PRESENTATION TO OCDEL STAKEHOLDERS LIFECOURSE PERSPECTIVE FEBRUARY 20, 2013

PRESENTATION TO OCDEL STAKEHOLDERSLIFECOURSE PERSPECTIVEFEBRUARY 20, 2013

Pat Yoder, presenter

PPP MEMBERS Maternal and Child Health programs

Title V- Federal block grant dollars to PA Dept of Health, which makes grants to 10 county and municipal health departments

and Healthy Start programs funded directly by

DHHS to 7 programs in PA

CONCEPTS AND LANGUAGE

OCDEL focus on early childhood from an educational perspective

MCH professionals focus on early childhood from a maternal/pregnancy/pre-pregnancy perspective

POSSIBILITIES

We serve the same people Our results are not as good as we’d like Collaboration should help improve our results If we do better, our clients should do better,

and there should be opportunities to increase funding

SO, LET’S TALK!

LIFE COURSE PERSPECTIVE FRAMEWORK

The current most promoted concept for thinking about maternal and child health

Designed to address the extremely resistant problem of racial disparities in infant mortality

IN THE BEGINNING

Adverse Childhood Experiences Study

Thanks to Dr. Ron Voorhees, M.D., M.P.H., Acting Director, Allegheny County Health Department. Several slides from his presentation on ACE, presented October 26, 2011 to PPP follow.

RELATIONSHIP OF CHILDHOOD ABUSE AND HOUSEHOLD DYSFUNCTION TO MANY OF THE LEADING CAUSES OF DEATH IN ADULTS: THE ADVERSE CHILDHOOD EXPERIENCE (ACE) STUDY

Vincent J. Felitti, Robert F. Anda, Dale Nordenberg, David F. Williamson, Alison M. Spitz, Valerie Edwards,

Mary P. Koss, James S. Marks

American Journal of Preventive Medicine, 1998; 14(4) 245-258

ADVERSE CHILDHOOD EXPERIENCES

More than 17,000 Kaiser patients were asked to recall their childhood experiences

Health conditions in the present were tabulated

ACE STUDY - CATEGORIES OF ADVERSE CHILDHOOD EXPERIENCES (ACE)

Psychological abuse

Physical abuse

Sexual abuse

Substance abuse in home

Mental illness in parent

Violence against mother

Incarceration of parent

KAISER HMO ENROLLEES HAD AT LEAST ONE TYPE OF ADVERSE CHILDHOOD EXPERIENCE:

0 Categories

49.5%

4 Categories

6.2%3 Categories

6.9 %

2 Categories

12.5%

1 Category

24.9%

Data from Felitti, et. al.

GROWING UP WITH ADVERSE CHILDHOOD EXPERIENCES INCREASES THE RISK FOR MANY LATER ADVERSE HEALTH CONDITIONS – RANGING FROM SMOKING TO OBESITY TO DEPRESSION AND SUBSTANCE ABUSE.

FOUR OR MORE ACES DOUBLE THE RISK FOR BEING A SMOKER

1.1 1.5 2.22.0

Data from Felitti, et. al.

Odds Ratio (relative to

0 ACEs)

Number of ACE Categories

ACES INCREASE RISK FOR CHRONIC BRONCHITIS/EMPHYSEMA

0

2

4

6

8

10

12

14

1 2 3 >=4

Number of ACE Categories

Od

ds

Rat

io (

Rel

ativ

e to

0

cate

go

ries

)

Data from Felitti, et. al.

1.6 1.62.2

3.9

ACES INCREASE THE RISK OF STROKE

0

2

4

6

8

10

12

14

1 2 3 >=4

Number of ACE Categories

Od

ds

Rat

io (

Rel

ativ

e to

0

cate

go

ries

)

Data from Felitti, et. al.

0.9 0.71.3

2.4

ACES INCREASE RISK OF ISCHEMIC HEART DISEASE

0

2

4

6

8

10

12

14

1 2 3 >=4

Number of ACE Categories

Od

ds

Rat

io (

Rel

ativ

e to

0

cate

go

ries

)

Data from Felitti, et. al.

0.90.91.4 2.2

ACES INCREASE THE RISK OF CANCER

0

2

4

6

8

10

12

14

1 2 3 >=4

Number of ACE Categories

Od

ds

Rat

io (

Rel

ativ

e to

0

cate

go

ries

)

Data from Felitti, et. al.

1.2 1.2 1.0 1.9

ACES INCREASE REPORTING OF HAVING AN STD

0

2

4

6

8

10

12

14

1 2 3 >=4

Number of ACE Categories

Od

ds

Rat

io (

Rel

ativ

e to

0

cate

go

ries

)

Data from Felitti, et. al.

1.4 1.5 1.9 2.5

ACES INCREASE RISK OF HAVING HAD OVER 50 SEXUAL PARTNERS

0

2

4

6

8

10

12

14

1 2 3 >=4

Number of ACE Categories

Od

ds

Rat

io (

Rel

ativ

e to

0

cate

go

ries

)

Data from Felitti, et. al.

1.7 2.3 3.1 3.2

ACES INCREASE THE RISK FOR DEPRESSION ALMOST FIVE TIMES

1.5 2.42.6

4.6

Data from Felitti, et. al.

Odds Ratio (relative to

0 ACEs)

Number of ACE Categories

FOUR ACES INCREASE THE RISK FOR USING ILLICIT DRUGS 4.7 TIMES; EVEN ONE ALMOST DOUBLES THE RISK:

Data from Felitti, et. al.

