Adverse Childhood Experiences Efforts

Transcription

1 Shasta County Adverse Childhood Experiences Efforts Andrew Deckert, MD, MPH Health Officer Public Health Branch Shasta County - HHSA

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4 KIXE ACEs Commercial

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6 The Impact: Chronic Illness, early mortality

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8 The risk of delay: ACEs accumulate over time Most children accumulate ACEs over the course of childhood. A multi-site study of children exposed to or at risk for maltreatment found that ACEs accumulate over time.

9 Who is the National Pediatric Practice Community on ACES for? Pediatric-focused primary care medical providers (physicians, nurses, and medical assistants) and their teams Medical practices at any stage of implementation of ACEs screening and intervention

10 What does the National Pediatric Practice Community offer? Virtual offerings Peer exchange Resources for practice Co-designed Community of Practice Shared lessons learned from experienced practitioners Opportunities for deeper engagement Latest relevant scientific information

11 Trauma and Social Location Adverse Childhood Experiences Historical Trauma Embodiment

12 Number of ACEs 3 Average number of ACEs by race/ethnicity (range 0-8) American Indian Asian/Pacific Islander Black Hispanic White

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18 Educating people about ACEs. Engages people you serve by helping them understand their own lives and behavior Empowers people Changes their understanding of others behavior Opens a channel for them to tell you what they need

19 : 40 Developmental Assets community effort 2008: HO pitching the science of original ACE study internally to Public Health staff in meetings : HO giving ACE PowerPoint presentations to the Shasta County Public Health Advisory Board, Mental Health Alcohol and Drug Advisory Board, Federally Qualified Health Centers, and all Public Health Branch staff etc

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21 Vision A connected community for strong, safe families. Mission Strengthen families and reduce Adverse Childhood Experiences (ACEs) by increasing protective factors, coordinating service systems and engaging the community.

22 Parental Resilience Strengthening Families Framework Social and emotional competence of children Concrete support in times of need Social Connections Knowledge of parenting and child development

23 ACE Prevalence Surveys, Shasta vs CA, 2012 California Shasta County 4 or more ACEs 16.7% 39.7% 2-3 ACEs 23.3% 32.2% 1 ACE 12.1% 21.7% 0 ACEs 16.1% 38.3%

24 The most common reported ACES, Shasta vs CA, 2012 Incarcerated Family Member 6.6% 17.1% SexualAbuse 11.4% 21.2% California ShastaCounty Witnessed Domestic Violence 17.6% 29.7% PhysicalAbuse 19.9% 34.8% Household Mental Illness 15.1% 43.8% Parental Separation or Divorce 26.7% 44.3% VerbalAbuse 35.0% 54.5% Family Substance Abuse 26.2% 57.7%

25 Prevalence of Household Substance Abuse by Education Level, Shasta County ACE Survey, % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% High School or Less Some College/Associate's Degree Bachelor's or Higher

26 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% Prevalence of 4+ ACEs by Educational Attainment, Shasta County % High School or Less Some College/Associate's Degree Bachelor's or Higher

27 100% Prevalence of Childhood Sexual Abuse Shasta County, ACE Survey % 80% 70% 60% 50% 40% 30% 20% 10% 0% Male Female

28 Prevalence of ACEs by Race/Ethnicity, Shasta County % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Household Mental Illness Sexual Abuse Latinx White, non-hispanic People of Color, non-hispanic

29 An ACEs Story

30 ACE presentation to Women s Fund 2012

31 Dr. Felitti Grand Rounds at Mercy Medical Center Redding, 2014

32 Dr. Petterson Training Event September 2015

33 Shasta County Community Health Assessment

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36 ACE Screening Identify screening tools Support with training and technical assistance Public Health to help coordinate referrals Parent Cafes and Parenting Classes Incentives for families Thanks to Partnership Health Plan for awarding HHSA - Public Health Branch $50,000 Social Determinants of Health Planning Grant to support this effort.

