Earlier this week, in the sun-filled and mirrored studio of the School of the Pennsylvania Ballet in a converted mill, participants in the Philadelphia ACE Task Force trickled into the room. They were winding down a pre-meeting with organizers of ACE initiatives in Memphis who'd flown in for the task force meeting, and a contingent from Pittsburgh. Both groups wanted to soak up information and learn from the task force, a two-year-old citywide organization of pediatricians, nurses, mental health professionals, scholars, and other community members working together to reduce adverse childhood experiences and build resiliency.
The timing was perfect for the city delegations to check in on the task force's accomplishments. It's made tremendous progress in creating a structure to do its work and gather the information about the community’s ACE profile. Task force members are eager to build on the relationships they have forged so far and put the data from the Urban ACEs Survey and from other sources to good use. The focus shifted from organizing and fact-finding to taking action: Now that more is known about the nature of the problems, what will we do to solve them?
Before Task Force Co-Chair Dr. Lee Pachter, chief of pediatrics at St. Christopher’s Hospital for Children, reviewed the group's achievements, he expressed gratitude for the participation of medical students and pediatric residents in the room, and pointed out that in the early years of his career he had no such opportunity to learn about the social determinants of health. He emphasized the need for a new paradigm in child health that will require a change in clinical care and the help of the larger community. Pachter said pediatricians cannot do it alone and the “silo-bound” way of operating has to be broken down. Consideration of the social context, including poverty, is important, he said, while recognizing the universality of adverse childhood experiences across all income levels.
Pachter highlighted several milestones: completion of the Philadelphia Urban ACE Survey with the Public Health Management Corporation; ongoing data collection, including focus groups on resilience and a survey of the American Academy of Pediatrics of Pennsylvania; and the May 2013 National ACEs Summit that convened experts from around the country and where Philadelphia's accomplishments were showcased.
Building the virtual community
Another milestone featured at the meeting was the creation of “Philadelphia ACEsConnection,” a group on ACEsConnection.com, which is facilitated by seven part-time community managers; all but one were introduced at the meeting. The community manager team includes people with the Scattergood Foundation, Drexel University, and the Health Federation of Philadelphia. The Philadelphia community managers will play the same role locally as the community managers for ACEsConnection.com play for all of members of the network. Community managers will post useful information on ACEs-related research, events and developments as well as facilitate communication among the members. Progress was made at the meeting to reach one of the goals of Philadelphia ACEsConnection—to enroll all members of the Task Force.
In her presentation on “ACEsConnection and the SocialStructed World,” founder and editor of ACEsConnection.com, Jane Stevens talked (via phone from Winters, CA) about a new decentralized world where communities are formed around common concerns and interests and where everyone can emerge as a leader, not just a participant. She described the groups on ACEsConnection as the “heart and soul” of the network where people can share resources and support each other’s work.
Stevens sees great value in the virtual community but not to the exclusion of face-to-face connections. The technology makes those connections possible, a recent example being a meet-up in Washington State around a conference featuring Dr. Rob Anda and Laura Porter on February 25 in Lynnwood, Washington.
In a decidedly low-tech exercise, everyone at the meeting took a few minutes to write down on an index card his or her views of what the task force should get done in the next two to five years to maximize its impact. A few offered some suggestions to the group:
- To educate policymakers at all levels of government on the importance of preventing ACEs and the potential of ACEs research to improve outcomes.
- To include adult-serving systems as well as child-serving systems since the problems we are addressing are multi-generational.
- To answer what the policy and practice implications are for multiple systems (e.g., juvenile justice, child welfare, schools) as different strategies are considered.
- To share what tools are being developed and used.
- To recognized that problems and solutions are often regional in nature and geographic boundaries may need to cross state and county lines.
The responses will be compiled and will inform future discussions of the task force’s priority agenda. Patricia Gerrity, task force member and founder of 11th Street Family Health Services, cautioned that "we have now opened the floodgate and the community expects us to respond."
The Philadelphia ACE Task Force is now housed at the Health Federation of Philadelphia, a 20-year-old non-profit dedicated to improving health care services in the city and serving a network of community health centers in Southwestern Pennsylvania. Previously, the Institute for Safe Families (ISF) provided support to the task force. The contributions of the former ISF head, Martha Davis, were praised at the meeting. She has moved on to join the Robert Wood Johnson Foundation.
Site visit by the Memphis delegation to the 11th Street Family Health Center
After the task force meeting, the six-member Memphis contingent visited the 11th Street Family Health Services center to met with Roberta Waite, Drexel University College of Nursing and Health Professionals, and Patricia Gerrity, founder and director of the Center. The Memphis activists included a diverse group of community leaders from a local hospital, child and family-serving organizations, and the new director of the Memphis ACE Initiative, Gwendolyn Price. Earlier at the Task Force meeting, Chris Peck of the Pyramid Peck Foundation described how Memphis has suffered the trauma of being the place where Martin Luther King, Jr. was assassinated and deals daily with the effects of violence, poverty and childhood obesity. By meeting with the task force and visiting the 11th Street center, the group is seeking “information and enlightenment,” said Peck.
On the ride over to the center, Barbara Nixon, chair of the Memphis ACE executive advisory board, told an inspiring story of how they came to where they are today as a cohesive group with new staff, and an eagerness to move forward. She recalled the time a little over a year ago when Vincent Felitti and Robin Karr-Morse visited Memphis and Felitti suggested that ACEsConnection could be a useful resource for them. Soon after Nixon signed up, she got a call from Jane Stevens—acting in her role as community manager—to learn what was going on in Memphis and how she might help. Yesterday, the Memphis ACE (Parenting Initiative) group was created on ACEsConnection.
The atmosphere at the center seemed joyful and expectant—preparations are far along to dramatically expand the center and there are high expectations about what can be done with the new capacity in the future. What began as a small storefront in the neighborhood has become a vital community hub for wellness. In its quest to reach its high aspirations, the organization is in the process of becoming certified under the Sanctuary Model.
The center grew out of a process of envisioning the future by a public housing community advisory board that included skilled activists who knew how to advocate for themselves and their families. The process identified the need for a health center.
Over the years since the current building opened in 2002, the community identified key needs: prevention and treatment of salmonella poisoning, car accidents, dog bites as well as CPR instruction and emergency food coverage. There are now 32,000 clinical visits yearly (one third are for children) and the staff has grown from 5 to 55. ACE questions are included in the intake instruments and open access scheduling has been used for several years. With the new funding, the center’s capacity will double and the site will be transformed to a health campus with green space, an industrial kitchen for learning healthy food preparation, and space for physical and other activities of all kinds.
The Center provides fully integrated services, including primary care, behavioral health, and dental, as well as an array of health and wellness programs including stress reduction, pain management, cooking classes, legal services, “farm to families” fresh produce, fitness (including “BLT”…..forget it if you’re smelling the bacon sizzle, BLT stands for Butt, Legs and Thighs), and yoga. Art and dance therapy are also fully integrated into the programming.
As the day came to an end, Patty and Roberta, as the staff knows them, paused to greet clients and colleagues. Patty pointed out the wall of portraits, the art project where children are learning about mural design, and joked with the security guard who is trained in massage and Reiki. He said his dream job is to be a therapist at the center. The receptionist welcomed several young families with early evening appointments. It was clear that wellness was the focus in this oasis in one of the “tougher” neighborhoods in the U.S.