| Definition | Acknowledges that health care organizations and teams need to have a complete picture of a patient’s life to provide effective health care services with a healing orientation | Potentially traumatic events occurring in childhood | Emotional connections between children and trusted adults; often defined as an SSNR |
| Impact | Patients with trauma have difficulty maintaining open relationships with health care providers Improved long-term health outcomes for patients Providers working with populations experiencing trauma experience burnout and higher turnover
| Associated with health or developmental challenges and negative long-term physical and mental effects | SSNRs serve as the foundation for building resilience Promotes health and development Leads to positive experiences Can buffer negative effects of trauma and adversity
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| Considerations | Core principles: | Abuse (eg, physical, emotional, sexual) Neglect (eg, physical, emotional) Household challenges (eg, mental illness, parental history of violence, substance abuse, incarceration, divorce)
| Use each clinical encounter to promote parenting behaviour that will help children develop |
| Methods | Create safe, caring, inclusive environments (physical, social, and emotional) for all patients Change organizational culture and atmosphere Address trauma with trained individuals at the clinical level
| Seek to address modifiable risk factors to transmit resilience Teach parenting skills and family relationship approaches to strengthen parent-child relationships Understand and address factors that put people at risk for or protect them from violence Reduce stigma related to seeking help Advocate for stronger economic support of families Promote early childhood education Connect youth to caring adults and activities
| Discuss specific aspects of parenting behaviour that support the concept (eg, noticing and responding to baby’s cues to promote secure attachment) Model behaviour during the visit (eg, warm back-and-forth interactions) Praise what you observe (eg, baby calms down when parent holds them) Recommend community support services
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| Rationale | Improves patient engagement Improves treatment adherence Improves health outcomes Improves provider wellness Reduces care visits and decreases costs to health care and social services
| Reduces the incidence of chronic health conditions Addresses health inequity Decreases health care costs associated with ACE-related consequences
| Preemptive parental assessment and guidance build confidence and skills in parents Positive parenting behaviour allows children to develop secure attachment, autonomy, self-regulation, perspective taking, and problem solving ERH is predictive of later well-being
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