April 29 - May 1, 2015 BEST START INITIATIVE: Helping Babies By Integrating Health Care and Home Visiting Services

Why Babies?

Brain Architecture

Increases in heart rate, blood pressure, serum glucose, stress hormones, and inflammatory cytokines fuel the “fight or flight response” to deal with acute threat... …but excessive or prolonged activation of stress response systems can lead to long-term disruptions in brain architecture, immune status, metabolic systems, and cardiovascular function. The Biology of Stress Source: National Scientific Council on the Developing Child Toxic Stress Prolonged activation of stress response systems in the absence of protective relationships. Toxic Stress Prolonged activation of stress response systems in the absence of protective relationships.

Household dysfunctions: % Reporting Substance abuse27% Parental sep/divorce23% Mental illness17% Battered mother13% Criminal behavior 6% Abuse: Psychological11% Physical 28% Sexual21% Neglect Emotional 15% Physical10% Source: Kaiser Permanente and CDC Study. Over 17,000 adult HMO members interviewed Adverse Childhood Experiences (ACEs)

Development Developmental Delays in the First Three Years Number of Risk Factors Source: Barth et al. (2008) Children with Developmental Delays % 40% 60% 80% 100%

ACE Score vs. Serious Job Problems

Adult Substance Abuse Self-Report: Alcoholism Self-Report: Illicit Drugs Self-Report: Alcoholism Self-Report: Illicit Drugs Source: Dube et al, 2002 Source: Dube et al, 2005 Source: Dube et al, 2002 Source: Dube et al, 2005 % ACEs Schilling et al, BMC Public Health 7 (2007)

Risk Factors for Adult Heart Disease are Embedded in Adverse Childhood Experiences Adverse Experiences Source: Dong et al. (2004) Odds Ratio ,67,

Similar connections appeared between early adversity and later: Smoking Chronic Depression Stroke Obesity Cancer

Toxic Stress Prolonged stress in early childhood, in the absence of protective relationships: Leads to some of the most serious, costly problems in our society Leads to problems in Education, Financial Stability, and Health

Why Focus on Home Visiting? Help parents develop a strong, trusting bond with their child Start early with the family - even prenatally Bring the services to the family Connect family members to other most appropriate community resources

By starting at the very beginning, how big a difference can we make?

3-Year Regional Plan Developed Key Partners: Maine Families Early Head Start Public Health Nursing Mid Coast Medical Group Mid Coast Hospital

Barriers Funding: Cost is about $2,000 per family. Current Referrals: Only perceived high-risk families referred. Medical staff often unsure where to refer. Drop-Off: Many referred never actually connect with a home visitor. Parent Resistance/Stigma.

Collective Goal for Mid Coast Maine For Home Visiting/ Parent Education to become the ‘norm’, so most families benefit and more adverse childhood experiences are prevented or reduced.

Four Key Components o f the Plan Integrate medical practices and community-based programs, including new Best Start Specialist position. Increase Home Visiting capacity. Evaluate the initiative and child outcomes. Ongoing “backbone” support.

Target Population Families receiving prenatal care at Mid Coast Medical Group (approximately 465 families per year)

Goal to Increase Home Visits with Families 20% 93 families 70% 325 families

Recruited Funding Partners United Way received 3 significant foundation grants, totaling $485,000 to implement and evaluate our 3-year plan.

Progress Prior to Launch Outreach to our UW Partner Agencies in 2012 Defined new Best Start Specialist job & contracted with partner to hire and support her. Contracted with an Evaluation Research Firm. MOUs with key partners. Confidentiality and Access to Medical Records.

Since Launch in September 2014 Facilitated System Changes, e.g. Electronic Medical Record integration. Moving to a “norm” – part of the prenatal care system. To date, 132 women have met with the Best Start Specialist. ____ of pregnant women/families have enrolled and are receiving supports.

Spin-offs & Sustainability Diaper Project. Developmental Screening Initiative. Integration project with Home Visitors and Pediatricians. Advocacy at state and federal levels for home visiting.

LESSONS LEARNED Strong support because based on research. This is changing SYSTEMS, which takes time. Strong leadership and support at key partners. Challenges of integrating complex health system with community-based programs. Several years of participating in a Early Childhood Funders Group helped to build foundation partners for our initiative.

Key Steps for Your Community Identify key partners – Home Visiting Programs, Medical OB/GYN Practice, Community Partners. Build on current relationships (e.g. UW Board/volunteers) Build consensus for a Plan. Work to identify and nurture potential champions within different systems, e.g. within medical professions. Backbone Organization – clarity of roles, continually reviewed.

A BIG BOLD PLAN! We see this as Collective Impact, putting resources toward starting early! We see this as Systems Change, changing the thought processes and system procedures among medical and home visiting staff. We see this as behavioral change among professional staff and prospective/new/current parents.

See you in Vancouver!

Contacts Barbara ReinertsenPeter Lindsay Executive DirectorDirector, Community Impact & Success By 6 United Way of Mid Coast Maine 34 Wing Farm Parkway Bath, ME

A Science-Based Framework for Early Childhood Policy, Center on the Developing Child at Harvard University, /policy_framework/ The Long Reach of Early Childhood Poverty Greg J. Duncan and Katherine Magnuson, Pathways magazine, Stanford Center for the Study of Poverty and Inequality, Winter inter11.pdf Adverse Childhood Experiences Study The Relationship of Adverse Childhood Experiences to Adult Health: Turning gold into lead For more links to ACEs reports and information, go to: