The problem of Adverse Childhood Experiences and the promis e of resilience High Level Review of Potential Areas of Focus for a Child Health Services Research and Action Agenda Christina Bethell PhD MBH MPH ID: 376040
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Promoting Early and lifelong healthThe problem of Adverse Childhood Experiences and the promise of resilienceHigh Level Review of Potential Areas of Focus for a Child Health Services Research and Action AgendaChristina Bethell, PhD, MBH, MPHFebruary 10, 2015National Child Health Policy Conference Overview
“It is easier to build strong children than to repair broken men.”
Frederick Douglass (1817–1895)Slide2
National and State Data on Adverse Childhood Experiences and Resilience FOR CHILDREN (2011-12 NSCH (HRSA/MCHB/CDC)State Variation In Prevalence of 2+ (of 9) ACES16.3% (UT) – 32.9% (OK) across states.2
5/13/13Christina Bethell, PhD, MPH. ACES & Resilience CAHMI AH Project OverviewSlide3
3Adverse Child Experiences: NSCH Adverse Childhood Experiences
National Prevalence
State Range
Child had
one
or more
Adverse Child or Family Experiences
47.9%
40.6% (CT) - 57.5% (AZ)
Child had
two or more
Adverse Child or Family Experiences
22.6
%
16.3% (NJ) -
32.9% (OK)
Extreme
economic hardship
25.7%
20.1% MD – 34.3% (AZ)
Divorce/separation of parent
20.1%
15.2% (DC) – 29.5 (OK)
Death of parent
3.1%
1.4%
(CT) – 7.1% (DC)
Parent served time in jail
6.9%
3.2% (NJ)
– 13.2% (KY)
Witness to domestic violence
7.3%
5.0%
(CT) – 11.1% (OK)
Victim or witness of neighborhood violence
8.6%
5.2% (NJ) – 16.6% (DC)
Lived with someone who was mentally ill or suicidal
8.6%
5.4% (CA)
– 14.1% (MT)
Lived with someone with alcohol/drug problem
10.7%
6.4% (NY) –
18.5% (MT)
Treated or judged unfairly due to race/ethnicity
4.1%
1.8% (VT
) – 6.5% (AZ)Slide4
Christina Bethell, PhD, MPH. ACES & Resilience CAHMI AH Project Overview4Slide5
Project BackgroundCore Leadership and Coordinating Team:CAHMI: Christina Bethell; Michele Solloway; Dave Ford; Caitlin Murphy (others)AcademyHealth: Lisa Simpson; Aditi Srivastav (others)Slide6
CAHMI Strategy (since 1997)Family-Centered, Data Driven Partnerships to Promote Early and Lifelong HealthPromote ChildHealth andSystem
Excellence
Inspire and Inform
Innovate and Act
Discern and Develop
Transformational
Partnerships
Actionable Data &
Data-Driven Tools
Transformative Goals
For Child HealthSlide7
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AcademyHealthAcademyHealth is a leading national organization serving the fields of health services and policy research and the professionals who produce and use this important work. Together with our members, we offer programs and services that support the development and use of rigorous, relevant and timely evidence to:Increase the quality, accessibility and value of health care,Reduce disparities, andImprove health.
A trusted broker of information, AcademyHealth
brings stakeholders together to address the current and future needs of an evolving health system, inform health policy, and translate evidence into action.
Christina Bethell, PhD, MPH. ACES & Resilience CAHMI AH Project Overview
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CAHMI and AcademyHealth Partnership (with you!) Focus:Transforming the roles of health providers and health systems to identify, prevent and address ACEs in their communities and promote healing and positive health attributes that may buffer, prevent and attenuate the intergenerational cycle of ACEs.Partnership activities will result in: an agenda on research and policy priorities to address ACEscommunications infrastructure Special journal issue APHA and set of field building/advancing articlesMaterials to engage the field in continued development, collaboration and collective actionFunding: CAHMI and Robert Wood Johnson FoundationChristina Bethell, PhD, MPH. ACES & Resilience CAHMI AH Project Overview
9Slide10
Project ScopeThe project will focus at three levels on this issue:The clinician/family level The healthcare organization level, including hospitals, clinics, and health plans.The health policy levelFor each level, we are asking: What do we know about ACEs and promoting child development and well-being.What do we know about how ACEs are currently addressed?What evidence exists? What research questions are of highest priority to address?What actions can be taken at each level?
Christina Bethell, PhD, MPH. ACES & Resilience CAHMI AH Project Overview
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Christina Bethell, PhD, MPH. ACES & Resilience CAHMI AH Project Overview11Broader CAHMI Focus and PartnershipsSlide12
Achieving a WHOLE Population EffectThe bigger landscape for work
Data Collection and
Analysis
Research, Interpretation
And Dissemination
Training, dialogue,
tools, techniques
Field Trials:
Trauma Informed Communities
and Care
Field Trial Evaluation
And Learning
1
.