37 Mercy Maternity Clinic Survey offered at first prenatal visit 300+ surveys collected to date Referred to our Healthy Babies Program

38 Mercy Family Health Clinic Screening with OB patients and in behavioral health counseling clinic Trained residents on ACE screening; want annual refresher Referrals starting to be made

39 Hill Country Community Clinic ACE screening patients for fit for an addiction program (Suboxone) ACE embedded in EHR Supporting them as needed

40 Hill Country ACEs Screening Tool

41 Shasta Community Health Center Attended Center for Youth Wellness Conference Screening parents at the 4- month well baby check-up Starting to screen in their family practice program

42 Shasta Community Health Center Pediatric ACE Questionnaire

43 One SAFE Place Received California Endowment funding Screening residents and some children Training and screening tool support from staff

44 Shasta County Women s Refuge (aka One SAFE Place) ACEs Data Report July 1, 2016 June 30, 2017 Household Substance Abuse Witnessed Domestic Violence 50% 44% 54% 26% 56% 49% Physical Abuse 68% 42% 54% 43% Sexual Abuse Emotional Neglect n=161 clients Parent Separation/Divorce Physical Neglect

45 Shasta County ACEs Referral Guide

46 ACE Referral Card - one phone # for clinicians

47 An ACEs Story

48 What can we do about ACE: Evidence Informed Approaches

49 Shasta County Community Health Improvement Plan

50 Nurse Family Partnership Success Story February 2017 In court, the nurse testified that Jennifer was severely impacted by Adverse Childhood Experiences (ACEs), and she required guidance, patience, structure and routine to succeed success that she had seen Jennifer* achieve during her time with NFP. The nurse also testified that separating the new baby from her mother would likely continue the cycle of ACEs for another generation. The judge was moved by the research presented about childhood trauma and its connection with addiction, and recognized significant improvement in Jennifer since her last court appearance. *Client s name has been changed

51 ACEs Town Hall Forum, April 2017 ACEs Town Hall Forum April 2017

52 ACEs Town Hall Forum, April 2017 Shasta Strengthening Families Rack Card

53 Dr. Robert Anda training Shasta County community leaders ACE Community Leader Luncheon May 19, 2017

54 Parent Cafes May 2017

55 ACE Champions Training June 2017

56 Shasta Strengthening Families website Request an ACEs presentation

57 Shasta County ACE Dashboard Indicators October 2017

58 Shasta Strengthening Families Community ACE Prevention Framework 2017

59 Shasta County HHSA Public Health Branch New Social Emotional Resiliency Unit 2017

60 Shasta County Provider News Publication of Shasta County Public Health Branch

61 Shasta County Public Health Branch Strategic Plan

62 Other Community Efforts Training in schools on the neurological model developed by Bruce Perry, MD at the Child Trauma Academy Triple P: Positive Parenting Program Help Me Grow: a project of First 5 Shasta

63 An ACEs Story

64 2018 WHAT HOW WHY? WHY We believe Adverse Childhood Experiences can be prevented and healed in the individuals and collective communities of Shasta County.

65 WHAT HOW HOW? Tell everyone you know Grassroots/Grass top community ownership of ACE Create institutional change WHY We believe Adverse Childhood Experiences can be prevented and healed in the individuals and collective communities of Shasta County. Build trust with the community Research & data driven Educate with trauma informed care Support families with protective factors

66 WHAT? Strengthening Families Collaborative (SFC) Learning Community educate with Commercial, Intro, Core ACE Interface Presentations Find inside Champion ACE Interface Workshop presentations Trainers working within sphere of influence Strengthening Families Collaborative PSAs/Town Hall/website/social media Tell everyone you know Fidelity to ACE Interface Grassroots/Grass top community ownership of ACE Create institutional change WHAT HOW WHY We believe Adverse Childhood Experiences can be prevented and healed in the individuals and collective communities of Shasta County. Build trust with the community Share success stories/social media Educate om historical trauma Research & data driven Educate with trauma informed care Brain Breaks Support families with protective factors Screen for ACEs Asset Map 5 Protective Factors SFC Date Committee creates Data Dashboard Success Stories/research from other communities SFC Parent Cafes SFC Table Host Trainings 40 Developmental Assets Local Family Resources

67 ACEs Town Hall Forum, April 2017 ACEs Town Hall Forum May 2018

68 Whole Child Assessment in Spanish

69 Partnering with ACE Interface Community ACEs Prevention Plan Data Dashboard to track outcomes ACE Interface Master Training and licensed materials Ongoing technical support and follow up sessions

70 Future Possible ACE Efforts We are long overdue for a national awareness campaign similar to public health initiatives on how seat belts save lives, smoking causes cancer, and hand washing prevents flu to educate physicians and families on how childhood trauma begets adult illness. Donna Jackson Nakagawa

71 Future Possible ACE Efforts

72 The solution of all adult problems tomorrow depends in large measure upon the way our children grow up today. - Margaret Mead, Anthropologist Regional Child Abuse Prevention Councils 2011

73 Resources for ACEs CDC website ACEs Policy Data and Resources about the health of children ACEs Connection To do your own ACEs test For more information contact: Andrew Deckert, MD, MPH Health Officer Shasta County Health & Human Services Agency Public Health Branch (530)