ADVERSE CHILDHOOD

EXPERIENCES Micaela Johnson

H&S 490

Analyzing different educational pieces for mental health for children.

Children’s mental health is being analyzed because the amount of education
on ACE’s is limited and this is a good topic to accompany ACE research and
health promotion. Creating a press release for a potential event or
breakthrough with ACE education or Trauma Informed Care. Also will be
analyzing target audience considerations and social marketing strategies and
campaigns.
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Micaela Johnson

H&S 490

May 5, 2018

Assignment 3

Assess the Health Education Materials

Scorecards are located in the appendix.

a. I scored the Center for Disease Control and Prevention’s webpage for “Children’s Mental
Health,” for the written health education understandability. This got a perfect score for
understandability as it contained all the aspects of the PMAT User’s Guide for Rating Materials. I
feel that there could still be improvements as there is basic data but it could be formatted in a
way that is more visually appealing or easier to comprehend. The formatting was good but could
probably be improved for readability.
b. I scored the Center for Disease Control and Prevention’s webpage for “Children’s Mental
Health,” for the written health education actionability. This got a perfect score for actionability
as it contained all the aspects of the PMAT User’s Guide for Rating Materials. The actionability is
very easy to identify and the steps are categorized well. For this piece the role in the child’s life
is identified so that there are actual steps that can be taken to help children’s mental health.
This could be improved by adding charts, graphs or a diagram to help with actionability.
c. I scored the Huffington Post UK’s video for “Here’s the Real Truth about Mental Health in
Children,” for the audiovisual piece understandability. This got a perfect score for
understandability as it contained all the aspects of the PMAT User’s Guide for Rating Materials.
The audiovisual piece was more interesting to rate because the layout is more visual and less
word-oriented. The tone of the actors speaking was very appropriate for the message given and
the use of children within the message was very powerful. The organization of the message was
ordered in a logical way and flowed smoothly from one topic to another.
d. I scored the Huffington Post UK’s video for “Here’s the Real Truth about Mental Health in
Children,” for the audiovisual piece understandability. This got a perfect score for actionability
as it contained all the aspects of the PMAT User’s Guide for Rating Materials. The actionability is
very easy to identify in this video as it gives very clear examples of what to say to children as
parents. There is also a plug at the end for their social media campaign and resources at the end
which could prove to be helpful for parents, guardians, and other close relatives of a child
experiencing mental health issues.
e. When considering health promotion on various topics, it is important to keep the affect
population in mind. The message could completely be misunderstood or ignored if not
approached in a specific way. Health literacy and keeping the culture of the population close to
the message will help in distribution of effective health education materials and concepts.

Press Release
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For Immediate Release

May 9, 2018

The City of Meridian Announces New Mandatory Training to All Healthcare

Professionals
Adverse Childhood Experiences to be assessed in the City of Meridian

“I understand that people can feel
really uncomfortable when discussing
our childhood trauma’s but there is
hope in this first step that we can
make the future of our children and
us better,”
said Susan Phillips, City Mayor at The
City of Meridian.
Meridian— May 9, 2018 — Today, the City of Meridian
announced immediate availability of training to all
healthcare professionals, this enables providers to better
assess the population of Meridian for number of Adverse
Childhood Experiences (ACE’s). This new information is to
help reduce the number of children experiencing adversities
and to help prevent against further damage to adults who
have already suffered from ACE’s when they were young.

Impact on the Population of Meridian

Many have already benefited from the analysis of utilizing the ACE Module. Professionals can help
provide resources for better addressing how parents are impacted by ACE’s as well as help prevent
childhood adversities. Parent’s may unintentionally be mistreating their children based off how they
were treated when younger. Enabling the healthcare professionals to this training will ultimately assist
the population of Meridian against past and present traumas for adults and children. This will also help
lower the number of children who are experiencing maltreatment overall in the Meridian area. This
training has been recently deployed to all healthcare professionals as additional required medical
training and is available online to anyone who may have any further questions.

Healthcare Professionals Availability

Training to all healthcare professionals is an update driven by the need for children to have adverse-free
childhoods and adults to help combat the negative effects of ACE’s from their own childhoods. The City
of Meridian’s commitment to deliver any updates to training and medical professional requirements can
be found online at the City of Meridian’s public website.

###

Any people mentioned or products or trainings are purely for educational purposes only and are entirely
fictional. Thank you for your time.