1.72.9

3.64.7

Odds Ratio (relative to

0 ACEs)

Number of ACE Categories

ACES INCREASE THE RISK FOR ALCOHOLISM

Data from Felitti, et. al.

2.0

7.4 4.9

4.0

Odds Ratio (relative to

0 ACEs)

Number of ACE Categories

ACES INCREASE THE RISK FOR SUICIDE ATTEMPT OVER 12 TIMES:

1.8

3.0

6.6

12.2

Data from Felitti, et. al.

Odds Ratio (relative to

0 ACEs)

Number of ACE Categories

SOCIOECONOMIC IMPACT OF CHILD ABUSE AND NEGLECT

David Zielinski (Duke University) estimated that almost 20% of unemployed adults report abuse or neglect as child

Adult victims of maltreatment:have less education

have more physical and mental health problems that interfere with their work

are twice as likely to be below federal poverty level

are twice as likely to be on Medicaid

DISPARITIES IN INFANT MORTALITY

Not so long ago, maternal and child health workers believed that just getting women in for at least ONE prenatal visit would make a difference in the rates of infant mortality

The science has changed; our understanding has deepened

Focus has shifted to racial disparities and why they are so persistent

WHY?

Many studies have shown that the factors that might explain the racial disparities, don’t!

Genetics Behavior Prenatal Care SES Stress Infection

MULTIPLE RISK FACTORS

Explain less than 10% of the variation in low birth weights between white and African-American babies

EARLY PROGRAMMING

Emphasis on importance of sensitive developmental periods in utero or early life during which future reproductive potential becomes programmed

KNOWLEDGE IS INCREASING

In the last 20 years, David Barker, MD, PhD, FRS, studied what happens to a low birth weight baby

Health consequences in adult life, such as heart disease and diabetes

Mother’s consistent prenatal stress affects her hormones, which in turn, affects the baby’s brain development

Epigenetics =another continuing aspect of study (trust me!!)

STILL MORE COMPLEXITY

Cumulative pathways All that happens throughout the life of the

mother, and her mother (not to mention what we’re learning about dads!)

THESE ARE NOT MUTUALLY EXCLUSIVE!

Early programming and cumulative pathways affect the life course over generations

WHAT TO DO?12 POINT PROGRAM

Improving Health care Services Provide interconception care to women with

prior adverse pregnancy outcomes Increase access to preconception care for

women Improve the quality of prenatal care Expand health care access over the life

course

STRENGTHENING FAMILIES AND COMMUNITIES

Strengthen father involvement in families Parental resilience

Enhance service coordination and systems integration

Create reproductive social capital in communities

Invest in community building and urban renewal

ADDRESSING SOCIAL AND ECONOMIC INEQUITIES

Close the education gap Knowledge of parenting and child development

Reduce poverty Support working mothers and families Undo racism

OPPORTUNITIES ABOUND!

Break down barriers Talk and work with one another Recognize commonalities Keep hope alive

REFERENCES

Barker, David, http://www.thebarkertheory.org contains complete references

Lu, Michael and Neil Halfon, “Racial and Ethnic Disparities in Birth Outcomes: A Life-Course Perspective,” Maternal and Child Health Journal, Vol. 7, No. 1, March 2003”

Lu, Michael, “Strong Roots Healthy Fruit: Transforming Generations through the Life Course Perspective,” June 29, 2010, Philadelphia Department of Public Health, Division of Maternal and Child Health, DVD presentation

Ronald E. Voorhees, MD, MPH, “Improving Health: First Things First,”

PPP, October 26, 2011, Power Point Presentation

Strengthening Families

Parents say they want to…

• Know their children feel loved

• Be responsive to child

• Have connections• Meet basic needs• Show courage

Strengthening Families began as an approach to child abuse prevention

• Research based• Focus on strengths, not risks• For all families• Start where families already go• Build on and connect existing programs and

strategies, not invent new ones

Strengthening Families quickly moved beyond child abuse prevention for young children and was adapted for a wide variety of programs, integrating a common approach to the needs of families into many kinds of services.

Partners at the national levelFederal Agencies

•Administration for Children, Youth and Families, Office on Child Abuse and Neglect

•Substance Abuse and Mental Health Services Administration (SAMHSA)

•Administration on Children and Families, Child Care Bureau

•Maternal and Child Health Bureau

•Centers for Disease Control and Prevention, Division of Violence Prevention

The protective factors

Social and emotional competence

“My child feels loved, a

sense of belonging and can get along with others.”

Adequate knowledge of parenting and child development

“I stay curious and am responsive to what my child needs.”

An array of social connections

“I have people who know me –friends. And at least one person who supports my parenting.”

Concrete support in times of need

“My family can access basic needs when they need it.”

Parental resilience

“I will continue to have courage during stress or after a crisis.”

Protective Factors definitions from Community Café

Parental resilience cont.

HopeCommuni-

cation skills

Problem-solve

Make changes for the future

Gather resources

Make good choices

Belief system

Coping strategies

Acknowledge feelings

Recognize challenges

Take action

Relationships – the foundation

• Mutual respect and partnership

• Trusting relationships with others, developed over time

• Relationships with schools, community agencies and services

Resources

Strengthening Families National Network

www.strengtheningfamilies.net

Online Modules : www.ctfalliance.org

Karen ShanoskiFamily Partnerships Project ManagerCenter for Schools and Communities

275 Grandview Ave., Suite 200Camp Hill, PA 17011

kshanoski@csc.csiu.org 717-763-1661 x 139

PA Strengthening Families : Toolkit for Educatorswww.pa-strengthening-families.org

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