1. 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

2. 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

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

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

5. How we connect

6. 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

7. 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.

8. 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”

9. 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

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

11. 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

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