For more information, press only:

Micaela Johnson
(208) 954-6525
John1296@vandals.uidaho.edu

For more information on

Training to All Healthcare Professionals:
johnsonmicaela.weebly.com
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Target Audience Considerations

When considering health promotion of Adverse Childhood Experiences for my intended
audience, I need to make sure that the audience is the focus of the media, advertising, and education.
This means that they can understand the message I am trying to convey without feeling judged or
misled. Numeracy is important to consider as there is a large population of well-educated individuals in
my population and it could be perceived as insulting if I define everything to them. Of course, I would
make sure to assess the minorities and populations of disparities to see if I can help make my message
more applicable or understandable for them.
I need to make sure that my population has a good understanding or civic literacy of the
information as well as knowing other resources of information that are reliable and helpful to the cause.
Misleading information may hurt the cause and provide faulty information. Identifying other groups like
showing what another state or location has done in relation to ACE’s or training. A non-profit
organization might also be a good source for this population to look into for further understanding.
Cultural Competency is another consideration that needs to be considered as there are many
families of different cultures. There are religious, Hispanic, Caucasian, low socioeconomic, etc.
populations that need to be considered so that the wording is appropriate and that they understand the
purpose of this advertising. Since this topic is a bit difficult to covey to parents, we need to tailor it to
them without making them feel attacked or guilted. This is also important to so that the steps are very
clear for these populations.
The article I analyzed is called A web-based group course intervention for 15-25-year-olds whose
parents have substance use problems or mental illness: study protocol for a randomized controlled trial.
Some considerations for this article is that web-based interventions do seem to be promising and able to
help children and adolescents with being able to cope with their parent’s alcohol abuse or help with the
mental illness that may impact them. This might be a good approach for reaching children for my project
as well since that seems promising for children in general.

Social Media Strategies and Campaigns

http://youtube.com/

Videos uploaded to YouTube can have a positive impact on the younger audiences. Younger audiences
tend to use this platform for entertainment purposes and many of the videos are advertised all over. As
long as the videos are educational and properly addressed for each demographic, it should be successful
for reaching these audiences. Successful youtubers can also be utilized for their impact on their select
audiences and can be very good for advertisement.

http://www.sermo.com/

Sermo is a physician networking website. It was founded so that physicians could have a means of asking
other licensed professionals for advice, other considerations and advancements in medicine. I feel that
this would be good for advertising the information on ACE’s and TIC training and advancements in this.
This would help make sure that physicians have access to this information globally. This website would
be used to inform and update physicians on this information.
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• http://www.shared-care.ca/toolkits
• Trauma overview PDF attached in appendix.
• There are many different platforms that this website makes helpful for both parents and
children. This could be very useful for my topic as it does address both major populations
that I want to consider for this topic. The only adaption I would make would be more
resources on the specific topic of ACE’s and TIC.
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Appendix
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References

Center for Disease Prevention and Control. Children's Mental Health. (2018, March 14). Retrieved from
https://www.cdc.gov/childrensmentalhealth/basics.html

Elgán, T. H., Kartengren, N., Strandberg, A. K., Ingemarson, M., Hansson, H., Zetterlind, U., & Gripenberg,
J. (2016). A web-based group course intervention for 15-25-year-olds whose parents have substance use
problems or mental illness: study protocol for a randomized controlled trial. BMC Public Health, 16(1), 1-
8. doi:10.1186/s12889-016-3691-8

Huffington Post UK. Here’s the Real Truth About Mental Health in Children. (2016, February 17).
Retrieved from https://www.youtube.com/watch?v=C9naBPVHlHw

https://www.sermo.com/

https://www.youtube.com/
 Trauma
Identification and management for
Canadian primary care professionals
Compiled by

Helen Spenser MD, CCFP, FRCPC,

Children’s Hospital of Eastern Ontario, Ottawa, Ontario

and Blair Ritchie MD, FRCPC,

Alberta Health Services, University of Calgary

in collaboration with

Peter Kondra, MSc, MD, FRCPC,

and Brenda Mills, C&Y MHC
Hamilton Family Health Team
Child & Youth Mental Health Initiative
Disclaimer
The content of this document is for general information and education only.
The accuracy, completeness, adequacy, or currency of the content is not
warranted or guaranteed. The content is not intended to be a substitute for
professional medical advice, diagnosis, or treatment. Users should always
seek the advice of physicians or other qualified health providers with any
questions regarding a health condition. Any procedure or practice described
here should be applied by a health professional under appropriate
supervision in accordance with professional standards of care used with
regard to the unique circumstances that apply in each practice situation. The
authors disclaim any liability, loss, injury, or damage incurred as a
consequence, directly or indirectly, or the use and application of any of the
contents of this document. (Disclaimer is copied from www.drcheng.ca.)

