Whole Population Well-Being When our science, lived experience and - PowerPoint PPT Presentation

Whole Population Well-Being When our science, lived experience and policies meet Ours is a social brain. Preventing and healing developmental trauma is a matter of public health. Knowledge about the biology of human relationships, brain plasticity, epigenetics and social determinants of health making doing so imperative.

Prioritize Possibilities Advances in the sciences of human development create unprecedented opportunities to proactively advance child well-being. Breakthrough findings across disciplines point to a new science of thriving that illuminate often untapped capacities for the promotion of healthy development and healing despite adversity. Given high rates of adversity, healing is prevention. Key to this possibility are policies and practices that enable and support families and communities to recognize and learn to heal and flourish in the face of stress and adversity.

Leveraging Existing Policies to Promote Child and Family Well-Being and Address Adverse Childhood Experiences Christina Bethell, Johns Hopkins University, CAHMI Mark Wietecha, Children’s Hospital Association Lacy Fehrenbach, Washington State Department of Health Richard Antonelli, Harvard-Pilgram Health System Jeffrey Schiff, Minnesota Department of Human Services, Medicaid

National Health Policy Conference, February 5, 2018 The presenters document that they have no financial relationships to disclose or conflicts of interest to resolve.

Mark Wietecha- Children’s Hospital Richard Antonelli – Harvard-Pilgram Health Association System, Boston Children’s Hospital “Cannon to the right of them “The woods are lovely, dark and deep, Cannon to the left of them Cannon in front of them But I have promises to keep, Volleyed and thundered And miles to go before I sleep, And miles to go before I sleep. Robert Frost Stormed at with shot and shell Boldly they rode and well…” Tennyson Lacy Fehrenbach - WA State Department of Health Jeffrey Schiff, Minnesota Department of “An open door days, ‘Come in.’ Health, Medicaid A shut door says, ‘Who are you?’ “All the ‘ woulda-coulda-shouldas ’ layin ’ in the sun Talkin ’ bout the things they woulda-coulda- Shadows and ghosts go through shut doors. shoulda done If a door is shut and you want it shut, why open it? But those woulda-coulda-shouldas all ran away If a door is open and you want it open, why shut it? and hid Doors forget but only doors know what it is doors forget. From one little ‘did’. Carl Sandburg

Panel Agenda 2:45-3:00: Introductions and Laying the Groundwork for Dialogue 3:00-3:25: Question #1 : Why are hospitals, state agencies and health systems interested? Impications for existing policies and payment and practice transformation efforts? 3:25-3:45: Question #2 : What’s in the way? What’s possible now? Policy actions and opportunities? 3:45-4:00: Panel Dialogue 4:00-4:15 Audience Dialogue NHPC 2018-Leveraging Policy for Well-Being and Addressing ACEs

Coverage & Coding Communication Within Costs and and Across Partners Payment and Patients The 7C’s of Policy and Practice Translation Contracting, Coordination Accountability, Within and Across Data Credentialing & Capacity & Integration Training Child and Adolescent Health Measurement Initiative

ACEs are a risk factor for trauma, toxic stress and neuro-endocrine-immune effects http://www.acesconnection.com/collection/aces-101 Source: Bethell, C 2016 Truth About ACESs Infographic Robert Wood Johnson Foundation . NHPC 2018-Leveraging Policy for Well-Being and Addressing ACEs 9

ACEs Impact Multiple Outcomes Relationship Married to an Poor Self- Smoking Problems Alcoholic Rated Health Alcoholism High perceived Difficulty in job Hallucinations Promiscuity stress performance High Perceived Depression Obesity General Health and Sleep Risk of HIV Social Functioning Disturbances Risk Factors for Mental Common Diseases Health Memory Disturbances Poor Perceived ACEs Illicit Drugs Anxiety Health IV Drugs Panic Reactions Prevalent Sexual Multiple Somatic Poor Anger Health Diseases Symptoms Control Cancer Liver Disease Teen Paternity Fetal Death Skeletal Chronic Lung Teen Unintended Fractures Disease Pregnancy Pregnancy Sexually Early Age of Ischemic Heart Disease Sexual Dissatisfaction Transmitted First NHPC 2018-Leveraging Policy for Well-Being and Addressing ACEs Diseases Intercourse

When a baby feels safe, they explore and if a baby The neuroendocrine immune biology of explores, they learn. stress is understood… NHPC 2018-Leveraging Policy for Well-Being and Addressing ACEs

