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Promoting Early and lifelong health Promoting Early and lifelong health

Promoting Early and lifelong health - PowerPoint Presentation

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Promoting Early and lifelong health - PPT Presentation

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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Slide1

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

7Slide8

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

8Slide9

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

10Slide11

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

17Slide18

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

31Slide32

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

32Slide33

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

33Slide34

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