Children are our future. The prosperity of our communities and society as a whole is conditional upon the success of our youth. Yet there are millions of kids growing up in dysfunctional households and/or exposed to toxic environments outside the home that impede their physical, mental, and social development. The best form of primary prevention lies with our expecting mothers or pregnant people with a uterus. By equipping soon-to-be parents with the tools and resources to ensure a stable and nurturing environment for their newborn, bringing in protective factors to build resilience, their child will achieve much greater growth.
This grant proposal project focuses on primary prevention by targeting pregnant individuals within the community, screening them for their ACE score, educating them on what ACEs are and the importance of mitigating childhood trauma, and referring them to resources as needed. This program will be held at all OB/GYN clinics, and all providers at these clinics will be trained on ACE's and trauma-informed care. The following are this program's primary goals:
- Within the first 3 months, engage at least 90% of OB/GYN providers via multiple live or pre-recorded online webinars covering ACEs and trauma-informed care.
- Within the first 3 months, develop and distribute the trauma-informed script to support provider conversations with patients.
- Within the first 3 months, develop and distribute care pathway for provider aide.
- Within the first 3 years, screen at least 90% of the target population for their ACE score, provide an explanation of what the score means, and offer resources or referrals as applicable.
This program covers two forms of prevention- primary and tertiary. This primary prevention approach mitigates the sources of trauma, preventing the children from having high ACE scores in the first place. It is also a tertiary form of prevention because it targets the parents with high ACEs and intervenes with tools, resources, and access in response to their score. This works towards putting an end to any trauma or negative situations that may be continuing within the household or other environment(s), as well as identify any ongoing physical, mental, or emotional illnesses and/or social or financial challenges that may be present.
Utilizing the Generalized Model for this intervention program means the following will be conducted: needs assessment, goal- and objective-setting, intervention development, implementation of the intervention, and evaluation of the results. The implementation of this program will either solidify or alter the theory and supply the results needed to continue the work as is needed by the target population.
Utilizing the CDC socio-ecological model, this program’s goals fall primarily in the individual-level of intervention, since its aim is to identify pregnant women with ACE scores and intervene prior to the baby’s birth. Adverse Childhood Experiences are influenced by factors outside of the individual, such as their relationships, where they live, their work environment, and the laws under which they live. This project will address those elements by starting with the individual. It is through screening the patient for her ACE score and discussing its meaning that the physician can help identify those relationships or environments that may be the source of her ACEs. For example, if the mother grew up in the same neighborhood in which she still lives that is wrought with violence or environmental toxins, then the provider could connect her with resources to find safer housing elsewhere. Or if the patient grew up with an abusive father who is still in the picture, the provider can connect her with resources to safely remove herself from that toxic relationship.
Of the Substance Abuse and Mental Health Services Administration’s (SAMHSA) six principles of trauma-informed care, there are three that most apply to this program: 1) Trustworthiness and Transparency, 2) Empowerment, Voice and Choice, and 3) Collaboration and Mutuality. Trustworthiness and Transparency are characteristics that will not only be encouraged throughout the clinics, but providers will be explicitly trained on how to implement them via the trauma-informed care webinars. Providers will be given tools to build strong, trustworthy patient relationships, and how to display honesty and transparency. Understandably, patients do not respond well to rigid, transactional doctor’s visits, so providers with these qualities will foster an open and supportive interaction that allows the patient to transparently trust the provider with their ACEs.
The next principle, Empowerment, Voice, and Choice, goes hand-in-hand with the former in that it is through the empowerment of the patient, allowing them an autonomous voice, that trust and transparency are built. It is important for patients to be an active part of their treatment, recovery, and overall health. Conversely, it is important for a provider to understand the circumstances that a patient may be in to tailor their treatment suggestions accordingly. For example, if the provider prescribes going on walks in the park 3 days a week to improve depression, that could be a triggering issue if the patient had physical or sexual abuse experienced in a park. It would only be through the transparency and voice of the patient that an appropriate alternative can be identified.
Lastly, Collaboration and Mutuality means the involvement of all applicable parties within the organization to support these efforts. Additionally, it is crucial for the entire organization to coordinate with local services to support the patients’ areas of need, such as financial support, housing or food insecurity, and counseling/therapy services.
Ultimately, the success of this program, and the data that will be collected from it, will illustrate the issue of ACEs in this community and support advocating for resources, such as community health workers, social workers, and other social services.
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