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Module 5 Resources: Public Health Approach and Cost-Benefits of Trauma-Informed Care

Websites and Online Materials

  1. Grand jury uses ACEs science to issue stinging critique of local health department, ACESConnection.com: After a civil grand jury attended an advisory board meeting of the Maternal Child and Adolescent Health section of the Sonoma County Department of Health Services’ Public Health Department, they issued this report, titled “Maternal Child and Adolescent Health: Caring for the Most Vulnerable.” They found that the reduction in health benefits and staff, is impacting the services provided to preventing ACEs. If you are unable to access the page through the hyperlink, please copy and paste the following into your browser http://www.acesconnection.com/blog/grand-jury-uses-aces-science-to-issue-stinging-critique-of-local-health-department.
  2. Utah Passes Resolution to Encourage State Policies and Programs Based on ACEs Science, ACEsConnection.com – This article describes a newly approved state resolution to address “severe emotional trauma and other adverse childhood experiences.” It includes recommendations that describe the impact of ACEs in health, school performance, employment success, and life expectancy. If the hyperlink does not work, please copy and paste the following into your browser: http://www.acesconnection.com/blog/utah-passes-resolution-to-encourage-state-policies-and-programs-based-on-aces-science
  3. Decoding the Relationship Between PTSD and Heart Disease, Blogs.VA.gov – This research update explores the effect of emotional trauma on the heart. It cites one study’s found link between trauma and poor physical health, as well as an indication that PTSD may be a precursor to cardiovascular disease.
  4. Iowa’s ACEs Coalition Continues to Advance Policy, ACEsConnection.com – This article describes the Iowa ACEs Policy Coalition’s legislative advocacy efforts, and offers two documents related to Iowa funding legislation. If the hyperlink does not work, please copy and paste the following into your browser: http://www.acesconnection.com/blog/iowa-aces-coalition-continues-to-advance-policy
  5. From “Problems” to “Issues”: Making Trauma-Informed Policy Change, ACEsConnection.com – This article focuses on trauma-informed policy changes in the United States, and highlights advocacy groups such as the Campaign for Trauma Informed Policy and Practice. It also addresses the process of policy change how to create specific policy proposals. Supporting topical webinars and documents are provided. If the hyperlink does not work, please copy and paste the following into your browser: http://www.acesconnection.com/blog/from-problems-to-issues-making-trauma-informed-policy-change
  6. Trauma-Informed Pioneers: First Ladies Working to Heal Communities, HuffingtonPost.com – This article features gubernatorial First Ladies and their work to expand trauma-informed policy and practice in their states.
  7. Building Community Resilience: Cincinnati, Ohio, ACEsConnection.com – This article describes the Mayerson Center for Safe and Healthy Children of Cincinnati Children’s Hospital and Medical Center’s Building Community Resilience (BCR) initiative in Cincinnati, and its priorities of education and awareness, advocacy and policy development, and activities and program development. If the hyperlink does not work, please copy and paste the following into your browser: http://www.acesconnection.com/blog/building-community-resilience-cincinnati-ohio
  8. Study: Girlhood Trauma Linked to Depression in Menopause, Philly.com – This article discusses recent findings from a University of Pennsylvania study on women and the effects of trauma on depression status during menopause.
  9. If They Can Do It, So Can We! Resources For System Change, ACEsConnection.com – This article introduces a resource guide for New Zealand entitled “Healthy Families: From ACEs to Trauma Informed Care to Resilience and Wellbeing: Examples of Policies and Activities Across IIMHL and IIDL Countries.” If the hyperlink does not work, please copy and paste the following into your browser: http://www.acesconnection.com/blog/if-they-can-do-it-so-can-we-resources-for-system-change
  10. The ABCs of ACEs: Addressing the Long-Term Health Effects of Adverse Childhood Experiences, HealthyDebate.ca – This article describes the relationship between ACEs and poor health outcomes and discusses the role of physicians in screening for ACEs and reducing stigma.
  11. Comprehensive Legislation Introduced in U.S. Senate and House to Address Trauma, ACEsConnection.com – This article describes the “Trauma-Informed Care for Children and Families Act” (S. 744, H.R. 1757). This legislation would create a multi-agency task force to recommend best practices for identifying and supporting children who have experienced trauma. If the hyperlink does not work, please copy and paste the following into your browser: http://www.acesconnection.com/blog/comprehensive-legislation-introduced-in-u-s-senate-and-house-to-address-trauma
  12. Clinical Considerations Related to the Behavioral Manifestations of Child Maltreatment, Pediatrics.AAPPublications.org – This clinical report from the American Academy of Pediatrics highlights neurobiological research that suggests maltreatment early in life may change a child’s psychological and physiological response to stressful circumstances and lead to mental health and behavioral challenges that continue after the trauma has ended.
