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February 2020

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Course – Lesson 1: II. What are key concepts and terms to explore?

CONCEPTS
Terms to explore

LESSON 1:II – What are key concepts and terms to explore?

INTRODUCTION TO THE PROGRAM

You are at the forefront of a new movement, focused on the data-driven, cross-sector and technology-empowered prevention of childhood trauma and maltreatment. Our work differs from what’s been done for two decades, since the publishing of the Adverse Childhood Experiences (ACEs) Survey by Doctors Felitti and Andor in 1998. 

Our approach is systemic and comprehensive, guided by decades of research focused on the social determinants of health, health equity, health and education disparities and historical trauma and resilience. Rather than focusing on how an individual addresses his or her own trauma, we are focused on how an entire county, including all cities, towns and communities within its borders, prevents and treats trauma.

We are not using jargon to make the process of preventing childhood adversity more complicated, instead we are committing to a very specific type of process that is results-focused.

We have worked hard to avoid insider phrases throughout the course, but a few upfront definitions might be helpful to readers not familiar with some terms used within behavioral health care, child welfare and public health.

The 100% New Mexico initiative is at the forefront of the data-driven and cross-sector prevention of adverse childhood experiences, trauma and maltreatment. 

For the past decades there have been trainings on trauma and the brain, design of delivery of health care, teaching and program activities that are sensitive to those who have been traumatized, sporadic in-services for health educators, workshops for parents, lessons for students and informational websites offering insights on emotional health and trauma. We applaud this work in generating awareness and offering sensitivity. These strategies, called being “trauma-informed,” is the first step in addressing ACEs. It is not, however, a comprehensive trauma prevention strategy. 

While the 100% New Mexico initiative continues to build awareness, it is first and foremost about building the capacity of communities to ensure that ten vital family-focused services exist in order to prevent ACEs, trauma and adversity before they can occur. As stated in Anna, Age Eight, the data-driven work we are proposing is a social moonshot level community project. We are honored to have you along for the ride.

  • Data-driven

    Instead of the method used in some organizations – decisions based on hunches, what’s been done before, or the whim of the director, we base all our work on data. We’re swimming in excellent data and research that provides all the information we need to start solving challenges today. And data are far from only quantitative (intimidating numbers). Data are also qualitative and come from the stories and inspiring life experiences of our friends and neighbors.

  • Cross-sector

    Instead of doing our work in isolation or a silo, we reach across the key sectors of the multi-disciplinary public sector to coordinate work. We’ve identified (described in our textbooks) ten vital services in ten distinct social sectors that make up a resilient family-friendly community. This means child welfare and public health work in synch with education, youth mentor programs, behavioral health care, and early childhood education programs. We communicate across our agencies to assess challenges, plan with research, implement action and measure progress.

  • Systemic

    Instead of looking at only one particular part of the challenge facing families, we approach our work by looking at the health of an entire community system. The magnitude of the problem requires that we take into thoughtful consideration all the interrelationships and interdependencies among the parts of the whole, whether it be our own organization or the communities we focus on. Technology makes systemic work, internally and externally, transparent. For meaningful change, systemic thinking is required.

  • Data Leaders programs

    These are continuous quality improvement programs housed within government agencies like child welfare and non-governmental agencies to train the workforce in using data to identify and solve problems. These programs build collaboration between data specialists, upper management, training staff, and the field workers, in order to improve outcomes for the populations their agencies serve. The design of the 100% New Mexico initiative, in many ways, was informed by the design of the Data Leaders for Child Welfare program sponsored by Casey Family Programs and implemented in New Mexico, New York City and Connecticut.

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Lesson 1: I

OBJECTIVES

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Lesson 1: III

WHY NOW?

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Course – Lesson 1: III. Why are we here?

WHY NOW?
20 YEARS LATER

LESSON 1:III – How we are finally making a difference

Why are we here?

More than twenty years ago the Adverse Childhood Study was published, explaining to the nation that a significant percentage of adults had endured ten adverse childhood experiences, including abuse and neglect. The Study detailed the emotional and physical costs of the experiences and made recommendations to address what some called a public health crisis.

Decades later, we have one in eight children being substantiated as maltreated by child protective services by age 18 and a quarter of the adult population reporting three or more adverse childhood experiences. While we have a child welfare system to intervene in cases of maltreatment, we have yet to create a city, county or state agency with the sole mission of preventing trauma and maltreatment. 

Yes, a county may have a coalition here, or a short term funded project there focused on awareness of the problem; however, we (champions in all 3000+ counties across the US) have not invented and institutionalized the prevention of ACEs on the local or state level. We are working toward the day when every city has a “Dept. of Family and Community Resilience” that does the work of a local 100% New Mexico initiative.

You are part of the process and we are grateful you are here.

How can a small group of people make a difference?

First, as you have no doubt read many times, anthropologist Margaret Mead is famous for saying, “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.” We agree 100%.

You, as a 100% New Mexico initiative participant, are part of a grand experiment. Our process is in a state of constant improvement as we seek to provide a learning experience for you and like-minded problem solvers. We are seeking to learn from you, as you move through the course and begin implementation of a local innovations and projects shown to increase access to our ten “surviving” and “thriving” services. 

Questions that guided the design of this course

  1. How do we ensure that our local 100% Community co-organizers and action team members have a shared understanding of the twenty key concepts guiding data-driven ACEs prevention?
  2. How do we ensure that our local 100% Community co-organizers and action team members have the support for the development of measurable and meaningful innovations and projects?
  3. How do we ensure that the initiative participants have the time and energy to be sweeping away obstacles and distractions in order to get real work done?
  4. How do we ensure that all action team members have access to the latest research on innovative solutions in our ten services sectors? 
  5. How do we know if initiative participants feel supported by technical assistance, using technology to communicate long distance?
  6. How do we support initiative participants and their long-term work, understanding that some innovations might be done in a few months while others could take a few years?

