People that have experienced adverse childhood events (ACEs) are at an increased risk for the development of heart disease. In order to reduce the risk, our goal is to begin screening those with an ACE history with regular cardiologist visits. In addition, we will be assessing lab values, daily weights, and blood pressure readings. This will be used as a tool for us to guide our medical interventions.
In addition, we would like to provide education for patients in terms of healthy lifestyle interventions. We will be utilizing dieticians to provide healthy diet education. We will also provide access to local gyms where people can bring their children with them for childcare while they are able to exercise. While there, they will have access to health trainers.
Last, we would like to provide access to regular therapy sessions to help with the healing process. These are sessions that may be attended individually or with families.
Public Health Framework
Public health is the practice of preventing disease, prolonging life, and promoting health through organized efforts and informed choices of individuals (CDC, 2021). Our project will not only address social issues that may lead to ACEs but also outcomes that ACE exposure may cause. With public health, there are three essential components to a promotion: primary which is the prevention of the disease, secondary defined as screening for the disease, and tertiary including management of the disease (Thompson et al, 2016). Our project will be utilizing all three strategies. We will aim to reduce ACE exposure by providing families with safe atmospheres to leave their children when they are exercising which may reduce potential exposure to ACEs. We will actively screen participants for the development of heart disease through scheduled appointments and regular monitoring. Through the screenings, we will identify individuals that are in need of preventative therapy such as medication for high blood pressure, high cholesterol, anxiety, etc. The program will also provide participants with methods to reduce the risk of development through lifestyle interventions such as guided physical activity with a trauma-informed team working alongside them at each step. We will also provide our participants with free counseling sessions that help them begin the process of healing from the emotional experiences that have experienced throughout their lives. This will help us in our primary effort to prevent future ACEs from developing in the participant's children.
Levels of the Social Ecological Model
The CDC’s Social Ecological Model uses a four-level approach to allow users to better understand violence and potential prevention methods (CDC, 2022). The model addresses individual, relationship, community, and societal factors that create a better understanding of the factors that place people at risk or help protect them. When looking at the model’s visual depiction, there are overlapping rings that signify how one level will influence factors at another level.
At an individual level, the intervention will help participants address factors that increase the likelihood of violence exposure. This will include safe childcare for people that may not otherwise have a safe place for their children while they are exercising or receiving clinical services and counseling sessions. In addition, it promotes prevention strategies to decrease the likelihood that parents will become perpetrators of violence by providing them with healthy alternatives to stress relief (CDC, 2022).
The second level addressed through the intervention will be the relational level. This includes the person’s closest circle including peers and children. Strategies will increase family-focused prevention, as already mentioned in the individual segment. It will also create an environment that promotes positive peer norms such as exercise and increased communication (CDC, 2022).
The final level will be the societal level. As mentioned, creating environments where families can safely bring their children while they seek help or receive medical services will routinely place the families in an environment that teaches them acceptable ways to resolve conflict (through counseling), and it places them in an atmosphere that does not condone violence (CDC, 2022).
Trauma-Informed Principles Utilized
All individuals that participate in the program will be subject to trauma training. This is the first step in ensuring that all participants, as well as their children, are appropriately approached.
The principle of trustworthiness and transparency will be paramount for our intervention. It is our goal to make sure that participants feel they can trust their providers and health team (SAMHSA, 2014). This includes all healthcare professionals, cardiologists, pharmacists, nurses, and all people that may be in contact with participants or their children throughout the program such as childcare providers. In addition to this, the principle of safety will be our focus. We believe that people need to feel safe in order to trust.
We acknowledge that the prevention of cardiovascular disease depends on more than clinical practices or physical activity. This will require participants to be empowered to make decisions that encourage habit development and healthy lifestyle changes (SAMHSA, 2014). With that in mind, it is important to identify and build upon an individual’s strengths and respect each individual’s choices. The organization is aware that people that have experienced trauma have, oftentimes, had their choices and voices ignored. Doing so as an organization could re-traumatize participants. This means that all individuals working with clients will be trained to encourage the strength they see in clients, but it will be emphasized that they are facilitators of healing rather than controllers of participants.
The final principle that will be important for success is that of collaboration and mutuality which has already been briefly touched on. It is important to acknowledge that everyone has a role in the healing process (SAMHSA, 2014). This means that all individuals, care teams, participants, and families, must be willing to participate and encourage change in order to promote healthy cardiovascular lifestyle changes and trauma healing.
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