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Agency for Health Care Research and Quality (AHRQ). (2021). SDOH and Practice Improvements.

American Academy of Child & Adolescent Psychiatry, American Academy of Pediatrics, & Children’s Hospital Association. (2021). Pediatricians, Child and Adolescent Psychiatrists and Children’s Hospitals Declare National Emergency in Children's Mental Health.

American Academy of Pediatrics. (2021). Policy Statement: Trauma-Informed Care in Child Health Systems. Pediatrics, 148(2): e2021052579.

American Academy of Pediatrics. (2021). Clinical Report: Trauma-Informed Care. Pediatrics, 148(2): e2021052580.

American Academy of Pediatrics. (2021). Policy Statement: Preventing Childhood Toxic Stress: Partnering With Families and Communities to Promote Relational Health.

American Academy of Pediatrics. (2021). Fostering Health: Standards of Care for Children in Foster Care.

American Academy of Pediatrics. (2021). COVID Pandemic and Children’s Health.

American Academy of Pediatrics. (2021). Policy Statement: Poverty and Child Health in the United States. Pediatrics, 137:4: e20160339.

American Academy of Pediatrics. (2016). Helping Foster and Adoptive Families Cope With Trauma (Trauma Guide).

American Academy of Pediatrics. (2016). Policy Statement: Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician: Translating Developmental Science Into Lifelong Health.

American Academy of Pediatrics. (2016). Technical Report: The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1), e232–e246.

American Academy of Pediatrics. (2015). Policy Statement: Health Care Issues for Children and Adolescents in Foster Care and Kinship Care. Pediatrics, 136(4), e1131-e1140.

American Academy of Pediatrics. (2014). The Medical Home Approach to Identifying and Responding to Exposure to Trauma. A Toolkit for Pediatricians.

American Psychiatric Association. (2021). Diagnostic and Statistical Manual of Mental Disorders (DSM–5-TR).

Centers for Disease Control and Prevention. (2021). Adverse Childhood Experiences (ACEs).

Centers for Disease Control and Prevention. (2021). Mechanisms by Which Adverse Childhood Experiences Influence Health and Well-Being throughout the Lifespan.

Centers for Disease Control and Prevention. (2021). Social Determinants of Health.

Cronholm, P. F., Forke, C. M., Wade, R., Bair-Merritt, M. H., Davis, M., Harkins-Schwarz, M., Pachter, L. M., & Fein, J. A. (2015). Adverse Childhood Experiences: Expanding the Concept of Adversity. American Journal of Preventive Medicine, 49(3):354-61.

Easterlin, M. C., Chung, P. J., Leng, M., & Dudovitz, R. (2019). Association of Team Sports Participation with Long-term Mental Health Outcomes among Individuals Exposed to Adverse Childhood Experiences. JAMA Pediatrics, 173(7): 681-688.

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4):245-58. [Abstract].

Garcia, A. R., Gupta, M., Greeson, J. K., Thompson, A., & DeNard, C. (2017). Adverse childhood experiences among youth reported to child welfare: Results from the national survey of child & adolescent wellbeing. Child Abuse & Neglect, 70, 292-302.

Harvard T.H. Chan School of Public Health. (n.d.). Mental Health.

Harvard University, Center on the Developing Child. (2022). Toxic Stress.

National Child Traumatic Stress Network

Paces Connection. (2022). The Three Realms of ACEs.

PCIT. (2022). Trained Therapist List.

Robert Wood Johnson Foundation. (2017). Traumatic Experiences Widespread Among U.S. Youth, New Data Show.

Sacks, V., & Murphey, D. (2018). The prevalence of adverse childhood experiences, nationally, by state, and by race or ethnicity. Child Trends.

Substance Abuse and Mental Health Services Administration. (2022). The Roots of Individual Trauma.

Substance Abuse and Mental Health Administration. (2017). Understanding Child Trauma.

Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. U.S. Department of Health and Human Services (HHS) Publication (SMA) 14-4884.

Tennant, P. (n.d.). How to Administer a Trauma Screening Using the ACEs Questionnaire. Texas Institute for Child and Family Well-Being, Steve Hicks School of Social Work, University of Texas at Austin.

Texans Care for Children. (2022). Teen Pregnancy in Texas foster care.

Texas Department of Family and Protective Services. (n.d). Guide to Medical Services at CPS.

Texas Department of Family and Protective Services. (n.d.). Transitional Living Services.

Texas Family Code § 261.101. (Abuse and Neglect).

Texas Health and Human Services Commission. (n.d.). Child and Adolescent Needs and Strengths Assessment.

