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Table 3 Proposed clinical implications of reviewed findings

From: Biological embedding of childhood adversity: from physiological mechanisms to clinical implications

Practitioner activity Recommendations Recommended resources
Understanding disease etiology and risk Consider how ELA contributes to a patient’s risk of common health problems, e.g.:
• Mental health disorders: Depression, anxiety, substance use disorders, post-traumatic stress disorder, psychosis
• Cardiovascular disease: Ischemic heart disease, hypertension, atherosclerosis
• Metabolic pathology: Obesity, type 2 diabetes, dyslipidemia, metabolic syndrome
• Neoplasm: Breast, liver, lung cancers
Results of major epidemiological studies assessing health effects of ELA [1,2,3,4,5,6]
Further reading suggested throughout
Screening • Screen for ELA history
• Assess social service and protection needs
• Consider ELA history when assessing risk and screening for ELA-related diseases or developmental needs
Adverse Childhood Experiences Questionnaire [1]
WHO Adverse Childhood Experiences International Questionnaire [104]
American Academy of Pediatrics Resilience Project Clinical Screening Tools [105]
Intervention General practice
Provide access to:
• Mental healthcare
• Early prevention and treatment for other ELA-related diseases
• Social services and poverty alleviation
• Violence response and prevention interventions
Pediatric practice
• Family and caregiver support programs
• Early development interventions
• Services to prevent or respond to ELA exposures, including child protection services
WHO Preventing Child Maltreatment guide [106]
WHO mhGAP Intervention Guide [107]
Interventions resources to support healthy child development from Frontiers of Innovation – Center on the Developing Child at Harvard University [108]
Transforming care models Adopt best-practices from “medical home models” to support ELA-exposed patients, including strategies promoting:
• Patient- and family-centered wraparound care
• Cultural competency
• Enhanced access and follow-up
National Center for Medical Home Implementation Tools & Resources [109]
Advocacy Incorporate evidence on ELA into advocacy relating to:
• Access to mental health services
• Poverty alleviation, criminal justice reform, and violence prevention
• Fair parental leave and high-quality child care
• Immigration and refugee policies protecting children and families
WHO guidance package on Advocacy for Mental Health [110]
United Nations Children’s Fund policy advocacy and children's rights tools [111]
Children’s Defense Fund policy campaign resources [112]
  1. ELA early life adversity, WHO World Health Organization