Our process will improve because of course participants’ willingness to communicate about what works, what doesn’t and how can we strengthen the entire process of online and technology-support tele-communication to meet the needs of all initiative participants as the move from assessing challenges and gaps in services to implementing change in the form of a local innovation.

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Lesson 1: II

CONCEPTS

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Lesson 1: IV

ACES SURVEY

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Course – Lesson 1: IV. ACEs Survey

ACES SURVEY
Adverse Childhood Experience Survey

LESSON 1:IV – MEASURING THE MAGNITUDE OF ACES AND TRAUMA

Using the tool with care

What is the magnitude of adverse childhood experiences (ACEs) in your county? The ACEs survey scores are a starting point for discussing the level of ACEs-related childhood trauma and untreated adult trauma in your county. The ACEs Survey was developed and first published in the The Adverse Childhood Experiences (ACE) Study. Felitti et al.1998. (https://aae.how/202)

In Anna, Age Eight we explore the survey, noting how adults respond differently to the results of the ten-question survey. This ranges on a continuum from thinking, “Yeah, my family was tough but I made it through” to those who are aware of their long-term struggles with feelings of trauma associated with childhood abuse and neglect.

The ACEs survey is a powerful tool. It will allow your community and county leaders and stakeholders to understand the magnitude of adverse childhood experiences and potential trauma within the youth and adult populations. The survey process should be used with care. The information it reveals to the survey taker can be a trigger for memories of adversity, abuse and neglect. We recommend that organizations using the survey let respondents know, before taking the survey, where they can access people to talk with (i.e. in a school setting, the school-based behavioral health care center would be such a place).

The role of the survey in 100% Community:

As stated above, your local initiative team will want to reach out to residents working in all 10 sectors to discuss how the ACEs survey might be used with both student and adult populations. Your local public health and child welfare data will provide a lot of information about the scope of trauma in your community.

ADVERSE CHILDHOOD EXPERIENCE SURVEY

ONE: Did a parent or other adult in the household often or very often push, grab, slap or throw something at you? Or ever hit you so hard that you had marks or were injured?

TWO: Did a parent or other adult in the household often or very often swear at you, insult you, put you down or humiliate you? Or act in a way that made you afraid that you might be physically hurt?

THREE: Did an adult or person at least five years older than you ever touch or fondle you or have you touch their body in a sexual way? Or attempt, or actually have, oral, anal or vaginal intercourse with you?

FOUR: Did you often or very often feel that no one in your family loved you or thought you were important or special, or that your family didn’t look out for each other, feel close to each other or support each other?

FIVE: Did you often or very often feel that you didn’t have enough to eat, had to wear dirty clothes or had no one to protect you? Or your parents were too drunk or high to take care of you or take you to the doctor if you needed to go?

SIX: Did you live with anyone who was a problem drinker or alcoholic? Or who used street drugs?

SEVEN: Was your parent or stepparent often or very often pushed, grabbed, slapped or hit by a thrown object? Or sometimes, often, or very often, kicked, bitten, hit with a fist or hit with something hard? Or ever repeatedly hit for at least a few minutes or threatened with a gun or knife? 

EIGHT: Was a household member depressed or mentally ill? Or did a household member attempt suicide?

NINE: Were your parents separated or divorced?

TEN: Did a household member go to prison?

Review the interactive Adverse Childhood Experiences survey below to understand what it can reveal to people of all ages. The ACEs survey is not provided here to serve as a diagnostic tool. It is provided to promote awareness of ACEs and encourage dialogue about the impact of adversity and potential trauma.

It is important to note that the ten questions above are the original ten that were asked in the first study. In recent years, tools have been developed that include other questions broadening the scope of Adverse Childhood Experiences to include experiences such as discrimination and parental separation. ACEs should be considered a starting point for measuring trauma, rather than a comprehensive list of all traumatic events that may happen in childhood.

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Lesson 1: III

WHY NOW?

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Lesson 1: V

OUR RECIPE

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Course – Lesson 1: Engage

ENGAGE
ENGAGE WITH THE COMMUNITY

LESSON 1:I – What are the learning objectives of this lesson?

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What are we learning?

In this session, we review the key concepts that guide our 100% New Mexico initiative. We will reinforce the goals and components of the county initiative — a program designed to strengthen a collaborative and data-driven process of capacity-building.

The ultimate goal of the initiative is to prevent adverse childhood experiences (ACEs), childhood trauma, social adversity and maltreatment that sends families into the child welfare systems. We seek to improve health and safety outcomes for the children, youth, families and communities we serve.

Our hypothesis: If we provide to families ten vital services for surviving and thriving, we can increase family and community resilience factors and decrease childhood adversity, trauma and maltreatment. The course supports an analysis of the community “systems of safety and care” to provide insights into problems and solutions.

Participants completing the online course will be able to:

  • Navigate the 100% Community course website to access lesson objectives, lessons and links to resources, data and research.
  • Describe the key points of the course text books Anna, Age Eight: The data-driven prevention of childhood trauma and maltreatment and 100% Community: Ensuring trauma-free and thriving children, students and families, including the root causes, cost and consequences of adverse childhood experiences, trauma and social adversity.
  • Describe the concepts and frameworks used to understand challenges and design solutions including: the social determinants of health, collective impact and continuous quality improvement.
  • Describe the social determinants of health, why they guide the 100% New Mexico initiative, and the ten vital family services/programs shown to create resilient childhoods and strengthen families.
  • Demonstrate how to communicate effectively about the course and initiative and local projects the team are developing.

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Pre-Course

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Lesson 1: II

CONCEPTS

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