Shining a light on ACEs is more than a “Courtesy Alert” “In my beginning is my end.” (?) T.S. Eliot, Four Quartets “Where you stumble, there your treasure lies” Joseph Campbell Bethell, C 2016

Relationships At the Core of Adaptive Systems: (Masten, ‘14) Safe, stable, nurturing Effective parents and caregivers Connections to other competent and caring adults Child - Awareness of sensations, feelings, meaning; self soothing - Problem solving skills; resourceful; - Positive beliefs about self - Beliefs that life has meaning; goals --Spirituality and faith; hope Community & Environment Socioeconomic sufficiency Pro-social culture and peers Effective teachers/schools Safety and trust Collective efficacy and capacity for problem solving Source: Bethell, C 2016

Maslow Rewired: The primacy of safe, stable, nurturing relationships to physical and mental health throughout life Source: Bethell, C 2016

When a baby feels safe, they explore and if a baby explores, they learn. Source: Bethell, C 2016

How we connect

The 7C’s of Translation Bethell, C 2016 Costs and Payment Coverage & Coding Costs and Payment Contracting & Accountability Capacity & Training Credentialing & Integration Coordination Within and Across Communication Within and to the Public & Consumers The 7C’s of Translation Bethell, C 2016

7C’s of Policy and Practice Translation 1. Coverage & Coding--along the continuum of primary prevention, secondary prevention and complex trauma treatment; to support screening, care coordination and codes to identify Developmental Trauma Disorder (National Child Traumatic Stress Network). 2. Contracting and Payment- test payment models that enable systems capacity to address social determinants of health overall, and ACEs in particular. Requires integration of trauma-informed behavioral health and community support services 3. Contracting and Performance Measurement-install contracting provisions and performance measurement methods to promote provider, health plan and related systems innovation around social determinants of health and ACEs. 4. Capacity & Training- identify and promote core competencies, install trauma-related Continuing Medical Education (CME) requirements. Align information technology (IT) systems and tools and define practice work flows and team models support goals.

7C’s of Policy and Practice Translation 5. Credentialing & Integration—specify the role and training for nontraditional providers, like peer-to-peer, family-to-family and community health workers. Align credentialing, supervision and payment models. 6. Coordination- envision and deploy delivery system models that coordinate data, teams, services and supports and collaborate in consistent public education and best practices 7. Communication—Engage children, families, communities, providers and leaders around a common communication platform and shift the dialogue to align with the “no shame, no blame, science-based ACEs framework”

Developmental Trauma Disorder (DTD): National Traumatic Stress Network suggests that DTD is indicated with: dysregulation of a child’s stress response, as exhibited by symptoms, behaviors and, potentially, biologic measurements; (often categorized as mental health diagnoses now) internalized negative attributions and diminished hope and expectations for life; difficulty with self-esteem regulation; and functional impairments in key areas such as making social connections, participating in school, etc. Source: Bethell, C 2016

Mindsets to match the mandate Metrics to match the mindset Methods to move the metrics Source: Bethell, C 2016

To Beauty BACKGROUND ….and the translation of the science and practice of promoting positive health and healing for children, youth and families. Source: Bethell, C 2016

Advancing concrete data-driven tools to engage families and children (www.wellvisitplanner.org)