There is a three way reciprocal link between asthma, adverse childhood experiences and poor health outcomes later in life. Minnesota has a higher than the national average in childhood asthma cases and in the number of adverse childhood experiences (ACEs). This grant proposal, utilizing all components of the SAMHSA's Principles of a Trauma Informed Approach as well as all social ecological levels of the Bronfenbrenner model, is aimed at secondary and tertiary prevention of asthma and adverse childhood experiences for patients in the Minnesota Department of Health Asthma Home-based Services Program. The goal of this project is to identify asthmatic patients who have the potential for or had adverse childhood experiences and connect them to healing mental health providers. This will be accomplished through the multifaceted approach of connecting health care providers, trauma informed advocates and mental health providers to provide a trauma informed approach to asthma care.
The prevention strategies to be applied are focused on secondary and tertiary prevention as well as to break down the silos amongst the “Core Group” of Minnesota Department of Health Asthma Home-based Services providers (MDH AHBS), ACEs advocates in Minnesota and mental health providers in Minnesota. The tertiary prevention segment of the project is focused on those who already have asthma while the secondary prevention is for those who are potentially living in an environment that puts them at risk for asthma. The goal is to identify and address ACEs that again have already occurred or have the potential to occur within the home environment for the target population.
One of our three silos includes those working within the State of Minnesota to make it a trauma informed state which currently include a State Official as well as members of the public self-identified through PACEs Connection. Another silo includes the health care professionals working in the MDH AHBS. And the final silo in our triad are the mental health providers working in Minnesota both at the county and state levels. By bringing this cross section group together in both the formal setting for trauma informed training and in the informal settings of social gatherings, the goal is to make the group trauma informed as well as abundant in resources to address both asthma and ACEs.
The Bronfenbrenner model for the social ecological model was chosen for this project and the following levels of the framework will be addressed. At the individual level, the asthmatic patients will not only gain knowledge and skills to manage their pulmonary disease state, but will also benefit from trauma informed providers who are able to identify ACEs that have occurred or have the potential to occur while making home visits. The microsystem level will be addressed as the family of asthmatic patients and the healthcare providers will benefit from the program through education on both asthma and ACEs. The mesosystem level will be addressed as there are interactions between the patients, their families and the trauma informed healthcare providers are occurring to treat asthma as well as identify and treat ACEs. The exosystem will also be addressed as governmental agencies, such as the Minnesota Departments of Health and Minnesota Department of Human Services, and the PACEs Connection Network will be bolstered and supported through the activities of this program. The macrosystem will be addressed as attitudes and the culture surrounding primary, secondary and tertiary prevention of asthma and ACEs are expected to change over the course of the program. And finally the chronosystem will be addressed in that the life course of the patients in the MDH AHBS will be altered by addressing their asthma as well as in addressing any ACEs and the life course of the providers will also be altered by becoming trauma informed.
Throughout the planning and implementation of this program the following SAMHSA Principles of a Trauma Informed Approach will be employed. Both physical and psychological safety will be of the utmost importance for the patients and providers. The MDH AHBS is primarily conducted in patient’s homes, however if patients or providers feel unsafe in providing care in homes especially due to the presence of ACEs inducing activities, inpatient care for both physical and psychological treatment will be utilized. Peer support will be encouraged primarily among the “Core Group” members in order to prevent vicarious trauma due to their activities with those that have or have had ACEs, but peer support could also be found amongst the asthmatic patients as the program develops. Empowerment, voice and choice will be promoted for both the asthmatic patients in managing their asthma and in recovery from ACEs as well as for members of the “Core Group” to advocate for their asthmatic patients who have lived experiences with ACEs. Gaining trustworthiness amongst the “Core Group” will be the focus of the training provided to become trauma informed providers. Further trustworthiness will be a goal through the data collection process by utilizing an open, honest, age and literacy appropriate manner in order to be transparent. The primary focus of this program is to promote collaboration and mutuality amongst the “Core Group” through both professional and personal interactions. The providers within the MDH AHBS program, the PACEs Connection Network within Minnesota and mental health providers in Minnesota will be working together to promote healing in asthmatic patients as well as amongst each other should vicarious trauma be of concern. Finally, historical and cultural issues will be challenged by addressing primary, secondary and tertiary prevention of asthma and ACEs amongst program participants.
References
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Minnesota Department of Health. Asthma. Retrieved from https://www.health.state.mn.us...es/asthma/index.html. Last reviewed 2/19/2021.
Minnesota Department of Health. Asthma Home-based Services. Retrieved from https://www.health.state.mn.us/diseases/asthma/professionals/home-basedservices.html Last reviewed 2/19/2021.
Vital Signs - Adverse Childhood Experiences (ACEs). CDC. Retrieved from https://www.cdc.gov/vitalsigns/aces/index.html. Last reviewed 2/19/2021.
Minnesota Department of Health. Adverse Childhood Experiences in Minnesota. Retrieved from https://www.health.state.mn.us...es/ace/acereport.pdf. Last reviewed 2/19/2021.
Minnesota Department of Health. Adverse Childhood Experiences (ACEs) in Minnesota. Retrieved from https://www.health.state.mn.us...ities/ace/index.html. Last reviewed 2/19/20201.
PACEs Connection Network. Minnesota ACEs Action: A Trauma Informed Network (MN). Retrieved from https://www.pacesconnection.com...innesota-aces-action. Last reviewed 2/19/2021.
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Guy-Evans, O. Bronfenbrenner’s Ecological Systems Theory. Simply Psychology. Retrieved from https://www.simplypsychology.org/Bronfenbrenner.html. Last reviewed 3/22/2021.
SAMHSA's Concept of Trauma and Guidance for a Trauma Informed Approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.
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