ACEs and Toxic Stress: Impact Pathways “You can go good places with your mind if you can’t go good places with your body. “ Stephen Porges, PhD Professor Emeritus, University of Illinois at Chicago. Director, Brain Body Center in the Department of Psychiatry. Author: The Polyvagal Theory “Without mindfulness, there is no therapy. Mindfulness is a necessary state to be in to live your life. All growth occurs because you are in a state of mindfulness. Without mindfulness, there is no growth.” Bessel van der Kolk Professor of Psychiatry, Boston University. Author : Treating Traumatic Stress in Children and Adolescents “The Body Keeps the Score” NHPC 2018-Leveraging Policy for Well-Being and Addressing ACEs

Creating an empowered relationship to The event(s) or circumstance(s) adversity…… Event(s) causing actual or perceived physical or psychological harm It’s not what’s wrong with you, it’s what One’s experience of the event – differs Experience happened to across individuals – depends on you. beliefs, availability of supports, developmental stage, meaning making It’s not what happened to The resulting effects or symptoms – Effects you, it’s how did neurobiological and behavioral it impact you? adaptations It’s not how did Trauma it impact you, it’s what can we do now to heal? Source: SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach (2014) NHPC 2018-Leveraging Policy for Well-Being and Addressing ACEs

14 Prevalence of ACEs Among Adults in 18 States Assessing ACEs Statewide BRFSS 36.10% 26.00% 15.90% 12.50% 9.50% No ACEs 1 ACE 2 ACEs 3 ACEs 4+ ACEs http://acestoohigh.com/got-your-ace-score/ NHPC 2018-Leveraging Policy for Well-Being and Addressing ACEs

Source: Harvard Center for the NHPC 2018-Leveraging Policy for Well-Being and Addressing ACEs Developing Child, 2018

Diseases of Dispair NHPC 2018-Leveraging Policy for Well-Being and Addressing ACEs

Those with two or more ACEs varies from15.0% (NY) to 30.6% (AZ). Most children with any one ACE had at least one other, ranging from 54.4% to 95.4%. NHPC 2018-Leveraging Policy for Well-Being and Addressing ACEs

Minimal Measure of Flourishing, Health Problems and Adverse Childhood Flourishing Experiences (US Children Age 6-17) (based on factors possible for parents to observe): 120.0% 1.Motivation: Curious and interested in learning new things 100.0% Flourishing 2.Resilience : Stays calm and in control when 82.9% 80.0% faced with a challenge 75.6% 3.Attention : Follows 64.2% through and finishes 60.0% At least 1 tasks 55.4% 53.8% health 46.3% problem 40.0% 38.7% 29.5% 24.8% 21.7% Flourishing 20.9% 20.0% 16.0% w/Health Problem 0.0% None of 9 1 ACE 2-3 ACEs 4+ ACEs ACEs NHPC 2018-Leveraging Policy for Well-Being and Addressing ACEs

Equally Unequal: Similarities of Impact Across Income Groups Prevalence of Emotional, Behavioral of Developmental Problems Among Children with 4+ ACEs: By Household Income All Children 400% Federal Poverty Level 200-399% Federal Poverty Level 100-199% Federal Poverty Level 0-99% Federal Poverty Level 50.0% 41.8% 37.7% 37.2% 35.4% 40.0% 30.0% 14.2% 20.0% 10.0% 0.0% Prevalence of Emotional, Behavioral or Developmental Problem NHPC 2018-Leveraging Policy for Well-Being and Addressing ACEs

“Led by a new paradigm, scientists adopt new instruments….and see new and different things when looking with familiar instruments.” Thomas Kuhn, The Structure of Scientific Revolutions, 1962 NHPC 2018-Leveraging Policy for Well-Being and Addressing ACEs Source: Bethell, C 2016

Chicken or egg questions — is it trauma or is it ADHD? Prevalence of Emotional, Mental or Behavioral Problems Identified by the CSHCN Screener, by Resilience and ACEs, age 6-17 years 30% 28.5% 25% Prevalence of emotional, mental or behavioral conditions 3.6 times 20% 17.4% lower among children who experience 2 or more Adverse 15% 11.9% Childhood Experiences when they 10% are taught resilience 4.8% (all US children ages 6-17) 5% 2.1% 1.3% 0% No ACEs 1 ACE 2+ ACEs Usually/always bounces back quickly when things don't go his/her way (has this aspect of resilience) Never/sometimes bounces back quickly when things don't go his/her way (no resilience) NHPC 2018-Leveraging Policy for Well-Being and Addressing ACEs