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Krissy Reinstatler, PharmD, BCPP, MBA
Clinical Pharmacy Specialist, Psychiatric Services and Addiction Sciences
UC Health University of Cincinnati Medical Center
CPNP Program Committee Member

Adverse childhood experiences (ACE), such as violence victimization, substance misuse in the home, or witnessing domestic partner violence, occur in approximately 60% of the US population.1 Exposure to ACE can evoke toxic stress responses leading to alterations of gene expression, brain connectivity and functioning, immune system function, and organ function. This has acute and long-term implications, including association with increased risk for alcohol and substance use disorders, suicide, mental health conditions, heart disease, and other chronic illnesses.1 Lower educational attainment, lack of health insurance, unemployment, and poor socioeconomic outcomes are all associated with ACE, and at least five of the ten leading causes of death are connected to ACE exposure.1 Recent studies have also demonstrated a link between parental ACE and developmental outcomes, behavioral problems, and poor overall health status in children.2 While everyone is at risk for ACE, inequities are attributed to historical, social, and economic environments.1

Research suggests ACE are preventable. Prevention is critical in addressing multiple public health and social challenges, as well as improving the lives of children, families, and communities. Data indicates preventing ACE might reduce the occurrences of diseases, such as depression, up to 44%.1 In 2011, the American Academy of Pediatrics published a call to action to address toxic stress and screen for childhood trauma; however, screening is still limited.2 The Centers for Disease Control and Prevention provides comprehensive guidance on ACE, including prevention strategies3, but integration into practice is not common. Awareness and education on evidence based strategies for prevention of ACE are imperative to address this public health crisis.

To assist clinicians in recognizing and addressing adverse childhood experiences, Katherine Lingras, PhD, LP will be speaking at the 2021 CPNP Annual Meeting.

Specific objects for Dr. Lingras’s talk include:

  1. Recognize risk factors and protective factors for adverse childhood experiences (ACEs) as well as best approaches to screening for ACEs.
  2. Describe the connections between ACEs and medical, social, and public health problems.
  3. Examine biological mechanisms by which exposure to early adversity negatively affects health outcomes.
  4. Review evidence-based strategies that can reduce or eliminate intergenerational spread of ACEs to improve lives of individuals, families, and communities.

Dr. Katherine (Katie) Lingras is an Assistant Professor in the Department of Psychiatry and Behavioral Sciences at the University of Minnesota College of Medicine and co-directs the Early Childhood Mental Health Program. Previously, she worked as a Psychologist at the New York Center for Child Development and held academic appointments at Columbia University Medical College, Weill Cornell Medical College, and hospital appointments with the Family Health Center of Harlem and New York Presbyterian Hospital.

Dr. Lingras specializes in social-emotional development in early and middle childhood, with particular emphasis on children who have experienced traumatic events. Her work is centered on community-based collaboration with pediatric primary care clinics and early childcare programs and focuses on early childhood psychology research, practical applications, and policy implications. Publications include work on aggressive behavior, social competence, risk, and resilience in children and families.

View course information


  1. Merrick MT, Ford DC, Ports KA, Guinn AS, Chen J, Klevens J, Metzler M, Jones CM, Simon TR, Daniel VM, Ottley P, Mercy JA. Vital Signs: Estimated Proportion of Adult Health Problems Attributable to Adverse Childhood Experiences and Implications for Prevention - 25 States, 2015-2017. MMWR Morb Mortal Wkly Rep. 2019 Nov 8;68(44):999-1005. doi: 10.15585/mmwr.mm6844e1. PMID: 31697656; PMCID: PMC6837472.
  2. Gillespie RJ. Screening for Adverse Childhood Experiences in Pediatric Primary Care: Pitfalls and Possibilities. Pediatr Ann. 2019 Jul 1;48(7):e257-e261. doi: 10.3928/19382359-20190610-02. PMID: 31305942.
  3. Accessed 10.16.20.
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