Trauma-Informed Care Implementation Resource Center. (n.d.). 10 Key Ingredients for Trauma-Informed Care.

U.S. Department of Health and Human Services. (2020). Child Maltreatment 2020.

World Health Organization. (n.d). Social Determinants of Health.

Resources for Patients and Families

American Academy of Pediatrics, healthychildren.org. Childhood Trauma: 3 Ways to Help Kids Cope.

American Academy of Pediatrics, healthychildren.org. Parenting After Trauma: Understanding Your Child's Needs.

Child Welfare Information Gateway. Resources on Trauma for Caregivers and Families.

Mental Health Connection of Tarrant County. (n.d.). Recognize Trauma.

North Carolina Division of Social Services and the Family and Children's Resource Center. Trauma-Informed Parenting: What You Should Know.

Texas Department of Family and Protective Services.  Transitional Living Services.

Trauma Survivors Network. Resources for Survivors.

Medical Definitions

The medical definitions in this module were adapted or obtained from the American Academy of Pediatrics, American Heart Association, Centers for Disease Control and Prevention, Dictionary.com, Lexico, Mayo Clinic, National Library of Medicine, National Child Traumatic Stress Network, National Institute on Drug Abuse and the University of Michigan.

Continuing Medical Education

The Texas Department of State Health Services, Continuing Education Service is accredited by the Texas Medical Association to provide continuing medical education for physicians. 

The Texas Department of State Health Services, Continuing Education Service designates this enduring material for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education

The Texas Department of State Health Services, Continuing Education Service is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. The Texas Department of State Health Services, Continuing Education Service has awarded 1.00 contact hour(s) of Continuing Nursing Education.

Social Workers

The Texas Department of State Health Services, Continuing Education Service, the continuing education provider, ensures that the education provided is directly related to the practice of social work; and that the individuals presenting the information have the necessary experience and knowledge in the topics presented. The Texas Department of State Health Services, Continuing Education Service has awarded 1.00 hours of credit.

Certificate of Attendance

The Texas Department of State Health Services, Continuing Education Service has designated 1.00 hour(s) for attendance.

General Disclosure

One of the requirements of continuing education is disclosure of the following information to the learner:

1. Notice of requirements for successful completion of continuing education activity. To receive continuing education credit the learner must successfully complete the following activities:
   • Create a Texas Health Steps account.
   • Complete on-line registration process.
   • Thoroughly read the content of the module.
   • Complete the on-line examination.
   • Complete the evaluation.
2. Commercial Support.
   The THSTEPS Web-based Continuing Education Series has received no commercial support.
3. Disclosure of Relevant Financial Relationships.
   The THSTEPS Continuing Education Planning Committee and the authors of these modules have no relevant financial relationships to disclose.
4. Non-Endorsement Statement.
   Accredited status does not imply endorsement of any commercial products or services by the Department of State Health Services, Continuing Education Service; Texas Medical Association; or American Nurse Credentialing Center.
5. Off-Label Use.
   Using a disclosure review process, the THSTEPS Continuing Education Planning Committee has examined documents and has concluded that the authors of these modules have not included content that discusses off-label use (use of products for a purpose other than that for which they were approved by the Food and Drug Administration).

The following are policies and definitions of terms related to continuing education disclosure:

The intent of disclosure is to allow Department of State Health Services (DSHS) Continuing Education Service the opportunity to resolve any potential conflicts of interest to assure balance, independence, objectivity and scientific rigor in all of its Continuing Education activities.

All faculty, planners, speakers and authors of Department of State Health Services (DSHS) Continuing Education Service sponsored activities are expected to disclose to the Department of State Health Services (DSHS) Continuing Education Service any relevant financial, relationships with any commercial or personal interest that produces health care goods or services concerned with the content of an educational presentation. Faculty, planners, speakers and authors must also disclose where there are any other potentially biasing relationships of a professional or personal nature.

Glossary of Terms

Conflict of Interest: Circumstances create a conflict of interest when an individual has an opportunity to affect Continuing Education content about products or services of a commercial interest with which she/he has a financial relationship or where there are any other potentially biasing relationships of a professional or personal nature.

Commercial Interest: Any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.

Financial Relationships: Those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, teaching, membership on advisory committees or review panels, board membership, and other activities for which remuneration is received or expected. Relevant financial relationships would include those within the past 12 months of the person involved in the activity and a spouse or partner. Relevant financial relationships of your spouse or partner are those of which you are aware at the time of this disclosure.

Off Label: Using products for a purpose other that that for which it was approved by the Food and Drug Administration (FDA).

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