"Medicine should join our community organizations and agencies and experts to work towards creating healthier families and children."- Dr. Robert Shapiro, Cincinnati Children's Hospital and Medical Center

The Mayerson Center for Safe and Healthy Children of Cincinnati Children’s Hospital and Medical Center spearheads the Building Community Resilience (BCR) initiative that now spans over 40 organizations and sectors in the greater Cincinnati region. The Mayerson Center, the child abuse Division at Cincinnati Children’s, has been diagnosing and treating victims of child abuse for over 20 years. Most recently, the Mayerson Center has been expanding their prevention efforts by increasing community awareness of ACEs, toxic stress and resilience. This work is being done under the collective impact initiative “Joining Forces for Children”. Through its robust network of committed partners, Joining Forces for Children strives to address & prevent the risks of childhood adversity and works to strengthen families with the skills, knowledge, support and resources they need to nurture their children’s health & well-being. Coalition members come from a wide range of sectors, including mental health and medical providers, schools, academic institutions, parenting support and home visitation services, the local United Way, child welfare, and child care providers. The coalition has coalesced around three priority areas:

1.    Education and Awareness. Goal: Create an informed community that understands the enormity of the risks created by adversity in the lives of children and families and the protective factors, which promote resilience and improve health outcomes.

2.    Advocacy and Policy Development. Goal: Educate policy makers about the lifelong consequences that adversity has for the developing child so that they can use this knowledge to create policies and practices that support the wellbeing of children and families.

3.    Activities and Program Development. Goal: Build and strengthen a universal, targeted, and restorative support system that equips children and families to thrive.

The Community Context

One of the Cincinnati BCR organizations, Children Inc. operates in Covington, KY, just across the Ohio River from Cincinnati where the opioid crisis and the consequential separation of children from parents is a growing issue. Children removed from parental care due to drug addiction or incarceration enter into kinship care to be raised by relatives, often grandparents. Around Covington, over 4,000 grandparents are acting as the primary caregiver for at least one grandchild. The shift in guardianship can result in financial instability, food insecurity, delayed childhood development, and other adversities for the grandparents raising grandchildren. Addressing the needs of caregivers and children at opposite ends of the lifespan has proven challenging for social service agencies that are not accustomed to balancing maternal and child health with the additional concerns of aging grandparents.

For the past 2 years, the Mayerson Center has been helping pediatric practices and clinics to implement SEEK (Safe Environment for Every Kid) within well child visits. SEEK is an intervention that creates a clinical environment within the out-patient setting to screen for specific social determinants of health that are also risk factors for child maltreatment. The clinic staff engages parents using motivational interviewing techniques to assist them in reducing their child’s environmental exposure to potentially harmful toxic stress.

The Role of BCR

The Mayerson Center concluded that simply adding components to clinical interventions would not be enough to reduce the effects of toxic stress. They created Joining Forces for Children (JFfC) and joined the BCR learning collaborative to help them work and learn from other partners around the country. The JFfC coalition recognized that this work was “new” and uncharted. Joining the BCR learning collaborative increased the depth of their work and created new partnerships with like-minded communities to help solve problems. 

Joining Forces for Children developed a five-year strategic plan that outlines specific strategies and goals. The vision of the coalition “incorporates the concepts involved in adversity reduction as well as resilience building within families”, says Shapiro. As a coalition member stated, “if we can help families to raise children in a strong, nurturing, safe and stable environment…the science is clear, we will make a difference.” Joining Forces has now created 3 distinct channels to concentrate future work which focuses on bringing measurable and scalable interventions within the healthcare, early childhood, school environments.

The Mayerson Center planned for financial sustainability early on, asking, “How do we fund this? There are new interventions to implement yet everybody is working very hard already. What is a sustainable financial model?” To build a foundation for sustainability, the Mayerson Center dedicated $50,000 from its own budget and received $375,000 from a five-year community gift to fund the coalition effort. Moving forward the coalition will rely on members to contribute expertise and resources to help sustain the effort. We need to demonstrate that our goals are all the same: improve child health, developmental & educational outcomes, safety and wellbeing. Joining Forces hopes to do just that – Join Forces to reach our goals together.

For the second half of 2016, Joining Forces for Children focused on developing a communications and advocacy platform. In August, the coalition engaged BCR staff and a consultant from Spitfire Strategies for a two-day strategic planning meeting to help coalition partners identify advocacy priorities and craft targeted messages. Cincinnati was then used as a case example communications and advocacy workshop at the Dallas meeting to help the BCR cohort develop their site-based communications platforms.

[Free Webinar March 21st: Learn how to use BCR communication tools to start a dialogue on how to prevent and address ACEs in your community. Register for Creating Real Community Change - Tools for Advocacy & Communication] http://go.gwu.edu/BCRwebinar

Next Steps

Having established a coalition and identified immediate strategies and goals, a next step for the Cincinnati team will be to pilot the BCR data dashboard to help assess progress and success across the coalition. As one coalition member pointed out, “This is a really hard question. There are a number of measures that we can be looking at.” The coalition’s goal is to identify additional measures that provide the greatest amount of accurate and relevant information without costing too much to gather and report. “There’s an entire action group dedicated to talking about the data and how we’re going to measure [success].”

In 2017, the Cincinnati team will leverage BCR’s partnership with NACCHO (National Association of City and County Health Officials) to strengthen ties and collaboration with local public health. The Cincinnati BCR team is also working with Cincinnati Public Schools (CPS) and Northwest Local School District to adapt trauma-informed care for the public schools setting.

Cincinnati will host the upcoming April 2017 BCR meeting. Planning meetings are underway to help the team leverage the opportunity to jump start cross-sector collaboration initiatives throughout the Southwestern Ohio and Northern Kentucky region.

To learn more about the Cincinnati BCR community context and BCR efforts download their full BCR summary here at http://go.gwu.edu/cincinnatisnapshot.