1 Addressing Childhood Trauma Optimizing Use of the National Survey of Childrens Health January 25 2017 PM 230400PM ET Christina Bethell PhD MBA MPH Johns Hopkins Bloomberg School of Public Health ID: 764537
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1 Addressing Childhood Trauma: Optimizing Use of the National Survey of Children’s HealthJanuary 25, 2017PM 2:30-4:00PM ETChristina Bethell, PhD, MBA, MPHJohns Hopkins Bloomberg School of Public HealthChild and Adolescent Health Measurement InitiativeDepartment of Population, Family and Reproductive Health
Pr omote Early and Lifelong Health of Childre n, Y outh and Families(using family centered data and tools) I n spire and Inform T r a n s f ormational Partnerships A ctionable Data & Data-Driven Tools Identify Shared Transformative GoalsFor Child & Family Health Bethell, C 2016
3 Promoting early and lifelong health leveraging prevention and human development sciences. A Critical Goal:Optimize the capacity of Medicaid to drive and ensure efforts at the individual, family, community and systems levels to effectively address social and emotional determinants of health, like ACEs, to promote positive health resilience and well-being among children, youth and families. ….and catalyze and epidemic of health for generations to come!
Hard Science Reveals Requirements for Healthy Development and Well-Being If regulation requires connection—what does “self-regulation” mean? Source: Bethell, C 2016
ACEs Skeletal Fractures Relationship Problems Smoking General Health and Social Functioning Prevalent Diseases Sexual Health Risk Factors for Common Diseases Hallucinations Mental Health ACEs Impact Multiple Outcomes Difficulty in job performance Married to an Alcoholic High perceived stress Alcoholism Promiscuity Illicit Drugs Obesity Multiple Somatic Symptoms IV Drugs High Perceived Risk of HIV Poor Perceived Health Ischemic Heart Disease Sexually Transmitted Diseases Cancer Liver Disease Chronic Lung Disease Early Age of First Intercourse Sexual Dissatisfaction Unintended Pregnancy Teen Pregnancy Teen Paternity Fetal Death Depression Anxiety Panic Reactions Sleep Disturbances Memory Disturbances Poor Anger Control Poor Self-Rated Health
Da ta Resource Center
Prevalence Among US Children (2011-12 National Survey of Children’s Health) Prevalence of 2+ (of 9) ACES: 16.3% (UT) – 32.9% (OK )Bethell, C, Newacheck, P, Hawes, E, Halfon, N. Adverse childhood experiences: assessing the impact on health and school engagement and the mitigating role of resilience. (2014) Health Affairs Dec; 33(12);210-2016 Source: Bethell, C 2016
10 Source: Bethell, C 2016
Impacts on chronic condition status appear early in life. Bethell, C, Newacheck, P, Hawes, E, Halfon, N. Adverse childhood experiences: assessing the impact on health and school engagement and the mitigating role of resilience. (2014) Health Affairs Dec; 33(12);210-2016 Source: Bethell, C 2016
Prevalence and Adjusted Odds Ratio of EMB Conditions, by ACEs Status and Age, Data: 2011-12 NSCH
Equally Unequal: Similarities of Impact Across Income Groups Prevalence of Emotional, Behavioral of Developmental Problems Among Children with 4+ ACEs: By Household IncomeRich or poorThe withholding of lovePiercesMay you be led to the mysterious transfiguration this piercing can allowAnd open to the truth from within like the nautilus closing off all former layers And slowly, patiently rising up into the love that always was Mirrored or notAlways wasAlways will be Excerpt from “Breaking Ground” Christina Bethell Bethell, C 2016
Nearly 2/3 of children with public sector insurance coverage carry ACEs, such as physical and emotional abuse and neglect, substance abuse or mental illness in the home, justice-involved family members, exposure to violence, and extreme poverty. 63.8% Public. 36.6% Private. 58.4% Uninsured
Maternal Health and Child Health
School Engagement Rate Among Children With Special Health Care Needs Exposed to 2+ Adverse Childhood Experiences: By Demonstration of Resilience Bethell, C 2016“You can go good places with your mind if you can’t go good places with your body. “ Stephen Porges, PhDProfessor Emeritus, University of Illinois at Chicago. Director, Brain Body Center in the Department of Psychiatry. Author: The Polyvagal Theory
Child Protective Factors Prevalence of School Success Factors Among US Children Age 6 to 17 with EMB Conditions and 2 + ACEs by Resilience Status. Data: 2011-2012 NSCH
Flourishing and Adverse Childhood Experiences (US Children Age 6-17 )
Flourishing and ACEs (2+) Among School Age Chidlren 44% CA to 25.8 NYZero ACEs: 62.9% ND to 44.7% DC
Public vs. Privately Insured Children Higher ACEs, Similar Across State Variation(www.childhealthdata.org)
Relationship and Family Level Protective Factors Prevalence of Resilience A mong Children with EMB Conditions and 2+ ACEs Exposures by Key P rotective F actors. Data: 2011-2012 NSCH
Percent estimates and estimated mean of total health care expenditur es among mind–body users and nonusers statistically significant at p≤05 . Use of Mind–Body Approaches and M ean of Total Conventional Medical Care Expenditures: Children with EMB Conditions and ADD/ADHD. Data: 2007 NHIS and NHIS-Child CAM Supplement and 2008 MEPS