This work is “licensed” under a Creative Commons License

Attribution-NonCommercial NoDerivatives 4.0 Canada
https://creativecommons.org/licenses/by-nc-nd/4.0/

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Understanding Trauma in Primary Care

• Epidemiology

• Screening and assessment

• Management and treatment

• Resources

• Comprehensive guides and references

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2
 Epidemiology

• Rare before adolescence

• 0.8-6% of children and youth meet criteria for

PTSD (Costello, 2005).

• Children often have clinically significant suffering

without meeting DSM-IV criteria.

• Prevalence is dependent on stability and safety of

a population’s environment.

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3
AACAP PTSD Guidelines for Screening
and Assessment

Recommendation 1
The psychiatric assessment of children and
adolescents should routinely include questions
about traumatic experiences and PTSD symptoms.

Recommendation 2
If screening indicates significant PTSD symptoms,
the clinician should conduct a formal evaluation to
determine whether PTSD is present, the severity of
those symptoms, and the degree of functional
impairment. Parents or other caregivers should be
included in this evaluation wherever possible.

Recommendation 3
The psychiatric assessment should consider
differential diagnoses of other psychiatric disorders
and physical conditions that may mimic PTSD.

(Cohen et al., 2010)

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4
 Identification

• Be mindful that certain questions and physical

exam maneuvers may be triggering for someone
who has experienced trauma. Bringing a third
party into the exam room for the physical exam is
prudent.

• Consequences of trauma:
 Children less likely than adults to present with
full criteria for PTSD

 PTSD symptoms best describe a person’s

subacute response to a discrete traumatic
event and include:
o Re-experiencing the trauma (e.g.
flashbacks, nightmares)
o Hypervigilance (e.g. insomnia, easily
startled, problems concentrating)
o Avoidance of people, emotions, and
places

 Chronic neglect and/or abuse can result in a

different presentation such as mood
instability and behavioural problems

 Neglect and abuse at early age can affect

development/attachment

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5
• As with any mental health presentation perform
review of systems, complete physical exam,
and screening bloodwork if indicated:
 Anemia (CBC and differential)
 Infection (CBC and differential, monospot,
STIs)
 Thyroid problems (TSH)
 Chronic illness e.g. asthma (liver tests,
electrolytes, kidney tests)
 Medications (over the counter, alternative,
and prescribed)
 Pregnancy
 Malnutrition
 Less frequent conditions like cancer

• Screen for other mental health problems including

 Anxiety
 Depression
 Substance use disorder
 Trauma or bullying
 ADHD and learning problems
 Eating disorder
 Significant negative life events (e.g., death of
loved one)

Whenever the issue of self-harm and

suicide is on a self-report questionnaire,
ensure youth fills out questionnaire in
presence of qualified office staff.
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6
• Assess functional impairment: The degree of
functional impairment along with the severity of
symptoms will guide your management plan.

Some free domain tools are listed below:

 Teen Functional Assessment

 Weiss Functional Impairment Rating Scale

(Self-Report)

 Weiss Functional Impairment Rating Scale

(Parent Report)

Free domain screening tools: No specific tools

known

Free domain tools for assessing co-morbid mental

illness (filled out by caregivers)

• Weiss Symptom Record

• T-CAPS

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AACAP PTSD Guidelines for Management
Recommendation 4
Treatment planning should consider a
comprehensive treatment approach which includes
consideration of the severity and degree of
impairment of the child’s PTSD symptoms.
Recommendation 5
Treatment planning should incorporate appropriate
interventions for comorbid psychiatric disorders.
Recommendation 6
Trauma-focused psychotherapies should be
considered first-line treatments for children and
adolescents with PTSD.
Recommendation 7
SSRIs can be considered for the treatment of
children and adolescents with PTSD.
Recommendation 10
Use of restrictive “rebirthing” therapies and other
techniques that bind, restrict, withhold food or
water, or are otherwise coercive are not endorsed.
Recommendation 11
School- or other community-based screening for
PTSD symptoms and risk factors should be
conducted after traumatic events that affect
significant numbers of children.
(Cohen et al., 2010)
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 Treatment
• Tips on developing a therapeutic alliance with
teens (Kutcher and Chehil 2009)

• Self-help and education (see below)

• Non-medication strategies:

 General Principles:
o Sleep Hygiene
o Diet
o Exercise
o Relaxation and socialization
o Mood-Enhancing Prescription (Activity Plan)

 Most evidence for trauma-focused cognitive

behavioural therapy (TF-CBT)

 Medication strategies:
o SSRIs can be used. For brief review of use of
antidepressants in children and youth
including SSRIs and suicidal ideation, see
Lam et al., 2009)

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 Resources
• Youth:
 Mindmasters (Orlick)

 http://www.mindyourmind.ca: Youth
information, resources and tools to help you
manage stress, crisis and mental health
problems.