  13. Stop Treating Solutions Like Problems- An ACE’s Informed Approach to Substance Abuse Treatment, ACEsConnection.com – This article describes trauma as a “gateway drug” to addictions, and suggest potential impacts of incorporating enhanced ACE’s informed perspective into substance abuse treatment. If the hyperlink does not work, please copy and paste the following into your browser: http://www.acesconnection.com/blog/stop-treating-solutions-like-problems-an-ace-s-informed-approach-to-substance-abuse-treatment?reply=466307103271822591
  14. Developmental, Behavioral Issues More Common Among Rural Children, Healio.com – This article raises the issue of underreporting of mental disorders in rural areas, and calls for more research regarding neighborhood risk and protection for childhood mental health disorders within rural communities.
  15. Using Data to Spark Action on the “Pair of ACEs,” ACEsConnection.com – This article describes the importance using statistics and data to demonstrate needs and opportunities for change in communities. The Building Community Resilience (BCR) collaborative has partnered with the Child and Adolescent Health Measurement Initiative to create fact sheets on the impact of ACEs on communities in the Cincinnati area with the hope of encouraging the city government to take action. If the hyperlink does not work, please copy and paste the following into your browser: http://www.acesconnection.com/blog/using-data-to-spark-action-on-the-pair-of-aces
  16. Where Dealing with Trauma is Part of Job Training, CityLab.com – Hopeworks ‘N Camden is a nonprofit in New Jersey for disadvantaged youth that combines real world work experience with counseling to overcome past pain.
  17. Practical Solution to Reduction in Life Expectancy, HuffingtonPost.com When the Surgeon General’s Report came out linking cancer and smoking; many people said it would not matter because smoking was inevitable. We sometimes hear the same claims about domestic violence and child abuse because it has such a long history. The reality is that communities like San Diego, Nashville and Quincy, Massachusetts enjoyed a substantial reduction in domestic violence and child abuse by implementing best practices to stop domestic violence.
  18. The Child is the Father of the Man: Family Physicians’ Screening for Adverse Childhood Experiences, STFM.orgA physician notes the importance of screening patients for adverse childhood experiences (ACEs) and describes the lack of screening done among most physicians.
  19. Childhood trauma leads to lifelong chronic illness – so why isn’t the medical community helping patients? HuffingtonPost.com 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. Only then can we help those who feel paralyzed by their pasts to achieve the healthy lives they deserve.
  20. Looking through the lens of 1000 Poulton at TEDxDunedinA multidisciplinary, longitudinal study of 1,037 babies born began in Dunedin between 1972 and 1979. The study members have been followed up since birth, at age 3; then every 2 years to age 15; and at ages 18, 21, 26, 32 and, most recently, 38 (2010-2012). It is next planned to see the study members at age 45. Recent assessments have included a broad range of studies in the psychosocial, behavioral medicine and biomedical research areas. This TED Talk resonates with the ACEs study in the UD – the advantage of the Dunedin study being that they have followed 1,000 children over 40 years into adulthood, unique in the world.
  21. Aspiring therapists learn on the ground at Casa Pacifica, VCStar.com Aided by a presidential initiative, the Casa Pacifica agency has doubled admission to a program that prepares psychologists to work with abused, neglected, and emotionally troubled youth.
  22. For Growing Number Of Kids Shot In Chicago, The Trauma Never Ends, DNAInfo.comAt least two dozen children 13 or younger have been shot this year in the city. Even for those who survive, shootings have a lasting impact. The violence can lead to long-term mental and physical health problems for those wounded by gunfire and those who are only exposed to the violence.
  23. Why is SA not dealing with its psychological trauma? – The hidden costs, BizNews.comIn this sequel to his ‘problem statement,’ outlining the pervasiveness of trauma in our daily South African lives, trauma activist Brian Rogers asks why the public health system has not dealt with psychological trauma, and continue to ignore its’ huge societal costs.
  24. Trauma-Informed Care Environmental Scan Released, ACEsConnection.comDescription of the Illinois ACEs Response Collaborative’s Environmental Scan Report, whose goal it is to uncover essential characteristics, promising practices, and obstacles for meaningful systems change towards trauma-informed care. Access article at http://www.acesconnection.com/blog/trauma-informed-care-environmental-scan-released
  25. An American Public Health Crisis- The 'Pair of ACEs,' HuffingtonPost.com – A discussion of the “Pair of ACEs Tree” graphic and concept, which depicts the interconnectedness of Adverse Community Environments and Adverse Childhood Experiences. This article includes example stories of affected children and the need to build community resilience.
