Featured

• American Academy of Pediatrics. (2023). Trauma-Informed Care.
• American Academy of Pediatrics and PATTeR. (2021). AAP Infographic: Moving beyond ACE Scores.
• American Academy of Pediatrics. (n.d.). Bright Futures Materials and Tools.
• American Academy of Pediatrics. Policy Statement (2012/2016). Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician: Translating Developmental Science Into Lifelong Health. Pediatrics, (129)1, 224-231.
• American Academy of Pediatrics. Policy Statement. (2013). Enhancing Pediatric Workforce Diversity and Providing Culturally Effective Pediatric Care: Implications for Practice, Education, and Policy Making. Pediatrics, 132(4), e1105-e1116.
• American Academy of Pediatrics. (2014). The Medical Home Approach to Identifying and Responding to Trauma.
• American Academy of Pediatrics. New Jersey Chapter. (n.d.). Understanding Adverse Childhood Experiences (ACEs): Perspectives on Hope and Resilience.
• American Psychiatric Association. Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder. (2017). Eye Movement Desensitization and Reprocessing (EMDR) Therapy.
• Arenson, M., & Forkey, H. (2023). Violence Exposure and Trauma-Informed Care. Pediatric Clinics of North America, 2023 Dec;70(6):1183-1200.
• Bartlett, J. D., & Steber, K. (2019). How to Implement Trauma-informed Care to Build Resilience to Childhood Trauma. Child Trends.
• Breedlove, M., Choi, J., & Zyromski, B. (2020). Mitigating the Effects of Adverse Childhood Experiences: How Restorative Practices in Schools Support Positive Childhood Experiences and Protective Factors. The New Educator, Vol. 17 Issue 3.
• Burns, J. D., Borah, L., Terrell, S. M., James, L. N., Erkkinen, E., & Owens, L. (2023). Trauma-Informed Care Curricula for the Health Professions: A Scoping Review of Best Practices for Design, Implementation, and Evaluation. Journal of the Association of American Medical Colleges. 1;98(3):401-409.
• The Center for Pediatric Traumatic Stress, Children’s Hospital of Philadelphia. Healthcare Toolbox. (n.d.). What is Culturally-Sensitive Trauma-Informed Care?
• Center on the Developing Child at Harvard University. (n.d.). InBrief: The Impact of Early Adversity on Children's Development (video).
• Centers for Disease Control and Prevention. (2020). Adverse Childhood Experiences (ACEs) web page.
• Centers for Disease Control and Prevention. (n.d.). Adverse Childhood Experiences, look at how ACEs affect our lives & society.
• Centers for Disease Control and Prevention. (2023). Prevalence of Adverse Childhood Experiences among U.S. Adults – Behavioral Risk Factor Surveillance System, 2011-2020.
• Centers for Disease Control and Prevention. (n.d.) About the CDC-Kaiser ACE Study.
• Child and Adolescent Health Measurement Initiative. Texas Fact Sheet 2021.
• 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. Volume 49, Issue 3:354-361.
• Colby, S., & Ortman, J. (2015). Projections of the Size and Composition of the U.S. Population: 2014 to 2060. U.S. Census Bureau.
• Crouch, E., Radcliff, E., Merrell, M. A., Hung, P., & Bennett, K. J. (2021). Positive Childhood Experiences Promote School Success. Maternal and Child Health Journal, 25(10):1646-1654.
• Ellis, W. R. & Dietz, W. H. (2017). A New Framework for Addressing Adverse Childhood and Community Experiences: The Building Community Resilience Model. Academic Pediatrics, 17(7S).
• Fang, Z., Cerna-Turoff, I. Zhang, C., Lu, M., Lachman, J., Barlow, J. (2022). Global estimates of violence against children with disabilities: an updated systematic review and meta-analysis. The Lancet, Child & Adolescent Health Volume 6, Issue 5, P313-323.
• Garner, A., & Yogman, M. (2021). Preventing Childhood Toxic Stress: Partnering with Families and Communities to Promote Relational Health. Pediatrics, 148(2): e2021052582.
• Gilgoff, R., Schwartz, T., Owen, M., Bhushan, D., & Burke Harris, N. (2023). Opportunities to Treat Toxic Stress. Pediatrics, 151 (1): e2021055591.
• Harris, N. B. (2015). TedMed video. How childhood trauma affects health across a lifetime.
• Harvard University, Center on the Developing Child. (2017). Toxic Stress.
• Harvard University, Immigration Initiative. (n.d.). WHO are immigrant origin children and youth?
• Health Resources and Services Administration, Maternal and Child Health. (June 2020). National Survey of Children’s Health (NSCH) Data Brief.
• Health Resources and Services Administration. Maternal and Child Health. (October 2022). National Survey of Children’s Health (NSCH) Data Brief.
