Matt Hirschfeld, MD/PhD Sarah Freeman, PharmD

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1 Matt Hirschfeld, MD/PhD Sarah Freeman, PharmD

2 Voluntary affiliation of 30 Alaskan tribes and tribal organizations providing health services to Alaska Natives/American Indians (7,000 employees) Each is autonomous and serves a specific geographical area 2

3 24% of all rural Native homes do not have adequate sanitation 3

4 A program managed by ANTHC Supports Tribal Health Partners statewide for: Both live (video) and asynchronous (store and forward) delivery of patient care through: Equipment Training Clinical programs Workflow processes 4

5 Oncology Cardiology Pediatric Endocrinology Pediatric Speech Language Pathology Adolescent Medicine (care delivered by Seattle Childrens Hospital) Breast Cancer Screening (care delivered by Mayo Clinic) Endocrinology Pulmonology HIV/EIS General Internal Medicine/Infectious Disease Neurology Dermatology Emergency Department Services Gastroenterology Hepatitis Nephrology Diabetes Rheumatology Many others are in development 5

6 Best Pediatric Endocrinologist in the State Dr. Rachel Lescher Sherry Hammock RN and diabetic educator Agnes Hunt The Brains behind the clinic

3 Peds SLPs on staff Alee Glass, Valerie

7 3 Peds SLPs on staff Alee Glass, Valerie Schmitz, Molly Lambert Hired 3 to help provide services to rural Alaska High rates of chronic ear infections leads to high rates of speech delay High rates of children with aspiration syndrome Telehealth to the regions

8 Vastly under-diagnosed across Alaska Mainly an access issue New diagnostic clinics Southcentral Foundation Norton Sound Telemedicine will be difficult for the diagnostic clinics, but follow-up has huge potential.

9 10 adverse childhood experiences surveyed: 1. Physical abuse 2. Sexual abuse 3. Emotional abuse 4. Emotional neglect 5. Physical neglect Witness domestic violence 7. Mental illness in home 8. Family member incarcerated 9. Alcohol/drug problems 10. Parental separation or divorce

10 Prevalence of ACEs in study group: Sexual abuse = 21% Domestic violence in childhood home = 13% Substance abuse in home = 28% Parental separation or divorce = 24% Physical abuse = 28% Emotional neglect = 15% Emotional abuse = 11% Physical neglect = 10% Mental illness in home = 20% Criminal household member = 5% M Dong et al. (2003) Child Abuse and Neglect v27, pp

11 Key finding: About 2/3rd of those surveyed reported at least one ACE. The 1/3 of participants with no reported ACEs were consistently healthier across all measures.

12 ACE score = total number of ACEs experienced. Examples: Childhood history of exposure to domestic violence only ACE score = 1 Childhood history of parental alcoholism and physical abuse ACE score = 2. Childhood history of physical neglect, sexual abuse, and parental divorce ACE score = 3. Up to a maximum score of 10. Key finding: higher ACE score = greater risk for health problems.

14 2013 Alaska BRFSS ACE SCORE All Alaskan Adults 35.6% 22.3% 14.7% 10.1% 6.5% 10.8% Age Group % 26.0% 15.9% 8.2% 5.8% 10.0% % 19.8% 15.5% 10.9% 8.4% 12.1% % 26.8% 10.5% 10.7% 6.2% 15.3% % 20.5% 13.6% 12.8% 6.3% 13.0% % 20.6% 16.7% 8.6% 5.9% 6.5% Gender Male 38.9% 22.5% 16.1% 8.5% 5.6%% 8.5% Female 32.0% 22.2% 16.1% 11.9% 7.5%% 13.2%

15 Stepwise increased risk for: Heart disease Asthma Diabetes Cancer COPD Skeletal fractures Sexually transmitted diseases Liver disease Autoimmune disorders Osteoarthritis Smoking Alcohol abuse Over eating and obesity Illicit drug use Promiscuity IV drug use Clinical depression And Autobiographical memory disturbance Poor anger control Relationship problems Employment problems Early age at first intercourse Teen pregnancy Unintended pregnancy Teen paternity Fetal death Suicide Domestic violence Anxiety disorders Hallucinations Sleep disturbances Chronic pain Headaches Early death

17 ACEs and Population Attributable Risks

18 Population Attributable Risks in Alaska Source: Alaska data from the 2013 Alaska Behavioral Risk Factor Surveillance System, Alaska Department of Health and Social Services, Division of Public Health, Section of Chronic Disease Prevention and Health Promotion, Graphic: AMHB/ABADA

Triple P Positive Parenting Program Gives parents practical strategies to: Build healthy family relationships Manage their children s behavior Prevent

19 Triple P Positive Parenting Program Gives parents practical strategies to: Build healthy family relationships Manage their children s behavior Prevent developmental problems Delivered in the Primary Care setting to target specific problem issue or behavior WSIPP benefit to cost ratio = $8.74

20 Triple P System Breadth of reach Intensive family Intervention... Broad focused parenting skills training... Narrow focus parenting skills training. Brief parenting advice Media and communication strategy. Level 5 Level 4 Level 3 Level 2 Level 1 Intensity of intervention

21 Lactation through telehealth to rural AK Lactation consultants based at ANMC Education for rural providers Direct to customer services

22 Centralized location of providers Lack of neurodevelopmental providers Therapies and payment for services Mental health services covered by primary care Technologic challenges (single video platform, inhome care delivery)

23 Questions or comments? Sarah Freeman Matt Hirschfeld

Trauma/ACEs 101. Tom Bradach IL Chapter, American Academy of Pediatrics

Trauma/ACEs 101. Tom Bradach IL Chapter, American Academy of Pediatrics Trauma/ACEs 101 Tom Bradach IL Chapter, American Academy of Pediatrics Providing pediatrician and interprofessional education, resources, and technical assistance Working on policy, advocacy, and systems