The ACE score is the sum of the 10 original categories of ACEs experienced before the 18th birthday. Help Me Grow National Center. Poverty, food insecurity, housing insecurity, racism, community violence, discrimination, alienation, disenfranchisement, and social isolation are examples that impose significant hardships on families and become potential barriers to developing SSNRs. Life Course Theory asserts that non-communicable diseases . In doing so, FCPMHs become the anchor for medical neighborhoods,149 in which community resources across multiple sectors (eg, health, education, justice, social services, faith communities, and businesses) collaborate not only to address barriers to SSNRs (such as home visiting programs,142 HealthySteps,150,151 medical-legal partnerships,147 coordinated responses to disasters,152,153 and efforts to promote access to healthy foods, safe housing, potable water, and clean air) but also to advocate for public policies (such as paid parental leave,154,155 income support,87,88 restorative justice,156158 and implementation of the Family First Prevention Services Act) that intentionally and actively foster SSNRs (Table 2).149,159161, Implementing a Public Health Approach to Relational Health Will Require Changes at the Provider, Practice, and Community Levels, as Well as Horizontal Integration Across Sectors. Module 3 Understanding & Using Theories - HDFS 501 - Studocu This principle points to the potential benefits of addressing stressors from across the spectrum of adversity, including those that might have been considered well beyond the scope of traditional pediatric practice in the past. For example, positive relational experiences, such as engaged, responsive caregivers,59,6265 shared childrens book reading,6668 access to quality early childhood education,6971 and opportunities for developmentally appropriate play with others66,7274 are associated with positive impacts on learning, behavior, and health. Educate residents about the many different facets of a fractured early childhood system of care (eg, Medicaid, Individuals with Disabilities Education Act Parts C and B, Child Care and Development Block Grants, Head Start, etc), as there is little collaboration or communication between the systems, funders, and programs that address child health, out-of-home child care, education, special education, protective services, or public health. Child-parent psychotherapy: 6-month follow-up of a randomized controlled trial, A multisite, randomized controlled trial for children with sexual abuse-related PTSD symptoms, Amygdala response predicts trajectory of symptom reduction during trauma-focused cognitive-behavioral therapy among adolescent girls with PTSD, Prevalence of adverse childhood experiences from the 2011-2014 Behavioral Risk Factor Surveillance System in 23 States, Enhancing social-emotional health and wellbeing in the early years (E-SEE): a study protocol of a community-based randomised controlled trial with process and economic evaluations of the incredible years infant and toddler parenting programmes, delivered in a proportionate universal model, Proportionate universalism in practice? Three indicators of flourishing are amenable to parental report and are rough markers of executive function: (1) the child shows interest and curiosity in learning new things, (2) the child works to finish tasks he or she starts, and (3) the child stays calm and in control when faced with a challenge.59 In analyses of data from the 20162017 National Survey of Childrens Health, the prevalence of flourishing children increased in a graded fashion with increasing levels of family resilience and connection.59 In fact, a higher percentage of children with high adversity (ACE scores 49) but high family connection and resilience were flourishing (30.5%) than children with low adversity (ACE score of 0) but low family resilience and connection (26.8%).59 Approaches to minimizing toxic stress that only look at measures of adversity (such as ACE scores or biomarkers) will miss out on opportunities to support the relational health that promotes flourishing despite adversity. 3. Posted on June 1, 2022 by More importantly, they are rarely integrated vertically with other programs that layer on additional efforts to address barriers to relational health (eg, SDoHs) or already strained or compromised relationships (eg, PCIT) when needed. Transactional theory emphasizes that: Periods of Development 1. The guidance in this statement does not indicate an exclusive course of treatment or serve as a standard of medical care. A public health approach that cuts across traditional silos and funding streams; a horizontally integrated public health approach also includes the educational, civic, social service, and juvenile justice systems. Second, it applies this EBD framework to better understand the complex relationships among adverse childhood circum-stances, toxic stress, brain architec-ture, and poor physical and mental health well into . Thinking Developmentally: Nurturing Wellness in Childhood to Promote Lifelong Health. Several researchers have noted that many other experiences in childhood are also associated with poor outcomes later in life, and these include being raised in poverty,41 