  26. A year to Find Out: Can Living Alone Help Health Trauma? ACEsConnection.com – Shenandoah Chefalo shares the benefits she experienced from living alone after aging out of the foster system. To access this resource copy and paste the following link into your browser http://www.acesconnection.com/blog/a-year-to-find-out-can-living-alone-help-heal-trauma
  27. ACEs articles by category Oct 18, 2016 – Wisconsin Dept of Health Services, ACEsConnection.com – Scott Web, from the Wisconsin Department of Health Services, has provided a comprehensive list of articles about ACEs covering Adversity Impact; Brain and Biology; Bullying; Courts, Juvenile Justice, Corrections, and Probation; Post-Traumatic Stress Disorder; Resilience; Schools; Substance Use Disorder; and Trauma-Informed Care. To access this resource copy and paste the following link into your browser http://www.acesconnection.com/blog/a-month-of-aces-articles-by-category-wisconsin-dept-of-health-services
  28. Activists, advocates at the White House screen “Resilience,” address childhood trauma, ACEsConnection.com – A panel discussion and screening of Resilience: The Biology of Stress and the Science of Hope was held at the White House. The documentary chronicles the adverse childhood experiences (ACEs) movement in the US. To access this resource copy and paste the following link into your browser http://www.acesconnection.com/g/washington-dc-metro-area-aces-connection/blog/activists-advocates-at-white-house-screen-resilience-address-childhood-trauma
  29. Alaska & Boston: Recovery-Oriented and Trauma-Informed Care in Health Care Settings, Including Medical/Health Home Settings. The slides provided at the webinar organized by SAMHSA in January 7, 2016 show how the recovery-oriented and trauma-informed care works in health care settings, including medical and health home settings in Alaska and Boston.
  30. Assessing the effects of foster care: Early results from the Casey National Alumni Study. This online document presents data collected from case records and interview about the life experiences, educational achievement, and current functioning of more than a thousand Casey Family Program foster care alumni who were served in 23 communities across the country between 1966 and 1998. The report also documents the incidence and cost of child maltreatment.
  31. Building a Trauma Informed Nation: Moving the Conversation Into Action. Hosted by the Federal Partners Committee on Women and Trauma, on September 29th and 30th, 2015, each day, more than 2000 individuals from across the country came together either in person or virtually, to answer the question, "What would a Trauma–Informed Nation look like?" For those who were unable to attend, or who did participate and want to experience the sessions once again, the archived presentations can be found on this website.
  32. Children in Foster Care: Behavioral Health Care use in Medicaid. Many children in the nation’s foster care system – nearly one in three – use behavioral health services. This population represents only three percent of all children in Medicaid, but 15 percent of those using behavioral health services and 29 percent of Medicaid expenditures for children’s behavioral health services. This infographic from the Center for Health Care Strategies (CHCS) compares behavioral health care use and expense for Medicaid-enrolled children in general vs. those in foster care. The graphic is a companion to a CHCS fact sheet that details behavioral health care use and expense for this high-need population. Both resources are based on CHCS’ national analysis of children’s behavioral health care use in Medicaid.
  33. Child Maltreatment: Prevention Strategies. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. January 14, 2014. This website contains information for effective programs to stop child maltreatment as well as guidelines and planning tools, community and societal level examples, and reviews of effective and promising programs for preventing child maltreatment.
  34. The Community Health Resilience Guide and Toolkit provides practitioners and experts from all sectors, disciplines, and functional areas who have roles, responsibilities, or interests in Community Health Resilience (CHR) access to guidance and resources to make their community (or organization) more resilient after a disaster or other major adversity. The Community Health Resilience Toolset was developed through a CHR Initiative in a year-long, rigorous, stakeholder-driven project sponsored by the U.S. Department of Homeland Security’s Office of Health Affairs (DHS/OHA) in partnership with the U.S. Department of Health and Human Services (HHS) and with representatives from other Federal partners, state and local agencies, and private sector and non-profit organizations from across the Nation. The Initiative built upon a wide range of health security, emergency preparedness, and related policies and activities at the Federal, State, and local levels, including evolving climate change resiliency considerations.
  35. Community Resilience Cookbook. When people learn about the ACE Study, they have a range of reactions, from sorrow to outrage to relief at having a framework—finally—that explains their own or others’ behavior. Then they ask, “What can I do?” This cookbook aims to answer that question. Whether you are the director of a YMCA, the head of a county health department, a sheriff, a school principal, a pediatrician or a parent, it will offer you context, definitions and questions to help you think about building resilience where you live. It will describe how communities in the United States and Canada are putting the theories of ACEs and resilience into practice.
  36. The Cost-Saving Potential of Trauma-Informed Primary Care. Jeffrey Brenner, MD is the Founder and Executive Director of the Camden Coalition of Healthcare Providers, who was awarded a MacArthur Foundation "Genius" grant for his work in one of the country's poorest cities. His coalition coaxed all hospitals serving Camden's population to stream daily patient data into its computers, identified the highest-risk, highest-cost patients that were leaving the hospitals, and then dispatched teams of clinicians, health coaches and social workers to comprehensively support those patients in their homes.
  37. The Data can help tackle childhood trauma at the community level, KansasCity.com – The Kansas Hospital Association and the Missouri Hospital Association delivered community Adverse Childhood Experiences (ACE) scores at the ZIP-code level in both states. This could help hospitals and their partners improve health improvement efforts.
  38. Early and Periodic Screening, Diagnostic, and Treatment (EPSDT). The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid. EPSDT is key to ensuring that children and adolescents receive appropriate preventive, dental, mental health, and developmental, and specialty services. This site by the Centers for Medicare & Medicaid Services provides details on EPSDT services, state program guidelines, and EPSDT data.
