Summary: Mental health diagnoses in childhood are increasingly common, with about 10% of youth between 5-16 years holding at least one diagnosis (Lowthian et al., 2021). The prevalence and the risk for mental illness increase with each cumulative adverse childhood exposure (Felliti et al., 1998). In Michigan, ACEs are widely prevalent, with nearly 20% of respondents experiencing 4 or more ACEs (Murad & Barth, 2016). Moreover, certain exposures pose greater risk for childhood mental illness: parental mental illness, household substance abuse, and other indicators of household dysfunction (Lowthian et al., 2021). Considering household substance abuse, parental separation, household mental illness, and domestic violence rank highest in ACEs prevalence among Michiganders (Murad & Barth, 2016), Michigan youth risk poor mental health. Further, 30% of Michiganders with 4 or more ACEs reported poor mental health, a significant disparity compared to those with 2 or less ACEs (Murad & Barth, 2016). However, the prevalence of poor mental health was 15% lower among Michiganders with 4 or more ACEs and high levels of social support, compared to those with low social support (Murad & Barth, 2016), demonstrating a need for greater integration of social support among those affected by 4 or more ACEs.
This program aims to increase ACE screening for youth who present to Sparrow emergency department and subacute healthcare facilities for mental health complaints. The evidence supports that mental health crises are more likely among children and adolescents who have cumulative exposure to adverse childhood events. Existing evidence suggests that familial and household exposures pose certain risks to youth, pointing to a need for family-focused interventions for children. Thus, the second aim of this program is to support children through broadening their network of healthy adult relationships. The third aim is supporting families in healing past trauma and in substance abuse recovery, therein preventing future harm.
Trauma-Informed Principles Your Grant Will Utilize: This program will employ principle-based strategies to serve our target community per SAMHSA Guidance (2014). Safety will be integrated into our project through the assurance of physically safe spaces for program services. The spaces will be kept calm and violence-free. Additionally, safety planning will be developed on day-one with the guidance of our skilled staff members for emotional safety; these will be signed by participants to ensure informed consent. The program will train staff on home visits protocol to ensure feelings of safety while off of program premises.
To address the principle of trustworthiness and transparency, program staff will communicate openly regarding the programs’ objectives, participant expectations, family expectations, as well as the safety planning in place. Our program will have a “No Secrets Policy” regarding communication between participants, family, and staff, unless personal safety is threatened; this policy will be communicated with the intention of preventing conflicts of interests that arise between youth, family members, or others within the unit who are enrolled in the program.
In committing to trauma-informed training for all program staff, this project will incorporate the principle of collaboration. As previously described, participants and their families will be required to commit to safety provisions on day-one. After enrollment, further amendments to safety planning can be added, as “trauma triggers” or other considerations for safety become apparent. Adding these requests and considerations from participants and their families serves to demonstrate collaborative safety planning and mutual respect for all parties.
The principle of empowerment, voice, and choice will be integrated into the program by granting participants and their families opportunities to decide the services and training which they feel may best suit their needs. Throughout the program participants and their families will be empowered to challenge inter-generational patterns and other lifestyle factors that may be re-traumatizing.
Level(s) of Social Ecological Model: Using the McLeroy social ecological model (1988), this project’s services will address influences at the intrapersonal, interpersonal, and community levels, while employing targeted interventions at the interpersonal and institutional levels. In using the ACEs screening tool, this program aims to identify key influences at the intrapersonal and interpersonal levels affecting risk of behavioral health crises. Our program’s offerings of individual and family psychotherapy grant participants the opportunity to heal from traumatic pasts and subvert problematic normative thought patterns, affecting intrapersonal level risk factors. In working with a case manager, social worker, and psychotherapist, we endeavor to affect change at the interpersonal level. Our program’s use of family psychotherapy will aim to heal traumatic inter-generational patterns. Relationship-building, education, and skills training with our skilled staff will impact family structures, skills that cross the interpersonal and community levels of McLeroy’s social ecological model. Our program’s screening services are offered within Sparrow health system, an intervention at the organizational level; additionally, services will be provided at the organizational level within our program. In taking a multi-pronged approach that addresses multiple levels of the social ecological model (McLeroy et al., 1988), this program has demonstrated investment and commitment to the effectiveness of trauma-informed care for this community (DeCandia & Guarino, 2020).
Public Health Framework: This program utilizes a public health framework, incorporating partners from multiple disciplines and granting our program to have a wider-ranging impact than a disease-centric approach. This program depends on the services and expertise of healthcare providers in emergency and subacute settings, psychotherapists, social workers, and case managers with in-depth knowledge of resources within the community; case managers will help in bridging the transition from inpatient care to the outpatient setting through the deployment of community resources across sectors, including mental health, early childhood, child welfare, welfare, and potentially housing. A multi-disciplinary approach is absolutely essential for the success of this program.
This program seeks to address the impact of ACEs and trauma primarily through secondary and tertiary prevention stages (Kisling & Das, 2021). In screening youth who present with behavioral health concerns for ACEs, this program aims for early detection of mental dis-ease and provision of resources to children and their families. This program provides psychotherapy for youth and their families after a behavioral health complaint has been vocalized, thus treating an occurring and ongoing mental health condition with the express goal of improving quality of life through interventions in mental health and relational health. This program focuses on populations at risk to prevent continued progression of mental dis-ease, prevent further ACEs by treating current trauma exposures, and to heal from past exposures to trauma.
References:
DeCandia, C., & Guarino, K. (2020). Trauma-Informed Care: An Ecological Response. Journal of Child and Youth Care Work, 25, 7-32. https://doi.org/10.5195/jcycw.2015.69
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American journal of preventive medicine, 14(4), 245–258. https://doi.org/10.1016/s0749-3797(98)00017-8
Kisling, L. A., & M Das, J. (2021). Prevention Strategies. In StatPearls. StatPearls Publishing.
Lowthian, E., Anthony, R., Evans, A., Daniel, R., Long, S., Bandyopadhyay, A., John, A., Bellis, M. A., & Paranjothy, S. (2021). Adverse childhood experiences and child mental health: an electronic birth cohort study. BMC medicine, 19(1), 172. https://doi.org/10.1186/s12916-021-02045-x
McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health education quarterly, 15(4), 351–377. https://doi.org/10.1177/109019818801500401
Murad, A. and Barth, O. (2016). Michigan Behavioral Risk Factor Surveillance System Survey Data. Lansing: Michigan Department of Health and Human Services, Lifecourse Epidemiology and Genomics Division.
Philanthropy Network Greater Philadelphia. (2016). Trauma-Informed Philanthropy: A Funder’s Resource Guide for Supporting Trauma-Informed Practice in the Delaware Valley. https://www.scattergoodfoundat...23&previous=1320
Substance Abuse and Mental Health Services Administration. SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA). 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.
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