Salus Health Care Forum July 2, 2025

Jack

Jeremy, we tried to implement with a group I’m working with nationally, having medical assistants do the screening for ACEs. And we had to stop within a few months because screening for ACEs amongst our medical assistants, who were mostly lower socioeconomic, lower education, was triggering. All of our clinics were having to deal with all of the stuff that came up for our staff who were doing the screenings. And so we had to stop doing it for a time until we could sort out what we were going to do next.

Bill B

Let’s go back to Craig. Craig, fortunately, you and I are still young men. So we have a whole second career now in positive sociology. But what are your thoughts about all these ideas that people are floating?

Craig

Oh, I think they’re right on the money. The differences that Jack talked about among rural communities, can be found in neighborhoods and in urban communities. Community structure matters. And we have Bowling Alone, if you remember that book, and the loss of social capital, people connected to one another across varying divisions. And that loss of social capital is part of the disintegration of communities.

One of the concepts that people talk about with respect to ACEs is building resilience. And too often, in my view, resilience is thought of as an individual quality. It’s the grit that an individual has. In fact, Yuri Bronfenbrenner alerted us to the fact that it’s a community, a collective property. To have resilience in a community, you need to have positive social supports, places to turn when there’s trouble. And individuals are not just on their own. They live in communities.  So, community structure matters.