left homeless,4244 exposed to neighborhood violence,4547 subjected to racism,4850 bullied,51,52 or punished harshly.53 This finding suggests that there is a wide spectrum of adversity that runs from discrete, threatening events (such as being abused, bullied, or exposed to disasters or other forms of violence) to ongoing, chronic life conditions (such as exposure to parental mental illness, racism, poverty, neglect, family separation or a placement in foster care, and environmental toxins or air pollution; unrelenting anxiety about a global pandemic, climate change, or deportation; or social rejection because of ones sexual orientation or gender identity). Finally, the diverse conditions included in a broader spectrum of adversity make the formation of SSNRs more difficult. A public health approach that includes primary universal preventions to promote wellness (like promoting positive parenting practices), secondary targeted interventions for those deemed to be at risk for poor outcomes (like using biomarkers both to identify those at higher risk and to monitor the effectiveness of various interventions), and tertiary evidence-based treatments for the symptomatic (like referring to providers trained in TF-CBT). ecobiodevelopmental (EBD) framework to stimulate fresh thinking about the promotion of health and prevention of disease across the lifespan. Many of the components of a public health approach to prevent, mitigate, and treat toxic stress responses (see examples) are also components of a public health approach to promote, identify barriers to, and repair SSNRs. Solutions Manual for Lifespan Development Canadian 5th Edition by Boyd Policy statements from the American Academy of Pediatrics benefit from expertise and resources of liaisons and internal (AAP) and external reviewers. Realizing the full impact of these principles within primary care practice, however, will also require fundamental changes in medical education and payment models. Acronym for adverse childhood experiences. Primary preventions in the toxic stress framework are focused on how to prevent the wide array of adversities that might precipitate a toxic stress response. Relational health, in the form of at least one SSNR, is a universal, biological imperative for children to fulfill their potential; to be healthy and resilient; to be successful academically, economically, and socially; and, perhaps most importantly, to be the caregivers that value and build SSNRs with subsequent generations. In fact, there is increasing evidence that strong social-emotional supports, such as high family resilience and connection and the provision of positive childhood relational experiences, are associated with children who are resilient and flourish despite their level of adversity.59,121 This finding has renewed interest in defining the critical elements that children, families, and communities need to thrive despite adversity.18,19,65,122124 Resilience, for example, is now understood to be the manifestation of capacities, resources, or skills that allow some children, families, and communities to respond to adversity in a healthy, adaptive manner.16,83,124 At the child level, foundational capabilities (such as social skills, emotional regulation, language, and executive functions like impulse inhibition, working memory, cognitive flexibility, abstract thought, planning, and problem solving) are the building blocks of resilience and need to be modeled, taught, learned, practiced, reinforced, and celebrated.16 A recent literature review identified 5 modifiable resilience factors relevant to clinical pediatric care: (1) addressing maternal mental health problems; (2) encouraging responsive, nurturing parenting; (3) building positive appraisal styles and executive function skills; (4) teaching children self-care skills and routines; and (5) using trauma-focused interventions and educating families about trauma.83 The emphasis on building new skills underscores the AAPs concern that excessive screen time might limit opportunities to develop more adaptive and generalizable skills.125, Flourishing despite adversity is another construct that has been studied. Early childhood experiences, both adverse and positive, appear to be biologically embedded and influence both disease and wellness across the life course.30 The ecobiodevelopmental model of disease and wellness explains how the ongoing but cumulative and reciprocal dance between ecology and biology leads to changes at the molecular (eg, methylation patterns), cellular (eg, brain connectivity patterns), and behavioral levels (eg, tobacco, alcohol, or other substance use).2,17 These changes are either adaptive or maladaptive depending on the context, and they are either benefits or risks to future health, academic success, and economic productivity.75. : Working Paper No. Fortunately, adversity in childhood is only half the story, as positive experiences in childhood are associated with improved outcomes later in life. Of the 3 principles, this is the one that aligns most clearly with the core functions of the FCPMH and is, therefore, the primary focus of this policy statement. This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. 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