 Kids Help Phone: www.kidshelpphone.ca or

1-800-668-6868

• Parents:
 Dr. Bruce Perry is an expert in child and
adolescent trauma and links to two of his
articles might be helpful for practitioners and
parents:
o Trauma and development

o Strategies for children and youth who

have been exposed to trauma

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10
 Freely Available Comprehensive
Guides

• For a comprehensive guide to PTSD in children

and youth in primary care, please download the
American Academy of Child and Adolescent
Psychiatry Practice Parameters (Cohen et al.,
2010)

• For a comprehensive guide to attachment

problems in children and youth in primary care
please download the American Academy of Child
and Adolescent Psychiatry Practice Parameters
(Boris et al., 2005)

• For a comprehensive guide to child and youth

mental health in primary care, see Healthy
Minds/Healthy Children and the Southern Alberta
Child & Youth Network’s “Mental Health in the
Primary Care Setting: Addressing the Concerns of
Children and Youth, 2nd edition, a Desk
Reference” (includes general mental health,
depression, suicide and self-harm, anxiety,
disruptive behaviour disorders, parental mental
illness and infant mental health) or 3rd edition
(includes fetal alcohol spectrum disorder,
childhood trauma, autism spectrum disorder and
eating disorders), or visit the Healthy Minds
Healthy Children website.
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 References

Boris, N. W., Zeanah, C. H.; Work Group on Quality

Issues. (2005). Practice parameter for the
assessment and treatment of children and
adolescents with reactive attachment disorder of
infancy and early childhood. Journal of the
American Academy of Child and Adolescent
Psychiatry, 44, 1206–1219.

Canadian Attention Deficit Hyperactivity Disorder

Resource Alliance (CADDRA). (2008). Canadian
ADHD Practice Guidelines. Available at
www.caddra.ca

Cheung, A., Ghalib, K., Jensen, P., Kelleher, K.,

Reiss-Brennan, B., Tomb, M., et al. (2010).
Guidelines for Adolescent Depression in Primary
Care (GLAD – PC) Tool Kit, Version 2. Available at
http://www.thereachinstitute.org/images/GLAD-
PCToolkit_V2_2010.pdf, retrieved June 11, 2015.

Cohen, J., Bukstein, O., Walter, H., Benson, S.,

Chrisman, A., Farchione, T., et al. (2010). Practice
parameter for the assessment and treatment of
children and adolescents with posttraumatic stress
disorder. Journal of the American Academy of Child
and Adolescent Psychiatry, 49, 414-430.

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Costello, E. J., Egger, H. L., and Angold, A. (2005).
The developmental epidemiology of anxiety
disorders: phenomenology, prevalence, and
comorbidity. Child and Aolescent Psychiatric Clinics
of North America, 14, 631-648, vii.

Healthy Minds/Healthy Children Outreach Services

and Southern Alberta Child and Youth Health
Network. (revised 2011). Mental health in the
primary care setting: Addressing the concerns of
children and youth (2nd edition): A desk reference.
Available at
http://www.albertahealthservices.ca/hp/if-hp-
hmhc-desk-reference-complete-second-edition.pdf,
retrieved June 11, 2015.

Healthy Minds/Healthy Children Outreach Services

and Southern Alberta Child and Youth Health
Network. (n.d.). Mental health in the primary care
setting: Addressing the concerns of children and
youth (3rd edition): A desk reference. Available at
http://www.albertahealthservices.ca/hp/if-hp-
hmhc-desk-reference-third-edition.pdf, retrieved
June 11, 2015.

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Lam, R., Kennedy, S., Grigoriadis, S., McIntyre, R.,
Miley, R., Ramasubbu, R., et al. (2009). Canadian
Network for Mood and Anxiety Treatments
(CANMAT) Clinical guidelines for the management
of major depressive disorder in adults. III.
Pharmacotherapy. Journal of Affective Disorders,
117(Suppl. 1), S26-S43.

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