  39. The Economic Value of Intensive Trauma Therapy. Trauma Institute & Child Trauma Institute. Economic value is an important consideration in obtaining mental health care. Nobody wants to spend more than they have to, and that applies to individuals as well as insurance companies or government agencies. This blog highlights why spending more up front for quality trauma treatment can be far more economical than the alternatives.
  40. Ending Domestic Violence: Witnessing Domestic Violence Can Have Lasting Effects. Toxic stress comes from chronic ongoing traumas, such as witnessing family violence and experiencing neglect. There is a growing amount of research available indicating that early life experiences play a significant role in shaping an individual's health trajectory.
  41. “Every one of us can play a role.” Eric Holder campaigns to reduce childhood trauma, WashingtonPost.com – 58% of American children were exposed to violence in 2015. Changing Minds is a campaign aimed at raising awareness, teaching skills, and inspiring public action to address children’s exposure to violence and trauma.
  42. ‘Expansive’ Juvenile Justice Reform Bill Close to Law in DC – The Comprehensive Youth Justice Amendment Act of 2016 has been passed by the Council of the District of Columbia (DC). The bill aims to make the juvenile justice system in DC as small and successful as possible.
  43. Making Meaningful Connections: The 2014 Prevention Resource Guide. This guide was created by the Children’s Bureau, which is under the U.S Department of Health and Human Services. Its primary purpose is to support community-based child abuse prevention professionals who work to prevent child maltreatment. It contains Protective-Factors Approaches to promote well-being and prevent child maltreatment and promote well-being. The guide contains six chapters: 1) Protective-Factors Approaches to Promoting Well-Being, 2) Working With Families Using Protective-Factors, 3) Engaging Your Community, 4) Protecting Children, 5) Tip Sheets for Parents and Caregivers, and 6) Resources.
  44. Mapping Broadband Health in America, FCC.gov. An online resource that provides health statistics based on geographic areas.
  45. Nationally Recognized West Virginia Program Helps Children Deal with Trauma. In 2013, the West Virginia Center for Children’s Justice launched a program called “Handle with Care”. The collaborative program is meant to help children who’ve experienced abuse, neglect or other types of trauma succeed in school. The program that started on the West Side of Charleston is now expanding across the state and in other communities across the nation.
  46. Nurse-Family Partnership. This community health program introduces vulnerable first-time parents to caring maternal and child health nurses. This program allows nurses to deliver the support first-time moms need to have a healthy pregnancy, become knowledgeable and responsible parents, and provide their babies with the best possible start in life. An evidence-based community health program, Nurse-Family Partnership's outcomes include long-term family improvements in health, education, and economic self-sufficiency.
  47. Partnership Will Evaluate Effect Of Trauma On Kansas City Community. This article from flatlandkc.org details an initiative known as Resilient KC. Resilient KC is a partnership between the Greater Kansas City Chamber of Commerce and Trauma Matters KC, a coalition of more than 30 organizations, including mental health centers and philanthropies.
  48. PAX Good Behavior Game® (PAX for short). PAX is officially included on the U.S. National Registry of Evidence-based Programs and Practices. It teaches children to self-regulate, to work together for common goals, and to focus on a positive future they co-create with others. These are core cognitive, emotional, and behavioral skills required for peaceful, productive, healthy and happy lives. PAX is not a classroom or behavior management program, yet has the benefit of making any classroom easier to manage. PAX reduces teacher and staff stress, and brings back joy into the classroom every day—while increasing time for meaningful instruction and learning. Watch the videos at http://paxis.org/news/videos to learn more about PAX in action, and listen to the teachers, administrators and students speak up.
  49. Philadelphia: brotherly love and trauma-informed practice. Philadelphia Inquirer (Blog), Jonathan Purtle, 03/21/2014. This blog is part of a serious of posts about what is being done to address trauma and toxic stress in Philadelphia. “Four years ago, on a train from Philadelphia to Washington, Sandra Bloom told me about the Adverse Childhood Experiences (ACE) Study. I hadn’t heard of it, and was astounded to learn about strong connections it found between exposure to trauma and toxic stress in childhood, and experiencing behavioral, social, emotional, and health problems as an adult. I told almost everyone I knew. I circulated the study’s publications among my public health peers. Hardly any of them had heard of it in 2011, when I wrote the first of several related posts.”
  50. A Public Health Approach to Prevention of Behavioral Health Conditions. (PPT, 3MB). Substance Abuse and Mental Health Services Administration (SAMHSA). Presentation by Administrator Hyde, Project LAUNCH Grantees' Spring Training Institute, May 15, 2012 (Slides). This presentation discusses factors important for a public health model to prevent substance abuse and mental health disorders. It reviews some of the challenges in preventing behavioral health problems and potential solutions, with an emphasis on early intervention.
  51. The Public Health Approach to Violence Prevention. Centers for Disease Control and Prevention. December 27, 2013. This link provides information about the public health approach including its four-step process.
  52. Public Health Interventions: Applications for Nursing Practice (The “Wheel” Manual). Minnesota Department of Public Health. March 2001. This link provides access to manuals and resources for the public health intervention model.
