Presentation by Sally Fogerty of Children's Safety Network (www.ChildrensSafetyNetwork.org) at Building Communities of Hope Event Oct. 23, 2012 in Springfield, Mass.

1. The
Public
Health
Frame
and
Approach
to
Learning the
Preven7on
of
Child
EDC transforms
lives.
Maltreatment
Sally
Fogerty
October
23,
2012

2. “Children’s health is the extent to which
individual children or groups of children are able or
enabled to (a) develop and realize their potential,
(b) satisfy their needs, and (c ) develop the
capacities that allow them to interact successfully
with their biological, physical, and social
environments.”
From Children’s Health, the Nation’s Wealth, National Academies
Press, 2004
2

3. It is in the national interest to have healthy
children.
Healthy children are …more likely to become
healthy adults who will contribute as a productive
citizenry and workforce to the continued vitality
of society.
National Academy of Sciences, 2004
Children's Health, the Nation's Wealth:
Assessing and Improving Child Health

4. 4

5. Adverse
Childhood
Experience
(ACE)
Study
q Maltreatment
§ Emotional, physical, and sexual abuse
§ Emotional and physical neglect
q Family Dysfunction
§ Family Substance Abuse
§ Family Mental Illness
§ Intimate Partner Violence
§ Parental Divorce/Separation
§ Incarcerated Family Member
– Almost two-thirds had at least one ACE
– More than one in five had 3 or more ACEs
Adverse Childhood Experiences (ACEs) fact sheet. www.cdc.gov/nccdphp/ace

6. Linked
to
Broad
Array
of
Problems
Depression Liver disease
Suicide Heart disease
Current smoking Unintended pregnancy
Teenage pregnancy STDs
Teenage paternity Memory deficits
Work Absenteeism Illicit drug use
IPV Perpetration Early alcohol use
Slide courtesy of Valerie Edwards, PhD. Div. of Adult and Community Health. CDC

7. ACE Score and Alcoholism
18
ACE
SCORE
16
Percent With Health Problem
0 1 2 3 4 or more
14
12
10
(%)
8
6
4
2
0
Problem w/alcohol or Began drinking <=14 years
consider self alcoholic
Slide courtesy of Valerie Edwards, PhD. Div. of Adult and Community Health. CDC

8. Why it matters?
8

9. Individual
Health
Influenced
by:
ž Biological
– individual attributes
ž Environmental - family, community
ž Social Influences – population experience
9

10. On-­‐going
Stressors
Influence
Individual
Health
ž Livingin poverty Activate
ž Financial strain Stress
ž Lack of social Pathways
support
Blood pressure
Heart rate
Altered reflexes
10

11. Physical
Cognitive Health and
Functioning
Development
Genetics
Environment
Emotional/
Social
Behavioral
Functioning
Functioning
11

12.
Social
‘Determinants'
of
Health
ž Circumstances in which people are born,
grow up, live, work and age, and the
systems put in place to deal with illness.
ž Circumstances shaped by: economics,
social policies, and politics.
Could someone help me
with these?
I’m late for math class
CSMHA - NASBHC MHET
12

13. Social-­‐Ecological
Model
Life Course
Individual Family/Peer Community Social/Cultural
Environment

14. Our Health Outcomes
are Multi-Factorial
Educa7on
Health
Family/Peer
Neighborhood
Services
Child
Policy
Community
Family
Support
Social
Welfare
Graphic
Concept
Adapted
from
Neal
Halfon,
UCLA
14

15. Child
abuse
and
neglect
is
result
of
complex
transac7ons
between
mul7ple
risk
factors
and
ecologies.
It
is
…
Preventable
Multifaceted
Requiring
Multilevel and Multidisciplinary
solutions
Collaborations & partnerships
which are cross-agency,
disciplines and community-
based
15

16. Reframing What We Do and
How We Do It.
De-scaling What Doesn’t
Work, Scaling Up What
Does Work
Measure Outcomes
not just Services
16

17. We are standing on the bank of
the river, rescuing people who
are drowning. We have not
gone to the head of the river to
keep them from falling in.
Gloria Steinem, 2002
17

18. Risk
Factors,
Protec7ve
Factors
and
Resiliency
Risk factors: something shown to be associated with
a
higher incidence when populations exposed to factor.
Protective factors: something present increases health
and well-being of children and families.
Resilience: set of skills & behaviors which appear to
prevent more serious effects due to trauma, illness and
other life events
18

19. Risk Factors
Protective Factors
Graphic
Concept
Adapted
from
Neal
Halfon,
UCLA
19

20. Safe, Stable, Nurturing
Relationships (SSNRs)
Safety. Safety refers to the extent to which
a child is free from fear and secure from
physical or psychological harm within his or
her social and physical environment.
Stability. This refers to the degree of
predictability and consistency in a child's
environment. Families that are stable and have
regular routines provide children with the
consistency needed to lessen the impact of
stressful experiences.
Nurturing. Nurturing refers to the extent
to which a parent or caregiver is available
and able to sensitively respond to and
meet the needs of their child
20

21. The
Public
Health
Approach
to
Ensure
Widespread
Preven7on
Adoption
Develop
and Test
Prevention
Strategies
Identify Risk
and Protective
Factors
Define the
Problem
21

22. Data Action
Research “Real World”
Silos Systems
Treatment Ecological Model
Relationships Results
22

23. Strengthening
Families:
Aligning
Results
for
Families
23

24. Do
Something
at
Each
Level
of
Preven7on
Influencing
Changing Organizational Policy &
Practices Legislation
Fostering Coalitions & Networks
Educating Providers
Promoting Community Education
Strengthening Individual
Knowledge & Skills
Prevention Institute
24

25. Lowest
Impact (1)
Equity
Education &
1 Counseling Framework
2 Clinical Interventions
3 Long Lasting Protection
Health Interventions
Highest Changing the Context Healthy
Impact (5)
4 Choices as Default Options
Social and Environmental
5 Determinants of Health
This pyramid is adapted from Thomas Frieden, MD, MPH, presented at the Weight of the Nation conference in Washington, DC, July
27, 2009

26. Child’s
Health
&
Well-­‐being
Depend
on:
A GOOD START
GOOD FUTURE
GOOD CARE
GOOD SUPPORT
26

27. Contact Information
Sally Fogerty
Children’s Safety Network
Education Development Center, Inc.
43 Foundry Ave
Waltham, MA 02453
www.ChildrensSafetyNetwork.org
1-617-618-2918
27