Summary
Adverse childhood experiences (ACE’s) have been identified as being avoidable, costly, and the largest threat to population health at the global level (Bellis et al., 2019). Identifying, mitigating, and even preventing ACE’s from happening, is a current task at hand for public health officials. Trauma-informed approaches have been identified as useful strategies in dealing with ACE’s. This grant proposal focuses on mitigating and preventing ACE’s by tackling them at the level of origin: within the home. Specifically, this project aims to effectively build parental skills and capabilities in three Florida counties (Hamilton, Hardee, and DeSoto). To do so, this intervention will diversify the office staff utilized in pediatric medicine by incorporating new disciplines into routine/standard pediatric care. Additionally, community classes will be held to educate and support local parents. As time progresses, this intervention has the potential to transform the entire field of pediatric medicine and the prevalence of ACE’s in our communities.
Trauma-Informed Principles Utilized in This Grant
Physical and psychological safety is key for office staff, patients, and their parents and will remain a priority (SAMHSA, 2014). Assessment of current pediatric offices will be completed early so we can incorporate a more inviting physical atmosphere. Pediatric offices should create confidence, playfulness, and hope to reduce stress on patients and their parents (Imagination Design Studios, 2021). Next, trustworthiness and transparency must be foundational for this program to function as intended and to its fullest potential. We acknowledge that it may be difficult for parents to allow staff to have a more intimate patient care relationship and the potential sensitivity of these topics, however peer support can foster these relationships. The principle of peer support is the foundation of this program, as we aim to develop new relationships with parents to build their skills and capabilities. Collaboration and mutuality between parents and staff is another foundational piece of this program. A true partnership must exist to level the power difference between parents and staff (SAMHSA, 2014). Parents must have shared power in decision making and this will be communicated to all staff members (SAMHSA, 2014). This principle also includes active listening between staff and parents so that this program can best address these specific communities’ needs (Philanthropy Network Greater Philadelphia et al., 2016). Empowerment, voice, and choice is central to this program, as a strength-based approach will be utilized to build parental skills and capabilities (Philanthropy Network Greater Philadelphia et al., 2016). This allows us to validate and enhance current feelings and strategies, while developing future skills (SAMHSA, 2014). Finally, this program recognizes that historically, pediatric visits are mainly concerned for children’s wellbeing. However, this principle will contest this and make pediatric care more family centered. It will combat outdated, lecture style, office visits and transform pediatric medicine.
Levels of the Social Ecological Model
This proposal will utilize the McLeroy, Bibeau, Steckler, & Glanz version of the Social Ecological Model (SEM), as it is helpful in guiding health interventions. This SEM acknowledges that behavior both is affected and affecting their surrounding social environment at five different levels: individual, interpersonal, organization, community, and public policy (McLeroy et al., 1988). People do not exist in isolation, but rather within a broader environment. These levels are specific intervention points and addressed within this proposal. First, the individual level is being addressed through the new pediatric office structure, as parents will have access to resources addressing trauma. The office staff will be able to enhance parental knowledge, attitudes, and skills. Next, the interpersonal level is being impacted by fueling a positive and supportive relationship between parents and their children. This improved interpersonal relationship will help mitigate and prevent ACE exposure. The organizational level is being addressed through new implementations within the pediatric offices. This is inclusive of their new training program and screening for ACE’s in their patients and families. Next, the community level is addressed, as this program will foster a trustworthy and supportive relationship between families and pediatric medical care, especially within community classes. Improving medical trust is especially important in rural and impoverished communities (Duke & Stanik, 2016). Lastly, local public policy is being impacted, as this intervention program will be mandated by local government. To increase ability to enroll in the program, we want to avoid issuing an unfunded mandate, making grant funding necessary.
Public Health Framework
This project will incorporate public health framework, rather than just taking a medical approach. Utilizing public health framework starts by recognizing that there are many determinants of health and circumstances that shape the opportunities of one’s life. As well, it is important to note that raising children is not easy. It requires an immense amount of sacrifice (i.e., monetary, time, responsibilities), can come unplanned, and can negatively impact relationships (Moore & Abetz, 2018). Many parents may not realize the weight these stressors can bear on them and will feel unsupported. When going to the pediatrician’s office, so much attention is focused on the child and their physical wellbeing, but rarely about the parent/guardian’s wellbeing and how that effects the child. The suggested interventions are both trauma-informed and trauma-specific. Not only do they identify that trauma happens, especially in impoverished circumstances, but go a step further to implement access to programs that can manage and prevent it. As well, these interventions address prevention at all levels: primary, secondary, and tertiary (Philanthropy Network Greater Philadelphia et al., 2016). Primary level prevention is being addressed through community classes and information being given to parents at pediatricians’ offices. Screening for ACE’s by speaking with parents and children is a secondary level prevention. Lastly, tertiary level prevention is a way to intervene once ACE’s have occurring and mitigate their associated outcomes (Philanthropy Network Greater Philadelphia et al., 2016). This will be done through the intervention of the diverse pediatric healthcare workforce and through home visits.
References
Bellis, M. A., Hughes, K., Ford, K., Ramos Rodriguez, G., Sethi, D., & Passmore, J. (2019). Life course health consequences and associated annual costs of adverse childhood experiences across Europe and North America: A systematic review and meta-analysis. The Lancet Public Health, 4(10), e517–e528. https://doi.org/10.1016/s2468-2667(19)30145-8
Duke, C. C., & Stanik, C. (2016). Overcoming Lower-Income patients’ concerns about trust and respect from providers. Health Affairs Forefront. https://doi.org/10.1377/forefront.20160811.056138
Imagination Design Studios. (2021, January 14). What is the future of pediatric medical office design? Idskids. https://idskids.com/what-is-th...dical-office-design/
McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education Quarterly, 15(4), 351–377. https://doi.org/10.1177/109019818801500401
Moore, J., & Abetz, J. S. (2018). What Do Parents Regret About Having Children? Communicating Regrets Online. Journal of Family Issues, 40(3), 390–412. https://doi.org/10.1177/0192513x18811388
Philanthropy Network Greater Philadelphia, Thomas Scattergood Behavioral Health Foundation, United Way of Greater Philadelphia and Southern New Jersey, Edwards, A. F., O’Brien, C., & O’Connor, S. (2016). Trauma informed philanthropy: A funder’s resource guide for supporting trauma-Informed practice in the Delaware Valley. Philanthropy Network Greater Philadelphia.
SAMHSA. (2014, July). SAMHSA’s concept of trauma and guidance for a trauma-informed approach. U.S. Department of Health and Human Services. https://ncsacw.acf.hhs.gov/use...es/SAMHSA_Trauma.pdf
Comments (0)