  53. Redevelopment effort in Hill District targets effects of long-term trauma, Post-Gazette.com. A new strategy has been piloted called Trauma-Informed Community Development. This strategy attempts to address trauma directly in the community one block at a time.
  54. Report finds government could save $9 billion in healthcare costs by addressing childhood trauma. This article highlights the finding from a report commissioned by Adults Surviving Child Abuse. Looking at four main symptoms of childhood trauma – alcohol abuse, mental illness, obesity, and suicide/attempted suicide - the report found that the economic impact of unresolved childhood trauma in Australian adults was $9.1 billion annually. The report recommends that costs could be reduced through improved training for healthcare providers to help them identify underlying childhood trauma or abuse and make appropriate referrals.
  55. The Safe Environment for Every Kid (SEEK). The SEEK project, funded by the US DHHS, Administration on Children and Families, the CDC, and the Doris Duke Foundation, offers a practical approach to the identification and management of targeted risk factors for child maltreatment for families with children aged 0-5, integrated into pediatric primary care. By addressing these problems, SEEK aims to strengthen families, support parents, and thereby enhance children's health, development and safety, while helping to prevent child maltreatment.
  56. Toxic stress in the classroom: How a public health approach could help, WashingtonPost.com: Two writers argue that schools and health providers must join forces to make sure children are getting the help they need.
  57. Triple P. The Triple P – Positive Parenting Program is a parenting and family support system designed to prevent – as well as treat – behavioral and emotional problems in children and teenagers. It aims to prevent problems in the family, school and community before they arise and to create family environments that encourage children to realize their potential. The U.S. Triple P System Trial, funded by the CDC, found lower rates of substantiated abuse cases, child out-of-home placements, and reductions in hospitalizations and emergency room visits for child injuries in nine study counties in South Carolina where parenting interventions were implemented.
  58. Understanding Evidence. The site is an interactive web resource developed by the Centers for Disease Control and Prevention’s Division of Violence Prevention that supports public health practitioners in making evidence-informed decisions around violence prevention. This free online resource offers practitioners and others working to prevent violence with important knowledge and resources for using evidence in their decision-making processes.
  59. U.S. Preventive Services Task Force (USPSTF). The following is a list of preventive services that have a rating of A or B from the U.S. Preventive Services Task Force that are relevant for implementing the Affordable Care Act. Services that have a rating of A or B are recommended by the USPSTF and have a high certainty that their benefit will be substantial or moderate. The preventive services are listed by date of release of the current recommendation.
  60. Violence Prevention Alliance (VPA). The Violence Prevention Alliance (VPA) was officially formed in January 2004 at the WHO-hosted Milestones of a global campaign for violence prevention meeting. VPA is an opportunity for groups from all sectors (governmental, non-governmental and private) and levels (community, national, regional and international) to unite around a shared vision and approach to violence prevention that works both to address the root causes of violence and to improve services for victims. Under the umbrella of the Global Campaign for Violence Prevention (GCVP), VPA participants intend to strengthen support for data-driven violence prevention programmes based on the public health approach and ecological framework outlined in the World report on violence and health (WRVH) and to facilitate implementation of the WRVH recommendations. VPA participants are committed to adopting a public health approach to interpersonal violence prevention and to participating in consensus-determined activities to promote further adoption of this approach.
  61. What We Need to Do About the Unseen Suicide Attempts Among Young Latinas, News.UTexas.edu. According to the youth survey released by the Centers for Disease Control and Prevention (CDC), young Hispanic girls attempt suicide at rates higher than girls and boys at other ethnic groups. This issue has been largely ignored by the American public and no actions have been taken to address the issue.
  62. What’s the Formula for Community Resilience? RWJF.org. The Gulf of Mexico region of the United States has been highly affected by climate change over the past decade. There is a need for programs that strengthen community resilience, so that these communities are able to rebound from natural disasters in order to increase and maintain positive health outcomes while also maintaining infrastructure.
  63. Youth Mental Health First Aid. Youth Mental Health First Aid is a public education program which introduces participants to the unique risk factors and warning signs of mental health problems in adolescents, builds understanding of the importance of early intervention, and most importantly – teaches individuals how to help a youth in crisis or experiencing a mental health or substance use challenge. Mental Health First Aid uses role-playing and simulations to demonstrate how to assess a mental health crisis; select interventions and provide initial help; and connect young people to professional, peer, social, and self-help care.


Downloadable Documents

  1. Webinar Report- Complex Trauma, Children, and the Health Home Option: Moving Research and Practice Into Policy – This report summarizes a webinar presentation sponsored by the National Child Traumatic Stress Network (NCTSN). Presenters from CMS, SAMHSA, and the New York State Department of Health explored the process and outcomes of establishing a policy to include trauma as an eligible chronic condition for the CMS Health Homes initiative for children in New York State. The webinar also addressed the nature and effects of trauma, qualities of the successful collaborative partnership between New York State, SAMHSA, and CMS, and NCTSN-recommended tools to assess trauma in children.
