Year: 2025
Type: article
Abstract: Screening for structural drivers or determinants of health (SDoH), as mandated by recent federal regulations, raises ethical questions about screening processes and tools.Early childhood adversity and trauma, which can influence a person's health throughout their lifespan and contribute to chronic disease and early death, can be identified through standardized screening for SDoH.However, screening without awareness of the potential interface between SDoH and trauma can retraumatize those administering or completing the screening process.This article suggests that implementation of a trauma-informed approach to SDoH screening is consistent with biomedical and public health ethics and contributes to efforts to keep clinical environments emotionally safe.The American Medical Association designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™ available through the AMA Ed Hub TM .Physicians should claim only the credit commensurate with the extent of their participation in the activity.Adverse Childhood Experiences Structural drivers or determinants of health (SDoH) are upstream contributors to health that have social, cultural, economic, or political origins and that can contribute to premature morbidity and mortality.1 The US Department of Health and Human Services (HHS) describes SDoH as "conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks." 2 HHS offers illustrative examples of SDoH, including "safe housing, transportation, and neighborhoods" and "education, job opportunities, and income," in addition to access to healthy food, water, and air.In its SDoH screening requirements for patients 18 years of age or older admitted to hospitals participating in the Hospital Inpatient Quality Reporting Program, the Centers for Medicare and Medicaid Services (CMS) includes "food insecurity, housing instability, transportation needs, utility difficulties and interpersonal safety" as relevant screening domains.3 Adversity, including early childhood adversity, is its own driver of health.Childhood experiences of poverty, community violence, and loss of a parent are examples of early childhood adversity; adverse childhood experience (ACEs) are associated with negative health outcomes, including lifelong biopsychosocial maladaptation, chronic adult illness,
Source: The AMA Journal of Ethic
Authors: Elizabeth Lanphier, James Duffee
Language: English
Topic: Child Abuse and Trauma
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: diamond
OpenAlex ID: W4413880109