An Academic-Community Partnership to support a local community initiative focused on addressing adverse childhood experiences (ACEs) in rural Appalachia: The story of the Watauga Compassionate Community Initiative Adam Hege, PhD, MPA, CHES Kellie Reed-Ashcraft, PhD, MSW Crystal Kelly, MSW Jennifer Warren, MA Denise Presnell, MSW Erin Bouldin, PhD, MPH Kayla Forliti, BSW
Disclosure of personal relationships with a commercial interest
Objectives 1. Provide overview of Watauga County and some key foundational statistical indicators 2. Describe the history and development of the Watauga Compassionate Community Initiative (WCCI) 3. Discuss the academic-community partnership that has been developed 4. Identify strengths, challenges and opportunities for academic-community based partnerships focused on ACEs
Watauga County, North Carolina • Located in southcentral portion of the Appalachian region • Home to a large regional public university (Appalachian State) • Serves as leader and central hub for “High Country” • High poverty and adverse social determinants of health • Primary challenges include food insecurity, mental illness, and substance abuse
Watauga County, North Carolina Census Community Facts, Watauga County (2013-2017 5-Year Estimates) Indicator Measure Population 53,421 Median Age 30.6 Median Household Income $41,541 Individuals below poverty level 28.3% White alone 51,228 (95.9%) https://factfinder.census.gov/faces/nav/jsf/pages/community_facts.xhtml?src=bkmk
Watauga County, North Carolina County Health Rankings, Watauga County (2019) Indicator Watauga County North Carolina Poor mental health days 4.5 (past 30 days) 3.9 (past 30 days) Frequent mental distress 14% 12% Food insecurity 18% 15% Uninsured children 7% 5% Income inequality 7.4 (ratio) 4.8 (ratio) Excessive drinking 20% 17% Severe housing cost burden 22% 14% https://www.countyhealthrankings.org/app/north-carolina/2019/rankings/watauga/county/outcomes/overall/snapshot
Adverse Childhood Experiences (ACEs) • Seminal study by Felitti and colleagues in the late 1990s brought about awareness of the importance of adverse childhood experiences (ACEs) as it pertains to health outcomes and wellbeing across the lifespan • Their study questions are still used today and focus on such issues as abuse (physical, mental, sexual, etc.) and household dysfunction (substance abuse in the household, mental illness, parent abuse, etc.) that one experiences before the age of 18 • ACEs linked with poverty and numerous other social determinants of health • https://www.cdc.gov/violenceprevention/childabuseandneglect/aces tudy/index.html
Community Approaches to Address ACEs • Washington state has been at the forefront and is a leader and model for initiatives focused on ACEs • ACEs Connection has over 35,000 members https://www.acesconnection.com/ • Building Community Resilience Model developed by Ellis and Dietz at George Washington University, which centers on four key components: a. shared understanding of ACEs and their effects at the community level b. building sense of readiness through capacity building c. developing innovative cross-sector partnerships bridging the gaps between clinical and community care (primary, secondary, and tertiary prevention) d. developing a more engaged community that has support systems and leadership it needs to thrive
Watauga Compassionate Community Initiative (WCCI) • In 2014, a group of child and youth-serving organizations came together to explore how the community could better serve children, youth and their families • Executive Director (Jennifer Warren) of a local nonprofit attended a large Adverse Childhood Experiences (ACEs) Summit in Asheville, NC in 2015 • Social Worker (Denise Presnell) from local school system interned with the nonprofit in 2016, leading to a partnership to better disseminate ACEs information in the schools and in the broader community • The larger group decided to use direction from the Centers for Disease Control and Prevention’s (CDC) “Essentials for Childhood” to inform their ongoing efforts, focusing on raising community awareness and providing education around trauma, ACEs, resiliency
Watauga Compassionate Community Initiative (WCCI) • Held first “State of the Child” Conference in spring 2017 • After the 1 st conference, the first “official” meeting took place with around 60 people in attendance • The group meets monthly to work on goals and is broken into subcommittees: Awareness; Prevention; Data; Funding; Policy; and Events • The vision is: “for Watauga County to be a relationship-driven, compassionate, and resilient community that is knowledgeable, inspired and empowered to prevent harm, promote wellbeing, and health from adversity • The mission is: “to promote health and resiliency in our community and to effectively prevent, recognize and treat trauma by creating safe, stable, nurturing environments and relationships through advocacy and policy change
Watauga Compassionate Community Initiative (WCCI) In using the Essentials for Childhood as the framework and model for the initiative, there are four primary goals. 1. Raise awareness and commitment to promote safe, stable, nurturing relationships and environments and prevent child abuse and neglect 2. Use data to inform actions 3. Create the context for healthy children and families through norms change and programs 4. Create the context for healthy children and families through polices
Key Accomplishments: Raising Awareness • Developing a WCCI business card with several crisis resources for emergency responders to utilize • Developing an informational presentation board housed at local public library • Speaking to numerous community groups to include: faith-based institutions, in university classes, service groups (firefighters, police officers/sheriff, medical), and the newspaper and other media sources • Hosting annual “State of the Child” Conference with increased attendance each year
Key Accomplishments: Using Data to Inform Action • Developing an interactive GIS resource map of the community • Tracking of presentations data – who, what, type, size, etc. • Making use of state and community level data to include: Behavioral Risk Factor Surveillance System (BRFSS) and Youth Risk Behavior Survey (YRBS) • Measuring ACE scores and resiliency among members of WCCI
Key Accomplishments: Changing Norms & Policies • Trauma-Informed Schools and School System/Compassionate Schools • Collaborating with local law enforcement and judicial agencies to consider ACEs and trauma when interacting with people at time of arrest, during sentencing, and upon incarceration • Aiming for implementation of universal home visiting program for families in the county to provide early support and intervention if needed • Appalachian State University offering course in Trauma-Informed Care, which focuses on developing health-related professionals ready to prevent and treat trauma at the individual, family, and community levels • Faith community has expressed significant impacts on their members • The High Country United Way including ACEs and the prevention of childhood trauma as one of its funding priorities • Local counties starting initiatives focuses on ACEs
Key Accomplishments: Funding • Pursuing grants and research collaboration with university professors from Social Work, Public Health, Nursing, and Education; the mix of the WCCI membership involves community practitioners and faculty from Appalachian State University • Funding and in-kind donations from local businesses and social service agencies to include High Country United Way, Juvenile Crime Prevention Council, and Watauga Education Foundation
Lessons Learned: Insights for other communities implementing an ACEs initiative Strengths: 1. Powerful change happens when skilled professionals and community members work collaboratively, particularly when each has long-term commitments and ties to the community 2. Co-leaders (Denise Presnell and Crystal Kelly) are inclusive and collaborative, communicate well, and recognize the skill sets of each member 3. Interdisciplinary perspective for problem-solving is critical – everyone’s “voice” matters 4. Data-driven approaches can effectively guide decision making and goal setting 5. Lack of funding doesn’t have to be a deterrent 6. University-community partnerships offer a good strategy for sharing of resources
Lessons Learned: Insights for other communities implementing an ACEs initiative Challenges/Barriers: 1. Developing a strategic plan and longer over-arching goals 2. Goals to guide data collection 3. Time commitment, lack of staff support, lack of funding, and the misalignment of systems must continually be addressed 4. Prevention efforts, particularly primary prevention, are often under-resourced and under-valued 5. Grassroots efforts provide a great deal of energy, but attention must be placed on efforts and role clarity 6. Community members most impacted by ACEs must have a continued voice and presence in community efforts
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