Writings from Daniel P.

Dear Congressman,

As a resident pediatrician at Indiana University School of Medicine and a voting member of your district, I am writing today to ask for the addition of questions related to adverse childhood experiences (ACES) into the Indiana Behavioral Risk Factor Surveillance Survey (BRFSS). I provide primary care at the Pediatric and Adolescent Care Center across from Methodist Hospital in Indianapolis. In my brief time of training, I have already noticed a troubling disconnect between the medical services we provide our children and the actual outcomes they experience. Why is that?

I commonly see children with severe asthma who have been prescribed all the right medications—inhalers, nebulizer solutions, and pills—who nevertheless visit the emergency department 3-4 times a year for flare-ups in their symptoms. Such visits might necessitate transfer to the ICU or insertion of a tube into their lungs to help them breathe.

The risk factors associated with poor control of asthma are numerous, including environmental, genetic, and behavioral issues. ACES are a lesser-known class of risk, including such various problems as abuse, violence, and poor caregiver relationships. Exposure to these stressors over time causes persistent harm to the developing brain and immune system, which associates with increased risk for poor physical and mental health. For example, an American child with asthma who has 2 or more ACES has 3.5 times the risk of experiencing moderate/severe symptoms than a child who has no ACES.

Given the far-reaching impact of ACES, one might be tempted to feel disheartened were it not for the many organizations here in Indianapolis who intervene to mitigate their effects in some our most burdened youth. One such group is VOICES, which partners with the Department of Child Services and Juvenile Probation to offer healing-centered engagement through education and self-expression. In order to understand the true impact of their programming, they need accurate data about the prevalence of ACES and their associations in the local Hoosier population.

BRFSS is already administered by the state of Indiana as part of a national endeavor seeking to better understand modifiable risk factors that negatively affect children’s health. Many states have already chosen to add a module of questions regarding ACEs to their questionnaires. I urge you to include such a module in Indiana's version of the survey. I am happy to provide assistance in this endeavor.

Thank you,

Daniel Riggins