1. All Children Excel (ACE) Nashville
A Public Health Approach to Preventing and Mitigating the Impact of Childhood Adversity

2. Tackling Complex Health & Social Issues With:$
OPPORTUNITY
No Money
Tremendous Opportunity
Strategic in approaching the opportunity
All Comers Model

3. Mechanisms by Which Adverse Childhood Experiences Influence Health and Well-being Throughout the Lifespan
The CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study is one of the largest investigations of childhood abuse and neglect and later-life health and well-being and was conducted from
This resulted in the identification of three categories of ACEs.
Abuse : Emotional , Physical and Sexual
Household Challenges: Mother treated violently, household substance abuse, Mental Illntess in household, Parental separation or divorce, Criminal household member
Neglect:1 Emotional neglect and physical neglect
Increasing numbers of ACES were related to increased rates of chronic illness, substance abuse and addiction, and early death.
Emotional abuse: A parent, stepparent, or adult living in your home swore at you, insulted you, put you down, or acted in a way that made you afraid that you might be physically hurt.
Physical abuse: A parent, stepparent, or adult living in your home pushed, grabbed, slapped, threw something at you, or hit you so hard that you had marks or were injured.
Sexual abuse: An adult, relative, family friend, or stranger who was at least 5 years older than you ever touched or fondled your body in a sexual way, made you touch his/her body in a sexual way, attempted to have any type of sexual intercourse with you.
Mother treated violently: Your mother or stepmother was pushed, grabbed, slapped, had something thrown at her, kicked, bitten, hit with a fist, hit with something hard, repeatedly hit for over at least a few minutes, or ever threatened or hurt by a knife or gun by your father (or stepfather) or mother’s boyfriend.
Household substance abuse: A household member was a problem drinker or alcoholic or a household member used street drugs.
Mental illness in household: A household member was depressed or mentally ill or a household member attempted suicide.
Parental separation or divorce: Your parents were ever separated or divorced.
Criminal household member: A household member went to prison.
Emotional neglect: Someone in your family helped you feel important or special, you felt loved, people in your family looked out for each other and felt close to each other, and your family was a source of strength and support.2
Physical neglect: There was someone to take care of you, protect you, and take you to the doctor if you needed it2, you didn’t have enough to eat, your parents were too drunk or too high to take care of you, and you had to wear dirty clothes.
Source: Anda, n.d.

4. The BCR Pair of ACEs tree image grew out of the need to illustrate the relationship between adversity within a family and adversity within a community.
The tree is planted in poor soil that is steeped in systemic inequities, robbing it of nutrients necessary to support a thriving community.

5. ACEs and Public Health
How do we take what we now know about ACEs, which have created a public health crisis to Creating a culture that promotes Safe, Stable, Nurturing Relationships and Environments as recommended by the CDC?
We adopt a Public Health Approach, moving from person level focus to population level focus
Policies, Systems and Environments
Metro Charter component

6. Opportunity: Community Health Improvement Plan (CHIP)
Advance Health Equity
Support Mental & Emotional Health
Maximize Built & Natural Environments
Community Health Improvement Plan created through a process MAPP Mobilizing for Action through Partnership and Planning
THE CHIP was developed using the MAPP, developed by NACCHO and CDC to allow users to improve the way the local public health community conducts community health planning and programming. This community health assessment process involves broad community representation and participation. The Healthy Nashville Leadership Council (HNLC) acts as the steering committee for the Nashville MAPP community health assessment process and the development of the CHIP.
Healthy Nashville Leadership Council
Community Health Assessment
All Children Excel-ACE Nashville is a collective impact public private partnership to help all children. When you hear ACE first thing that comes to mind for many is Adverse Childhood Experiences. ACE Nashville intentionally made this change to mitigate the negative and focus on creating a firm foundation for children.

7. Opportunity: Tennessee’s Building Strong Brains Initiative
Juvenile and Adult Justice
Health Care Services and Financing
Human Services
Faith Based Communities
Education and Early Care
Media
Mental Health & Substance Abuse Services
Philanthropy
Child Welfare
Businesses and Corporations
Professional Practice
Programs and Services
Policies and Funding
Philosophy and Approach
Recognize this slide from BSB
Community-wide culture change requires trust and relationship building between multiple sectors who can move forward together to develop strategies for promoting a trauma-informed, resilience-focused approach in our policies, programs and practices.

