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The Science of Preventing ACEs in a Pandemic: Key Concepts Guiding the Work

 

SCIENCE AND COMPASSION 

The 100% Community initiative is a radically simple data-driven strategy to address the root causes of adverse childhood experiences (ACEs) and social adversity.  Science guides this vital process. To ensure trauma-free childhoods, we are taking on one of the most complicated challenges facing all fifty states: ensuring that 100% of families have access to the ten vital services for surviving and thriving. 

We are advocating for this work amid a global pandemic and severe economic disruption that will bring more hardships to families and put more children at risk for ACEs in all fifty states. As you will learn, in some counties as many as 50% of parents surveyed reported needing help and facing challenges accessing behavioral healthcare. 30% reported needing care and lack of access to a medical provider. (It’s a long list of access issues to survival services.) 

Our data-driven and cross-sector county-based 100% Community initiative, currently being implemented in seven counties in New Mexico, starts with initiative participants getting on the same page with a shared language. We offer a 100% Readiness Workshop designed to explore the 20 key concepts guiding the initiative.

The 100% Community is a groundbreaking ACEs prevention project in many respects. It brings together elected leaders and stakeholders on the local level to join in using a data-driven and a collaborative process to identify gaps in vital services--like medical and mental health care and food and housing security programs--to ensure a seamless countywide system of support for 100% of residents. 

Without access to vital services, we can’t prevent and treat ACEs, trauma and social adversity. With the right tools, we can end the social injustice, benign neglect and health disparities that doom so many children to a life of trauma. The 100% Community is a book, a course, an initiative and most importantly, a movement to make every child’s health, safety and education a priority.

If you seek to ensure trauma-free childhoods, please explore the key concepts guiding the 100% Community initiative. An understanding of these concepts can strengthen all ACEs prevention efforts across the nation.

PART ONE: UNDERSTANDING WHAT CHALLENGES AWAIT US

The first concepts represent the “what,” meaning what challenges do our county residents face. Instead of one challenge, there are many that collide in a variety of ways. Some challenges for the 100% Community initiative to address appear inside the home while others greet people as they step outside their front door.

CONCEPT 1: SOCIAL ADVERSITY

Social adversity are the challenges a person, of any age, faces when they step out their front door. These challenges are rooted in access to the ten vital services for surviving and thriving. Lack of access and reasons for disparities are a focus as we discuss social adversity. 

CONCEPT 2: FIVE SERVICES FOR SURVIVING

“Five surviving services,” coined in the book 100% Community as the five services for surviving, are medical care, mental health care, food security programs, housing security programs and transportation. These are the services that none of us can do without, as they provide the foundation for health, safety, resilience and clarity of mind.

CONCEPT 3: FIVE SERVICES FOR THRIVING

Five thriving services, coined in the book 100% Community as the five services for thriving,  which are parent supports, early childhood learning programs, fully-resourced community schools with health centers, youth mentors and job training aligned with future job markets.

Without access to the survival services there is no way we can dream of thriving. Each one of the ten local services in your county have their own histories, research and political relationships associated with them. The reason these two concepts — surviving and thriving services are key to understanding our initiative, is that without such services people struggle.

This has been illustrated the most effectively through Maslow’s Hierarchy of Needs. We will revisit the importance of ensuring vital services throughout the course. Fundamentally, with Maslow, people must have their basic needs met before anything else. Education, enlightenment and actualization are entirely possible for all of us, but only if we have stable shelter, food and the basics.

Without basic services, a wide variety of challenges emerge that include substance misuse, mental health challenges, poor school achievement, lack of job readiness, and adverse childhood experiences (ACES) which include various forms of child abuse and neglect that can lead to trauma and poor health outcomes.

CONCEPT 4: SOCIAL DETERMINANTS OF HEALTH

The social determinants of health is a field of study that explores how a person’s community environment can impact their physical and emotional health and opportunities with learning, work and wealth. The social determinants of health are the services and technology people have access to in order to improve their lives.

CONCEPT 5: HISTORICAL DISPARITIES AND HISTORICAL TRAUMA

Historical disparities and historical trauma are fields of study documenting centuries of social injustice and all the “-isms” (such as racism) you’re familiar with to describe the unfair treatment of people. When we talk about community environments and who does or doesn’t have easy access to vital services, we will be talking about how one’s zip code can determine to a large degree one’s destiny. Disparities based on geographic location is something written about in Anna, Age Eight: The data-driven prevention of childhood trauma and maltreatment,  “Chapter 7: Why your zip code should not determine your destiny.” Historical Trauma is written about in 100% Community and details why each 100% Community initiative has a Task Force on Historical Trauma and Historical Resilience. We explore how challenging it can be to address and discuss these concepts.

