For Pediatricians and Pediatric Care Providers

Phoenix Children’s Center for Resiliency and Wellbeing (CRW) encourages trauma-informed care (TIC) – understanding how past trauma influences current mental and physical health, as well as behavior. 

Throughout life, the brain makes new nerve connections based on experiences – a process called neuroplasticity. This process is the most active from birth to 5 years of age and again during puberty. During these sensitive and critical stages of rapid growth, both positive and negative experiences affect a child’s brain development, structure and pathways. Traumatic, extreme or persistent, stressful experiences can interfere with healthy brain development. 

Our CRW specialists offer ACE-related resources for providers and services based on the evidence-based care model from experts in childhood trauma. Our approach protects, supports and heals the whole person. 

Our multiphase approach helps to prevent or mitigate toxic stress and ACE-related complications, such as:

• Anxiety, depression and mood disorders
• Eating disorders
• Overeating  
• Smoking  
• Substance abuse or addiction
• Suicide risk
• Academic problems and/or underperformance 

Types of ACEs

Public health officials originally identified the following 10 primary ACEs that can change the health, wellbeing and lives of children and teens: 

1. Sexual abuse
2. Verbal abuse
3. Physical neglect
4. Emotional neglect
5. Depressed or mentally ill family member
6. Family member addicted to alcohol or drugs
7. Imprisoned family member  
8. Witnessing a mother being abused
9. Losing a parent to separation, divorce or death

The CDC and other experts now recognize many others, such as poverty, homelessness, bullying and racism. Any type of trauma – such as natural disasters or community violence –  can cause ACE-related complications.

CRW specialists at Phoenix Children’s follow an “Integrated and Integrative” care model. We identify ACE-related risks, but focus on the inner strengths of the patient and family or caregiver. We build upon and develop greater levels of resilience. 
Experts define resilience as the ability to withstand adversity and adapt in healthy ways. We use both the well-known medical and mental health model (Integrated) and a preventative care model (Integrative).

• Integrated medical care – Works across specialties to address, treat and improve a child’s physical and mental health
• Integrative medical care – Provides prevention-focused “well care,” which combines conventional and complementary healthcare practices to evaluate and address the mind, body and spirit

Guided by a specialized pediatrician, our CRW team combines the expertise of a resiliency counselor for short-term counseling and case management, a wellness nurse and a pediatric psychiatrist. Our model provides highly individualized education, care and treatment. Our goal is to mitigate signs and symptoms, treat illness and prevent future ACEs.

Integrated and Integrative Phases

You can learn more about CRW’s evidence-based approach in our downloadable Integrated and Integrative white paper. This care model includes:

• Foundation phase – Evaluating strengths and opportunities  
• Wellbeing phase – Strategies to support, protect and heal
• Connecting phase – Building resilience and promoting healing through communication
• Skill-building phase – Strengthening empowering skills while building resiliency, coping abilities and support systems
• Contributing phase – Giving back to the community, which helps build confidence, connection and competency

Our CRW team begins by working to understand the dynamics of each child or teen within their respective family system. We do this through a comprehensive wellness evaluation to capture the unique mental, physical, environmental and social aspects of each family. We look at family strengths, needs and positive, protective factors, including:

• Appropriate developmental expectations for the child
• Caregiver knowledge and understanding of parenting  
• Close relationship with nurturing and predictable caregivers
• Family and community support systems
• Parental resilience
• Practical support 
• Sense of purpose and meaning

Our CRW team includes a wellness nurse who can help children or teens learn integrative techniques and goal-setting. Kids build strength, confidence and resilience through practices such as:

• Finding calm through breathing techniques
• Getting good, balanced nutrition
• Learning about sleep and sleep hygiene (habits, environment and routines)
• Learning the value and importance of giving back 
• Practicing self-compassion and self-efficacy (effectiveness) 
• Staying physically active 
• Understanding the emotion-body connection

Our resiliency counselors use the Integrated and Integrative Care Model to understand the patient as a whole person. They offer short-term support while helping families set up long-term counseling if needed. They support kids and families by:

• Addressing challenges and teaching ways to deal with and recover from difficult situations 
• Fostering community and overcoming barriers by offering connections to community partners  
• Helping kids build safe, stable and nurturing relationships that are reliable and consistent
• Strengthening regulation and co-regulation – the ability to manage thoughts, emotions and behaviors in acceptable ways toward positive personal and shared goals
• Working on parenting support while building parents’ strengths and skills
• CRW resiliency counselors also support continuity of care, where needed, through referrals for housing, domestic violence shelters, food and nutrition, and support from service-oriented community organizations.

Phoenix Children’s CRW team includes:

• Pediatrician (oversees program)
• Pediatric Psychiatrist 
• Resiliency Counselor 
• Wellness Nurse
• Medical Assistant
• CRW Operations Manager