  2. Beyond ACEs: Building Hope and Resiliency in Iowa: Findings on adverse childhood experiences in Iowa from 2012-2014 and opportunities to respond, PromisePartners.org – This report defines ACEs and their impact on development, highlights findings regarding the prevalence and impact of ACEs within Iowa, offers case studies framed around areas such as physical health, mental health, impact on health risk behaviors, and ways that parents, young people, educators, employers, and community members can “break the cycle” with ACEs.
  3. Principles of Trauma-Informed Approaches to Child Sexual Abuse: A Discussion Paper, APO.org – This paper discusses the status of the application of trauma-informed care in Australia and identifies several challenges. While there is a significant interest in trauma-informed approaches to care, there is not yet a body of coordinated, publicly available material, or an agreement on how principles of trauma-informed care should be put into practice. The authors encourage the development of collaborative initiatives to design, implement, and evaluate systemic approaches to trauma-informed care.
  4. From the NCTSN Co-Directors: An Invitation to Explore the Network’s Data and Evaluation Initiatives, NCTSN.orgSpecial edition of IMPACT discussing the role of data and evaluation initiatives to improve the quality of care for children who experienced trauma, improve delivery of care, and raise awareness of the impact of trauma. This issue suggests partnering with foster care parents to collect data, use data to assess trauma impact and recovery in the juvenile justice system, collecting data about refugee trauma, and other strategies.
  5. Adult psychiatric outcomes of bullying and being bullied by peers in childhood and adolescence. (PDF, 475KB). Copeland WE, Wolke D, Angold A, Costello J. JAMA Psychiatry, Online February 20, 2013. This study tested whether bullying or being bullied in childhood predicts psychiatric problems and suicidality in young adulthood after accounting for childhood psychiatric problems and family hardships. The results showed that the effects of being bullied are direct and long lasting, with the worst effects for those who are both victims and bullies.
  6. The Child and Family Traumatic Stress Intervention: Secondary prevention for youth at risk of developing PTSD. (PDF, 183KB). Berkowitz SJ, Stover CS, Marans SR. Journal of Child Psychology and Psychiatry. 2010;52(6): 676-685. This study evaluated the effectiveness of The Child and Family Traumatic Stress Intervention (CFTSI). This four-session intervention was provided within 30 days of exposure to a potentially traumatic event. The study found that children who received CFTSI had lower anxiety scores than those who did not receive the intervention.
  7. Child Exposure to Trauma: Comparative Effectiveness of Interventions Addressing Maltreatment. Goldman Fraser J, et al. Comparative Effectiveness Review No. 89. AHRQ Publication No. 13-EHC002-EF. Rockville, MD: Agency for Healthcare Research and Quality. April 2013. This review provides background on the prevalence, long-term impacts, and cost of child maltreatment. The main focus of this review is on the comparative effectiveness and outcomes of parenting interventions, trauma-focused treatments, and enhanced foster care approaches that address child exposure to maltreatment.
  8. A Comprehensive Public Health Approach to Child Trauma. (PDF, 4MB). Dr. Larke Nahme Huang detail’s the Substance Abuse and Mental Health’s (SAMHSA) public health approach to child trauma. The presentation also provides data from grantees.
  9. Consumers and Carers perspectives on poor practice and the use of seclusion and restraint in mental health settings: results from Australian focus groups. (PDF, 917KB). Seclusion and restraint are interventions currently permitted for use in mental health services to control or manage a person’s behavior. In Australia, serious concerns about the use of such seclusion and restraint have been raised at least since 1993. Consumers and their supporters have also expressed strong views about the harm of these practices. This paper presents the results of ten focus group discussions with people with lived experience of mental health issues and also carers, family members and support persons in relation to the use of seclusion and restraint.
  10. The economic burden of child maltreatment in the United States and Implications for prevention. Fang X, Brown DS, Florence CS, & Mercy JA. Child Abuse & Neglect, 2012; 36(2):156-165. This study presents new estimates of the average lifetime costs per child maltreatment victim and aggregate lifetime costs for all new child maltreatment cases incurred in 2008 using an incidence-based approach. The results highlight that compared to other health problems, the burden of child maltreatment is substantial, indicating the importance of prevention efforts to address the high prevalence of child maltreatment.
  11. Educational and employment outcomes of adults formerly places in foster care: Results from the Northwest Foster Care Alumni Study. (PDF, 350KB). Pecora PJ, Kessler RC, O’Brien K, et al. Children and Youth Services Review. 2006;28:1459-1481. This study evaluated the intermediate and long-term effects of family foster care on adult functioning using a sample of 659 young adults from two public and one private child welfare agencies, case record reviews, structured interviews, and a survey response rate of 76%. Two foster care experience areas were estimated to significantly reduce the number of undesirable outcomes in the Education outcome domain: positive placement history (e.g., high placement stability, few failed reunifications), and having broad independent living preparation (as exemplified by having concrete resources upon leaving care).
  12. Effects on bullying last into adulthood, study finds. The New York Times, February 20, 2013. This article highlights a study that was published in the Journal of the American Medical Association Psychiatry. Researchers have found that for children who are bullied, there was an elevated risk of psychiatric trouble that extends into adulthood for more than a decade after the bullying has ended.