CONCEPT 6: ADVERSE CHILDHOOD EXPERIENCES (ACES)

This concept focuses on the complex world of adverse childhood experiences (ACEs). This is a field of study that came into public awareness in 1998 with the publication of the ACEs Study by Drs. Felitti and Andra, working in collaboration with the US Centers for Disease Control. ACEs are ten forms of abuse and neglect that children endure in their homes, controlled by parents and other adults. ACEs can lead to being in a state of fight or flight 24/7. ACEs and the trauma that may result from ten forms of abuse and neglect does not necessarily end in childhood. ACEs may impact an adult’s physical and emotional health, capacity to learn, ability to be job ready and keep a job, and be a caring parent. During a public health crisis or economic disruption, people with high ACEs scores may feel especially insecure and destabilized.  

PART TWO: FRAMEWORKS GUIDE US AS WE ADDRESS CHALLENGES

The mission of 100% Community initiative is to empower local champions to create the services to ensure the ten vital services for surviving and thriving. The initiative is guided by three frameworks/models, designed to be implemented on a countywide scale.

CONCEPT 7: OUR COUNTY MODEL AND FOCUS FOR THE INITIATIVE

The 100% Community initiative is a county-based collective impact project. This means that it focuses on ensuring ten vital services within all cities, towns and communities within a county’s borders. This leads us to the framework we use to take on such a monumental task across ten sectors. We chose the county model for some very pragmatic, economic and political reasons. One reason is that it allows for the development of sustainable funding streams to support the initiative, including the “1% for 100% funding formula,” in which 1% of a county and city governments’ budget is earmarked for 100% Community activities.

On a countywide scale, we can do the following:

  1. Assessment: identify service gaps in the county and why they exist
  2. Planning: research solutions; create public-private sector partnership to fix gaps in all communities within a county’s borders 
  3. Action: collaborate and  innovate with technology, to ensure ten services meet the needs of 100%, including creating the businesses and jobs of the future
  4. Evaluation: track all projects and what county residents report access to, and user-friendliness of, ten vital services

CONCEPT 8: CONTINUOUS QUALITY IMPROVEMENT (CQI)

We are a data-driven process guided by the continuous quality improvement framework that includes four phases: assessing, planning, acting and evaluating.  This process has been used successfully in the private and public sectors, including the Data Leaders for Child Welfare program implemented in NYC, Connecticut, New Mexico and Pennsylvania.

CONCEPT 9: COLLECTIVE IMPACT

The 100% Community initiative is following the collective impact model with the following components: a shared vision, goals, use of data, use of communications strategy, interrelated activities and solid economic base.

CONCEPT 10: ADAPTIVE LEADERSHIP

One invaluable concept and field of study to understand when working with the 100% Community initiative is called Adaptive Leadership, a way of solving challenges described in the book The Practice of Adaptive Leadership: Tools and Tactics for Changing Your Organization and the World by Heifetz, Grashow and Linsky. The book describes how there are two types of challenges as work to improve organizations and communities called technical challenges and adaptive challenges. This is a way of thinking about identifying and solving complex and political challenges that will be part of the work of the 100% Community initiative. Technical challenges, described briefly, have an agreed upon path to follow for problem-solving. Adaptive challenges have no agreed upon path forward and you’re in uncharted waters. The authors warn, with good reason, that change agents don’t want to confuse a technical challenge with an adaptive one.

PART THREE: TOOLS IN THE TOOLBOX AS WE MOVE FORWARD

You have many tools in your toolbox, which are the components of our initiative. Think of the 100% Community initiative as a problem-solving machine focused on all the communities within your county’s border, with many moving parts and all working in sync to empower all initiative participants and residents.

CONCEPT 11: READINESS AND CAPACITY ASSESSMENT

Each county engaged with the 100% Community initiative will be doing a Readiness and Capacity Assessment, assessing to what degree local leaders and stakeholders are committed to improving the ten services for surviving and thriving.

CONCEPT 12: WORKING IN ALIGNMENT

All our work with the 100% Community initiative is designed to be working in alignment with existing local efforts. These may be groups working within county government, city government, task forces, coalitions or nongovernmental organizations. Action teams working in a particular sector (like food security) should identify all the leaders working on problem-solving in their sector within the county’s borders. This will also include state agencies whose work impacts a county’s services. We seek to be in alignment with other data-driven, result focused entities.

