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
1
Relationships At the Core of Adaptive Systems: (Masten, ‘14)
Relationships
• 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
5
Coverage &
Coding
Communication
Within and to
the Public &
Consumers
Coordination
Within and
Across
The 7C’s of
Translation
Credentialing
& Integration
Bethell, C 2016
Costs and
Payment
Contracting &
Accountability
Capacity &
Training
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 traumarelated 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:
(1) dysregulation of a child’s stress
response, as exhibited by symptoms,
behaviors and, potentially, biologic
measurements; (often categorized as
mental health diagnoses now)
(2) internalized negative attributions and
diminished hope and expectations for
life;
(3)difficulty with self-esteem regulation;
and
(4)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 andSource:
healing
Bethell, C 2016
for children, youth and families.
Advancing concrete data-driven tools to engage families and
children (www.wellvisitplanner.org)