  13. EPSDT – A Guide for States: Coverage in the Medicaid Benefit for Children and Adolescents. (PDF, 613KB). This guide is intended to help states, health care providers and others to understand the scope of services that are covered under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services so that they may realize EPSDT’s goals and provide the best possible child and adolescent health benefit through their Medicaid programs. While it does not establish new EPSDT policy, this guide serves the important purpose of compiling into a single document various EPSDT policy guidances that CMS has issued over the years.
  14. Essentials for Childhood: Steps to Create Safe, Stable, and Nurturing Relationships. (PDF, 6MB). Centers for Disease Control and Prevention, 2013. This guide provides the reader with strategies that communities can use to promote healthy relationships between parents and children. This guide seeks to help create stronger communities by helping children grow up to be healthy and productive citizens.
  15. Estimated Annual Cost of Child Abuse and Neglect. (PDF, 415KB). Gelles R, Pearlman S. 2012. Chicago IL: Prevent Child Abuse America. This report includes the direct (hospitalizations, mental health care system, law enforcement, etc.) and indirect costs (special education, lost productivity to society, etc.) attributed to child abuse and neglect.
  16. Healthy, Resilient, Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. (PDF, 390.55KB). This book authored by the Committee on Post-Disaster Recovery of a Community's Public Health, Medical, and Social Services, the Board on Health Sciences Policy, and the Institute of Medicine of the National Academies can be downloaded for free or read on-line. In the devastation that follows a major disaster, public, private, and charitable sources spend billions of dollars from to help communities recover. National rhetoric often characterizes these efforts as a “return to normal.” Yet for many American communities, pre-disaster conditions are far from optimal. Large segments of the US population suffer from preventable health problems, experience inequitable access to services, and rely on overburdened health systems. A return to pre-event conditions in such cases may be shortsighted given the high costs—both economic and social—of poor health. This book makes the case that disaster recovery should be guided by a community vi­sion, where health considerations are integrated into all aspects of recovery planning before and after a disaster and funding streams are leveraged in a coordinated manner and applied to health improvement priorities in order to meet human recovery needs and create healthy built and natural environments.
  17. Healthy Native Families – Preventing Violence at all Ages, 2nd Edition. (PDF, 9MB). Kemberling, MM, Avellaneda-Cruz, LD. Anchorage, AK: Alaska Native Tribal Health Consortium, Alaska Native Epidemiology Center. March, 2013. This second edition of the bulletin updates the data and resources on domestic and sexual violence affecting Alaska Native people of all ages. Beginning with pregnancy, this bulletin moves through the major stages of life. For each stage of life, it shares the consequences of violence, how many people are affected, and Alaska-specific responses.
  18. Model Trauma System: Planning and Evaluation. (PDF, 1MB). U.S. Department of Health and Human Services. HRSA. February 2006. This guide provides the reader with a planning and evaluation tool to create a trauma-informed system. Some of the information discussed includes the phases of injury prevention, public health system services and functions, and planning for mass casualty incidents.
  19. Preventing Child Maltreatment Through Promotion of Safe, Stable, and Nurturing Relationships Between Children and Caregivers. (PDF, 279KB). Center for Disease Control and Prevention (CDC). This document describes a five-year vision for the CDC’s work in child maltreatment prevention. The overall strategy in preventing child maltreatment is to promote safe, stable, and nurturing relationships between children and their caregivers.
  20. Prevention of Sexual Abuse in Children. (PDF, 819KB). In this webinar, Dr. David Finkelhor discusses a devastating impact of sexual abuse on young victims and how the violent or sexual victimization of children can often lead to an intergenerational cycle of violence and abuse. The uncertainty about the meaning of this trend underscores how much remains to be accomplished in terms of drawing lessons from past experience to determine future policy and prevention of sexual abuse of children.
  21. Population-Based Public Health Interventions. Practice-Based and Evidence Supported. Part I. (PDF, 456KB). Keller LO, Strohschein S, Lia-Hoagberg B, Schaffer M. Public Health Nursing, 2004;21(5):453-468. The Intervention Wheel is a population-based practice model that encompasses three levels of practice (community, systems, and individual/family) and 17 public health interventions. Each intervention and practice level contributes to improving population health. Part I describes the Intervention Wheel, defines population-based practice, and details the recommended modifications and validation process.
  22. Population-Based Public Health Interventions. Practice-Based and Evidence Supported. Part II. (PDF, 461KB). Keller LO, Strohschein S, Lia-Hoagberg B, Schaffer M. Public Health Nursing, 2004;21(5):469-487. The Intervention Wheel is a population-based practice model that encompasses three levels of practice (community, systems, and individual/family) and 17 public health interventions. Each intervention and practice level contributes to improving population health. Part II provides examples of the innovative ways that the Intervention Wheel is being used in public health/public health nursing practice, education, and administration.
