Spotlight Series: Dr. Tanisha E. Silas-Young

The Opportunity for ACE Screening in Prenatal Care

ACE screening offers maternal health care providers a tremendous opportunity to address toxic stress, interrupt the cycle of intergenerational trauma, and set patients on a path to healing. In this month’s ACEs Aware Spotlight, Dr. Tanisha E. Silas-Young of the Department of Obstetrics and Gynecology from Kaiser Permanente in Vacaville shares experiences and lessons learned from implementing ACE screening into her prenatal care practice.

When I first learned how toxic stress and trauma can impact mental and physical health and predict health outcomes, I became intrigued. When I learned how resiliency and caring interpersonal relationships can heal and mitigate the negative impact of trauma, I became empowered.

Much of the work on Adverse Childhood Experiences (ACEs) to date has involved pediatric or adult non-pregnant populations. We are just beginning to understand how toxic stress and trauma can impact maternal health. We have a tremendous opportunity with our prenatal patients to not only screen for trauma, but also to help break the cycle of intergenerational trauma.

When I started to implement ACE and resiliency screenings in my prenatal practice, I was surprised to learn that while many of our pregnant patients have been impacted by trauma, most have tremendous strengths and a supportive social network that helps to shield them from the negative impact of previous trauma. When patients have a high ACE score, but lack a supportive social circle, I can provide them with resources from Kaiser Permanente and community organizations to help them in their journey of healing.

Many of my patients appreciated enrolling in the “Positive Parenting” classes offered in the community; they saw it as an opportunity to set their family on the path of healing. Others benefitted from Kaiser Permanente’s Health Education classes to improve sleep or understand their own anxiety. Some of my patients embarked on a new practice of meditation for self-care and reported that their anxiety was much better controlled. Most patients thanked me for taking the time to get to know them and felt cared for when we discussed trauma.

Most patients thanked me for taking the time to get to know them and felt cared for when we discussed trauma.

One woman had an ACE score of eight and was in an active domestic violence situation in the middle of her pregnancy. We made a safety plan together, and I referred her to community resources to help her and her children safely exit the relationship. As a follow up, we discussed how she witnessed domestic violence as a child and how this put her at risk to experience domestic violence as an adult. She planned to join a domestic abuse survivors’ group to get support in her journey of healing.

Like most physicians, I had some reservations before I started screening for ACEs and resiliency in my practice. Would it take up too much appointment time? Would screening trigger the patient in a way I would not know how to navigate? Would I really know how to help the trauma-impacted patient sitting across from me, looking to me for answers? The ACE screening was easy to implement in my busy practice, it made my patients feel cared for, and it empowered them to start their journey of healing.

Trauma is the number one public health crisis of our time, and in the field of obstetrics we are uniquely positioned to completely change the course of trauma and its negative health impacts for our patients and our communities.

In Solidarity,
Tanisha Silas-Young, MD


Hear more on ACEs Aware and maternal health practice in the ACEs Aware webinar “Supporting Patients in Pregnancy: ACEs and Maternal Health.