8. ACE Nashville: A Brief History
CDC Guidelines
Other National Initiatives
Community Health Improvement Plan (CHIP)
Consensus Workshop: 44 Nashville Leaders
A.C.E. Nashville
ACE Nashville is based on an evidence-informed public health approach, including:
CDC Recommendations for addressing ACEs on a population level
CHIP, 5 year strategic health plan for Nashville
Communities from around the nation who are addressing ACEs at a population level with success
Consensus from 44 other nonprofit, government and healthcare leaders in Nashville

9. Community Consensus
Workshop Question: What strategies can we use to implement a comprehensive public health initiative which will prevent childhood adversity, promote family resilience and improve lifelong health?
Public Awareness Campaign
Community Commitment to Trauma-Informed Care
Parent & Community Engagement & Education
Policy Advocacy
Continuous Quality Improvement
Use of a Collective Impact Model
Tool: Consensus
I feel mixed about using this slide. On the one hand it gets a little bit in the weeds, on the other it highlights the use of consensus.

10. Collective Impact
How we get there (how we achieve the work of the CHIP)
Common agenda - Collective impact requires all participants to have a shared vision for change, one that includes a common understanding of the problem and a joint approach to solving it through agreed upon actions.
Mutually Reinforcing Activities - Collective impact initiatives depend on a diverse group of stakeholders working together, not by requiring that all participants do the same thing, but by encouraging each participant to undertake the specific set of activities at which it excels in a way that supports and is coordinated with the actions
of others.
Shared Measurement- Collecting data and measuring results consistently on a short list of indicators at the community level and across all participating organizations not only ensures that all efforts remain aligned, it also enables the participants to hold each other accountable and learn from each other’s successes and failures.
Continuous Communication – regular meetings, structured agendas, neutral facilitators – developing trust
Backbone Support - The backbone organization requires a dedicated staff separate from the participating organizations who can plan, manage, and support the initiative through ongoing facilitation, technology and communications support, data collection and reporting, and handling the myriad logistical and administrative details needed for the initiative to function smoothly. 
JDC

11. The mission of ACE Nashville is to prevent and mitigate the lifelong impact of childhood adversity to improve the safety, health and prosperity of our community.
Common Agenda
Our vision is for Nashville to be a safe, stable, and nurturing community for all. 

12. Current Cross Sector Involvement
ACE Nashville
Local Government
Business
Healthcare
State Government
Local Nonprofit leaders
School System and Higher Education

13. Staying Power: What’s in it for me?
Network expansion: Cultivating trust and building relationships
Participating organizations have greater impact towards individual goals

14. ACE Nashville Structure
Leadership Team
Workgroups
Policy
Continuous Quality Improvement
Parent and Community Education
Trauma Informed Care
Learning Collaborative
Learning Collaborative Quarterly meetings focused on:
Learning from local initiatives doing innovative work to prevent and mitigate ACEs
Updating larger membership on ACE Nashville activities, opportunities and successes
Opportunities to connect with workgroups
Participation levels flexible, workgroup, quarterly meeting

15. Collective Impact Challenges
Identifying population level indicators
Solidifying structure/Backbone organization
Too many “chiefs” – high level leadership populates leadership team
Trust building among partners that have historically competed for funding
Being “trauma sensitive” in our leadership style
No dedicated staff
Collective Impact Challenges
JDC and Angie

16. ACE Nashville Successes
Involvement from 350+ individuals and 50+ organizations
In 2 years, over 14,000 individuals who live or work in Davidson County have attended a presentation on ACEs, toxic stress, child development and/or resiliency.
Focus on ACEs in funding community, including Metro Nashville United Way, prioritizing ACEs in every funding category
Funding to pilot “Templates for Resilient Organizations”
Engagement as partner with statewide Building Strong Brains Initiative
ACE Nashville Successes
In template for resilient organizations comment on new grant that has been submitted with UT School of Social Work expanding impact statewide

17. Leveraging Built Relationships
Approached by Senate HELP Committee staffer to inform opioid legislation
Trauma-Informed Schools initiative at Metro Nashville Public Schools
ACEs Prevention Coordinator at Metro Public Health Department
ACE Nashville has used it’s built relationships to leverage influence for several opportunities, including:

18. New Opportunity
Collective Impact Catalyst formed and ACE Nashville selected to participate.
100 hours of free consulting to help ACE Nashville determine strategic goals, population level indicators and identify backbone structure.
Angie

19. Link and leverage resources in order to achieve unity of purpose in the effort to prevent and mitigate the lifelong impact of adverse childhood experiences.
Angie
Community norm that we all share responsibility for the well-being of children.

20. It is easier to build strong children than to repair broken men.
1800’s – Frederick Douglas
It is easier to build strong children than to repair broken men.
1800’s common sense, but no science
Today common sense, science, and opportunity and commitment to use science
community norm that we all share responsibility for the well-being of children.

21. Contact Information
Jennifer Trail ACE Prevention Coordinator Metro Public Health Department Angie Thompson Director Division of Behavioral Health and Wellness
Angie