Population Effect
& Public Acceptance
Adjustments and
Spread to Scale
Tools, Trainings,
Curriculum
Consulting, Strategy,
Collective ImpactSlide13
13Our Audacious Yet Humble AspirationsWe would judge the overall nine month (now 24 months) project co-led by CAHMI and AcademyHealth to be successful if one or more of the following is accomplished:A prioritized child health services research and policy agenda is widely distributed to key stakeholders and funders;A set of field advancing/research papers published and widely distributedThe agenda and communications materials are distributed to key actors who use them in their advocacy/action strategies; and/or
New connections are formed between essential actors in this country and internationally that advance a collective impact around childhood trauma prevention & healing and family well-being
.Christina Bethell, PhD, MPH. ACES & Resilience CAHMI AH Project OverviewSlide14
14Addressing key health services & policy research domains for each key action area and priority populations and possibilities (pre-meeting input)Critical HSR/P Area Emerging from Pre-Meeting Co-Digital Input and DialogueDesign and develop new research and knowledgeTranslate and integrate existing knowledge1. Organization & financing of health systems and servicesProblemsPossibilitiesPriority
questionsPriority Populations
Existing and Promising PracticesExisting and Potential Partnerships2. Access & coordination of services & resources
3.
Practitioner & family engagement, communication & behavior
4. Measurement, informatics & clinical decision making
5.
Health professions work force capacity, training & support
6.Clinical evaluation & outcomes research
Christina Bethell, PhD, MPH. ACES & Resilience CAHMI AH Project OverviewSlide15
Emerging Scope of AgendaSix Fundamental Health Services and Policy Research DomainsChristina Bethell, PhD, MPH. ACES & Resilience CAHMI AH Project Overview15Slide16
Agenda and Communications Process and MethodsDiscovery phaseSynthesis phase Dissemination phase Christina Bethell, PhD, MPH. ACES & Resilience CAHMI AH Project Overview16Slide17
Steps for Building an Agenda1) Review goals, strategies and/or priorities and conduct a research needs assessment.2) Review existing supporting research and identify gaps in current available research (or gaps in awareness of gaps).3) Determine additional research needed and assess funding innovations and resourced options and research resources/skills capacity.4) Prioritize existing and additional research based on criteria.5) Align research to goals, strategies, priorities, and add effectiveness indicators.6) Link research to other plans and initiatives.7) Establish timeline and trajectories envisioned for research and action8) Share with the broader constituency groups for feedback and information sharing.9) Adjust research agenda accordingly based on feedback.10) Promote and foster implementation of the research agenda, and conduct ongoing
review research and reevaluate research agenda.Christina Bethell, PhD, MPH. ACES & Resilience CAHMI AH Project Overview
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Discovery: Process and MethodsMarch-June 2014: Convene starting working group and specify goals and priorities for summit meeting and agendaMarch-June ‘14 and Ongoing: Conduct an environmental scan of research and initiativesJune 5-6, 2014: Convene early stage partners to review and further specify goals, priorities and to strengthen relationships, collaboration and facilitate shared visionChristina Bethell, PhD, MPH. ACES & Resilience CAHMI AH Project Overview18Slide19
Synthesis: Process and MethodsJuly-September ‘14: Convene working group to agree on core summit meeting summary and core themes and components for emerging research agendaidentify topics and focus for a series of papers to commission and publish on what is known and recommendations for research and action.further refine the environmental scan and project nicheOctober-December ‘14: Invite and gain agreement from identified candidate paper author leads. March ‘14-ongoing: propose and procure additional funding to ensure full funds available to commission all envisioned papers and public special journal issue5/13/13Christina Bethell, PhD, MPH. ACES & Resilience CAHMI AH Project Overview19Slide20
Synthesis: Process and MethodsJanuary-March ‘14: Launch start of commissioned papers (to be completed Summer, 2015)April-December ‘14: Research and write baseline paper on ACEs in children in the US (Health Affairs, December ‘14)July-November ‘14: Assess capacity of NSCH to produce local reports on ACEs and develop for key ACEs summit meetings focused on counties/cities.July ‘14-January ‘15: Develop short video based on June meeting; Develop a basic web presence to communicate about the project and continue to update and convene working groups as possible and needed.Christina Bethell, PhD, MPH. ACES & Resilience CAHMI AH Project Overview20Slide21
Dissemination: Process and MethodsSeptember-ongoing: Submit abstracts and proposals to report on and further evolve a collective action approach to advancing the promotion of early and lifelong health through an effective approach to ACEs.October-February 2014: Plan for and conduct a special panel at National Child Health Policy Conference in DC—early review and dialogue on agendaFebruary-December 2015: Publish papers; complete version 1.0 of agenda; complete “Champions Toolkit”; evolve project; disseminate; Christina Bethell, PhD, MPH. ACES & Resilience CAHMI AH Project Overview21Slide22