  23. Post-Traumatic Stress Disorder and Children in Foster Care. Information Packet. (PDF, 585KB). Hieger, J, Ariyakulkan L, Serdjenian, T. National Resource Center for Permanency and Family Connections. December 2012. Federal legislation can support diagnosis and treatment of PTSD among children in foster care. A provision of The Fostering Connections to Success and Increasing Adoptions Act of 2008 requires all states to increase their oversight of the health and mental health of foster care children, including initial and follow up health assessments to determine whether a child needs additional help. This document highlights states that have amended their policies and implemented programs to meet these legislative mandates.
  24. Responding to Childhood Trauma: The Promise and Practice of Trauma Informed Care. (PDF, 369KB). Pennsylvania Office of Mental Health and Substance Abuse Services. February 2006. The goal of this paper is to build on efforts by the National Technical Assistance Center for Mental Health Planning, the National Association of State Mental Health Program Directors, and their partners. This guide provides information about the challenge of childhood trauma and meeting the challenges of implementing trauma-informed care.
  25. Return on Investment in Systems of Care for Children With Behavioral Health Challenges. (PDF, 932KB). Stroul, B, Pires S, Boyce S, Krivelyova A, & Walrath C. (2014). Washington, DC: Georgetown University Center for Child and Human Development, National Technical Assistance Center for Children’s Mental Health. This report documents what we know to date about the return on investment, specifically cost savings, from systems of care, summarizing data from national studies and from states and communities that have produced this type of information.
  26. Supporting infants, toddlers, and families impacted by caregiver mental health problems, substance abuse, and trauma: A community action guide. (PDF, 1.92MB). This community guide developed by the Substance Abuse and Mental Health Services Administration offers resources that service providers, advocates, and practitioners might use to better understand and respond to struggling families impacted by mental health problems or substance abuse or trauma. Even more important, this guide presents information, resources, and tips useful for engaging the wider community to come together for families in need of resources and support. The aim is to build a responsive community: a community that has as its goal to respond as sensitively to the needs of a family as a committed caregiver does to his or her child.
  27. Toxic Stress, Behavioral Health and the Next Major Era in Public Health. (PDF, 8MB). September 8, 2014 SAMHSA Webinar hosted by Mental Health America (MHA). This webinar discusses the impact of toxic stress and trauma on health outcomes. Presenters also discuss a public health approach for addressing risk factors and enhancing protective factors on an individual, community, and societal level.


Additional References

  1. Creating Schools that Heal: Real-Life Solutions. Lesley Koplow. Teachers College Press, 2002. Koplow, a psychotherapist, discusses the mandate for violence prevention and offers an intervention framework for teachers, administrators, and school-based clinicians who want to improve the emotional climate in their school.
  2. In the best interest of society. Harris WW, Lieberman AF, Marans S. Journal of Child Psychology and Psychiatry. 2007;48(3): 392-411. This paper focuses on domestic violence as a paradigmatic source of violent traumatization and (a) describes the impact and consequences of exposure to violence on children's immediate and long-term development; (b) examines the opportunities for, as well as the barriers to, bridging the clinical phenomena of children's violent trauma and the existing systems of care that might best meet their needs; and (c) critiques current national policies that militate against a more rational and coherent approach to addressing these needs.
  3. Phenomena of Childhood Trauma and Expanding Approaches to Early Intervention. Marans S. International Journal of Applied Psychoanalytic Studies. 2013;10(3): 247-266. Throughout my career, psychoanalytic training has always served three invaluable roles or functions. It has been central to conducting all of my clinical work with patients; informs all of the teaching and supervision I do as a professor of child and adult psychiatry at the Yale School of Medicine; and it has been the basis for developing new treatment approaches that might benefit a substantial number of children and families who are deeply impacted by trauma that results from their exposure to violence and other catastrophic events.
  4. The Public Health Approach for Understanding and Preventing Child Maltreatment: A Brief Review of the Literature and a Call to Action. Covington T. Child Welfare. 2013;92(2): 21-39. Over the past 50 years, most major advances in child maltreatment have focused on protecting severely maltreated children and punishing perpetrators. This article argues that it is time to rigorously apply a public health framework to improve our understanding of, and accelerate efforts to, prevent child abuse and neglect. The article describes the fundamentals of a public health approach; discusses how this approach has been applied to improve surveillance of serious maltreatment injuries and fatalities, the understanding of risk and protective factors, and the long-term consequences of maltreatment; and describes how a public health approach is an effective means to prevention.
  5. Unsmiling Faces: How Preschools Can Heal. Lesley Koplow. Teachers College Press, 2007. The first edition of this book set the standard for high-quality intervention and prevention programs in early childhood practice. Once again making complex psychological concepts available to classroom teachers, this thorough revision: (1) incorporates important understandings gained since the tragic events of 9/11; (2) addresses many of the challenging issues that confront educators in the current high-pressure climate focused on academic performance; (3) includes recent scientific research that supports the concepts underlying high-quality intervention and prevention in early childhood practice-concepts that were the basis for the first edition of this book; and (4) provides an essential framework to help teachers understand the emotional lives of the young children they serve.