• McManus, M.A., Ball, E. (2020). COVID-19 Should be Considered an Adverse Childhood Experience (ACE). Journal of Community Safety and Well-Being, Dec. 2020.
• The National Child Traumatic Stress Network. (n.d.). Resilience and Child Traumatic Stress.
• The National Child Traumatic Stress Network. (n.d.). Trauma Types.
• National Human Trafficking Training and Technical Assistance Center. (n.d.). The Original ACE Study and The Expanded Ace Study.
• Population Reference Bureau. Kids Data. (2024). Black and Latino Children Experience Multiple Adversities at Disproportionately High Rates.
• Peterson, C., Florence, C., & Klevens, J. (2018). The economic burden of child maltreatment in the United States, 2015. Child Abuse & Neglect: The International Journal, 86, 178–183.
• The Philadelphia ACE Project. (2023). Philadelphia Expanded ACE Study.
• Qu, G., Ma, S., Liu, H., Han, T., Zhang, H., Ding, X., . . . Sun, Y. (2022). Positive childhood experiences can moderate the impact of adverse childhood experiences on adolescent depression and anxiety: Results from a cross-sectional survey. Child Abuse and Neglect, Vol. 125 10551.
• Sanders, L. M. (2020). Is COVID-19 an adverse childhood experience (ACE): Implications for screening for primary care. Journal of Pediatrics. 222:4–6.
• Shonkoff, J. P., Garner, A. S., & AAP. (2012/2016). Technical Report: The Lifelong Effects of Early Childhood Adversity and Toxic Stress. Pediatrics, 129(1), 232-246.
• Slopen, N., Umaña-Taylor, A. J., Shonkoff, J. P., Carle, A. C., & Hatzenbuehler, M. L. (2023). State-Level Anti-Immigrant Sentiment and Policies and Health Risks in U.S. Latino Children. Pediatrics. 152 (3): e2022057581.
• Substance Abuse and Mental Health Services Administration, Trauma and Justice Strategic Initiative. (2014). SAMHSA's Concept of Trauma and Guidance for a Trauma-Informed Approach .
• Substance Abuse and Mental Health Services Administration, GAINS Center. (n.d.). How Being Trauma Informed Improves Criminal Justice System Responses. Fact Sheet: Historical Trauma.
• Texas Children’s Hospital. (n.d.) The Impact of Toxic Stress in Children.
• Texas Health and Human Services Commission. Texas Health Steps Checkup Components.
• Texas Health and Human Services Commission. Texas Health Steps Periodicity Schedule.
• Texas Medicaid & Healthcare Partnership. (2024). Texas Medicaid Provider Procedures Manual (TMPPM).
• Texas State Legislature. (2011). Texas Family Code §261. The Parent-Child Relationship and the Suit Affecting the Parent-Child Relationship.
• The Child and Adolescent Health Measurement Initiative. (n.d.). ACEs Project. Childhood Trauma and Positive Health.
• U.S. Department of Health and Human Services, Administration for Children and Families, Office of Refugee Resettlement. (2023). Fact Sheet: Unaccompanied Children (UC) Program.
• Webster, E. M. (2022) The Impact of Adverse Childhood Experiences on Health and Development in Young Children. Global Pediatric Health, 2022; 9: 2333794X22107870.

Medical Definitions

The medical definitions provided in this module were obtained from the American Psychiatric Association, the Centers for Disease Control and Prevention, the National Human Trafficking Hotline, the U.S. Department of Health and Human Services, the U.S. National Library of Medicine and WebMD.

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 1.25 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 1.25 contact hour(s) of Continuing Nursing Education.

Licensed Marriage and Family Therapists

The Texas Department of State Health Services, Continuing Education Service, the continuing education provider, ensures that the education provided is related to the practice of marriage and family therapy; 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 1.25 hours of credit.

Licensed Professional Counselors

Up to 1.25 LPC hours may be earned at this event.

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 1.25 hours of credit.

Certificate of Attendance

The Texas Department of State Health Services, Continuing Education Service has designated 1.25 hour(s) for attendance.

Certified Community Health Worker

The Texas Department of State Health Services, Promotor(a)/Community Health Worker Training and Certification Program has certified this course for 1.25 contact hour(s) of continuing education for Certified Community Health Workers and Community Health Worker Instructors.

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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