Agenda Setting Input and Status Slide23
CO-Digital Collective Insight QuestionsQuestion 1: What should the specific goals of our community be related to ACEs and resilience? (e.g. the child health services research and policy community.Question 2: What research and policy domains and questions are highest priority.Questions 3: What are the research questions, policy actions and existing efforts to consider as priorities in an agenda.Christina Bethell, PhD, MPH. ACES & Resilience CAHMI AH Project Overview23Slide24
Emerging Agenda ComponentsThree interlocking components comprise the emerging research and action agenda as outlined below. Component #1: Functions and Types of ResearchComponent #2: Priority Topics and Focal AreasComponent #3: Short Term Collaborative Actions Christina Bethell, PhD, MPH. ACES & Resilience CAHMI AH Project Overview24Slide25
5/13/13Christina Bethell, PhD, MPH. ACES & Resilience CAHMI AH Project Overview25Slide26
Top 3 Ideas: What Should the Goals Be?Christina Bethell, PhD, MPH. ACES & Resilience CAHMI AH Project Overview26Slide27
Christina Bethell, PhD, MPH. ACES & Resilience CAHMI AH Project Overview27Slide28
Top 3 Ides:What are priority domains and questionsChristina Bethell, PhD, MPH. ACES & Resilience CAHMI AH Project Overview28Slide29
Christina Bethell, PhD, MPH. ACES & Resilience CAHMI AH Project Overview29Slide30
Top 3 Ideas: Existing Efforts and Knowledge to Build OnChristina Bethell, PhD, MPH. ACES & Resilience CAHMI AH Project Overview30Slide31
Component #1: Functions and Types of ResearchDesign & Develop: synthesize existing knowledge and design and develop new translational knowledge, methods, and tools Implement & Evaluate: adapt, implement, and evaluate existing and emerging strategies to prevent and buffer impact of ACEs to promote well-beingEducate & Communicate: assess existing awareness and contribute to public, provider and stakeholder education and awareness, knowledge and action. Disseminate & Support: develop methods and capacity to scale, spread and support effective prevention, intervention, and training models in the field5/13/13Christina Bethell, PhD, MPH. ACES & Resilience CAHMI AH Project Overview
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Component #2: Priority Topics and Focal AreasMeanings and Measures: Advance standardization of definitions, measures, and dataCore Science: Promote research to address gaps in science especially pertinent to policy and practice Public Health: Understand public health impact and opportunities for translation of knowledge into public health practiceCommunities: Know what a healthy community is and how to address ACEs through community based collaborations and efforts Economics: Define and measure economic impact of ACEs and return on investment through effectively addressing ACEs 5/13/13Christina Bethell, PhD, MPH. ACES & Resilience CAHMI AH Project Overview
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Component #3: Short Term Collaborative Actions Move the Game Board: Define a conceptual map and model to clarify definitions and foster shits in mindset and norms to facilitate collective action Continuous Translation and Improvement: Synthesis, dissemination, translation, and ongoing assessment of existing models, methods, and practices Training and Capacity Building: Provider, community, and family education and training Policy platform and demonstration: Define recommendations to align health reform and systems design with needs and health improvement opportunities5/13/13Christina Bethell, PhD, MPH. ACES & Resilience CAHMI AH Project Overview
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Possible Questions to ConsiderWhat should be the goals of the child health policy community be related to ACEs and resilience and positive health development?What research questions, program and policy actions and current programs should be considered as priorities in an agenda? Why is now a good time for a broader focus on ACES in health policy? Christina Bethell, PhD, MPH. ACES & Resilience CAHMI AH Project Overview34Slide35
(OR) Possible Questions to ConsiderWhy is now a good time for a broader focus on ACES in child health policy?What will it take for the child health policy community and health care system to respond to ACES?What do health policymakers, program leaders and the public need to know about ACES? What are the most significant barriers to an improved policy response to ACES? If there is one thing you could change in health policy to make progress on ACES, what would it be?Christina Bethell, PhD, MPH. ACES & Resilience CAHMI AH Project Overview35Slide36
Partnering and ParticipationVisit the AMCHP CAHMI DRC booth #6 and poster #PA5 (Sunday PM and Monday AM)www.cahmi.org (select adverse childhood experiences under “projects”)www.academyhealth.org/ACESinfo@cahmi.orgmsolloway@cahmi.orgaditi.srivastav@academyhealth.org5/13/13Christina Bethell, PhD, MPH. ACES & Resilience CAHMI AH Project Overview36Slide37
There is no greater agony than bearing an untold story inside youMaya Angelou5/13/13Christina Bethell, PhD, MPH. ACES & Resilience CAHMI AH Project Overview37