between the ACE
and resiliency
scores and future
health. Resident is
unable to explain
to families how
they can foster

Reflects on how
the ACE study
informs his/her
patient care.

particular childs
risk for future
health
complication
related to the score
and provides
guidance to family
on how to foster
resilience in the
child. Resident
makes family
aware of
appropriate
resources.
Reflection is based
upon an accurate
understanding of
the ACE study and
implications for
future health;
reflection explains
how the individual
resident applies
this information
into his/her patient
care.

message to the
individual child
based upon the
results of their
quizzes.

resiliency in their
children.

Reflection is
present but the
concepts are not
richly explained or
the resident does
not explain how
(s)he personally
incorporates the
principles from the
ACE study into
patient care. The
reflection may
discuss how the
ACE study informs
care at the
systems-based
level.

Reflection is
cursory, and
resident does not
describe how the
ACE study
influences patient
care either
individually or at
the systems-level.