CONCEPT 13: THE 100% COMMUNITY SURVEY

The 100% Community survey will measure to what degree your county’s residents have access to the ten vital services for surviving and thriving because you will be asking them during the survey process, “Do you need any of the ten vital services, to what degree can you access services and if you face challenges, what are they?” With this data, the 100% Community action teams can analyze the challenges in order to begin making plans to address them.

CONCEPT 14: LOGIC MODEL

One key planning tool we use to design our projects is called a logic model, a one-page visual representation of a plan to guide a project that includes the project’s goal, purpose, inputs, activities, outputs and outcomes.

CONCEPT 15: EVIDENCE-INFORMED STRATEGIES

As we seek to improve the quality of family and community services and their accessibility, we will research evidence-informed strategies. We will find that many of our local challenges have already been tested and evaluated in other localities, meaning we don’t need to reinvent wheels.

CONCEPT 16: TECHNOLOGY

Technology has a large role in the 100% Community initiative and projects designed to increase access to the ten vital services for surviving and thriving, as well as improving how governmental and nongovernmental organizations are run. Technology will be a part of each of the 100% Community innovations and projects.

PART FOUR: PARTNERSHIPS AND YOU

The success of any large scale initiative or social change movement comes down to people working together to achieve shared goals. Healthy relationships are at the core of the work, and these include those working within the 100% Community initiative and with our partners in the public and private sectors.

CONCEPT 17: PARTNERSHIPS

To get anything of substance accomplished, we must build relationships and partnerships with the leaders and stakeholders on the state, county, city levels, including schools, higher education, nongovernmental organizations and foundations.

CONCEPT 18: PUBLIC-PRIVATE SECTOR PARTNERSHIPS

The 100% Community initiative will be developing and launching innovations and projects, many of them requiring public-private sector partnerships. Business professionals and entrepreneurs often think very differently about projects and the value of getting to measurable results. In the private sector, if results are not achieved, businesses cease to exist. This is not always true for the public sector. Most public sectors projects require the engagement of people from the private sector.

CONCEPT 19: ROLES, RESPONSIBILITIES AND REWARDS

The 100% Community initiative is a countywide process, working like a machine with many moving parts. The initiative is guided by a radically simple idea and hypothesis: if county leaders and stakeholders ensure that the ten vital services for surviving and thriving are accessible to 100% of county residents, the health, safety, education and job readiness increase while long-standing challenges such as health disparities, substance misuses, childhood trauma, hunger, home insecurity and lack of a livelihood decrease. The initiative is a first-of-its-kind countywide program with the capacity to help all residents transition through pandemics and economic disruptions. At its heart, the initiative works because the people working within it are committed to respectful partnerships.

CONCEPT 20: SELF-CARE

We don’t underestimate the importance of self-care while a local champion works on the 100% Community initiative or any community work. The initiative is long-term work, requiring that all participants prioritize their health as they develop local projects and interact with both heroic leaders and obstructionists.

CONCLUSION: A SOLID FOUNDATION FOR ACEs PREVENTION

Twenty concepts guide the collaborative local work, designed to be both measurable and meaningful to all our families. Think of it this way, imagine your new house is being built on a foundation of twenty large wooden beams. You cannot afford to have one break. It’s the same way with the key twenty concepts, each one plays a critical role in building a local 100% Community initiative. To learn more please visit us at the Anna, Age Eight Institute in Santa Fe, New Mexico. www.AnnaAgeEight.org










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This is an impressive set of principles to challenge and guide community action aimed at preventing childhood adversity. The framework is powerful, but Concepts 4 and 6 are much too narrowly conceived. The social determinants of health include the economic, social and physical (including environmental) conditions of individuals and families. Thus, poverty, racism, housing and food insecurity, neighborhood violence, Access to health care and other social services may be social determinants but their importance depends in large part on exposure to other social conditions such as economic insecurity. It is crucial to name these larger social determinants because many of them can be addressed by social policy.

Concept 6 appears to adopt that narrow view of ACEs contained in the original ACE research and since added to and supplemented by extensive neuroscience research. A broadened view of adversity encompasses many of the social determinants of health. And access to  the services and community resources can protect against toxic stress arising from household and larger social conditions. Adverse community environments need to be included in this picture along with important work to build community resilience. Once again, doing so should alert us to the need for social policies that improve those toxic social conditions.

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