Summary:
Cardiovascular Disease (CVD) is the term utilized for any disease related to the heart, this may include coronary heart disease, stroke, heart failure, or arrhythmias (American Heart Association, 2024). Currently, CVD is the leading cause of death among individuals in the United States (Centers for Disease Control and Prevention, 2023). It was estimated by the Centers for Disease Control and Prevention (CDC) that approximately one in every five deaths in the United States were attributed to CVD (CDC, 2023). While this may seem like a nationwide issue, individuals in Miami-Dade County, Florida are also at increased risk for CVD mortality. The Florida Department of Health (FDOH) estimated that across the State, approximately 275 per 100,000 individuals died from CVD in 2021 (FDOH, 2022). Putting this into perspective, there are approximately 442,000 individuals living in Miami-Dade which means that over 1,100 individuals died from CVD within the county alone (FDOH, 2023).
There are several, preventable causes of CVD which include diabetes, physical inactivity, obesity, hypertension, poor diet, and most importantly: adverse childhood experiences (ACEs) (AHA, 2019). ACEs are defined as potentially traumatic events that occur during one’s childhood, these events could possibly include experiencing various acts of neglect, violence, and abuse (CDC, 2023). ACEs have been shown to be associated an increase the risk for long-term adverse health complications like CVD in adulthood (CDC, 2023). The FDOH estimated that approximately 1.9 million CVD cases could have been avoided if proper ACE prevention interventions occurred (FDOH, 2023). Given this information, it is vital to consider a trauma-informed approach when creating interventions geared towards CVD prevention among Miami-Dade residents. As there are currently no programs or initiatives in place to address the association between ACEs and CVD, it is paramount that a trauma-informed CVD prevention program be enacted.
Grant funds will be utilized to establish a two-hour bi-weekly course, called the Miami-Dade Health Achievement Program (MHAP), held in public libraries throughout Miami-Dade between June 2024 and June 2025. The education program, led by the project board, will provide participants with an in-depth education on CVD risk reduction, the relationship between ACEs and CVD, and how participants can mitigate health impacts of ACEs. In addition to education, attendees will also participate in hands-on demonstrations on how to engage in meaningful physical activity through group exercise, stress reduction through toolkit development, and emotional regulation through guided therapy; all educational components of the program will have a trauma-informed lens.
Trauma-informed Principles:
Since the MHAP utilizes a trauma-informed framework to educate participants regarding the relationship between ACE exposure and CVD development, several trauma-informed principles will be utilized (Substance Abuse and Mental Health Services Administration [SAMHSA], 2016). The trauma-informed principles of safety, trustworthiness, peer support and Cultural, Historical, and Gender Issues will be utilized and built within the MHAP (Scattergood Foundation, n.d.).
The Substance Abuse and Mental Health Services Administration (SAMHSA) describes the principles mentioned as a guide for interventionists to consult when creating trauma-informed interventions (SAMHSA, 2016). The principle of safety ensures that individuals are safe in their environment to discuss potentially triggering topics; trustworthiness ensures that there is a clear path of transparency between program operators and participants; peer support ensures mutual trust between parties; lastly, cultural, historical, and gender issues removes any biases and encourages cultural competency (SAMHSA, 2016).
To ensure the MHAP is trauma-informed, we will rely heavily on the principles outlined previously. Firstly, the program will be seen as a confidential and safe environment that prioritizes participant safety. Peer leaders will be required to outline a safety plan for meetings to ensure safety of participants and staff should a threat arise. The program will also incorporate the principle of trustworthiness as it is important to ensure peer leaders are seen as trustworthy individuals with the knowledge, empathy, and transparency to provide education. The program will also rely heavily on peer support, whether it be through peer leaders or within participant groups. It is vital that participants feel they have adequate peer support when attending the program because it allows for them to heal, build trust, establish safety, and empower themselves to advocate for social change (Scattergood Foundation, n.d.). Lastly, the program will incorporate the principle of cultural, historical, and gender issues through cultural competency trainings. Peer leaders will be required to recognize their own cultural biases, and learn how to provide culturally competent, trauma-informed care.
Levels of the Social Ecological Model (SEM):
The CDCs Social Ecological Model (SEM) will be the leading theoretical framework utilized in this intervention as it was created to address the various individual, relationship, community, and societal-level causes of violence (CDC, n.d.). Given the main goals of MHAP are to address the individual and relational impacts of ACEs and CVD risk, the SEM is the best model to consult.
For the individual level, an in-depth education will be given to participants to teach them how their personal histories and genetics could increase their risk for CVD; in addition to providing education, participants will be asked to complete pre- and post-test mental health assessments to determine the efficacy of the education they received. The mental health assessments will also be utilized for instructors and peer leaders to assess whether further interventions and referrals to additional counseling are necessary. To address the relationship level of the SEM, participants will be grouped into parties of four upon entry into the program. After each session, each group will meet in a private space to discuss their takeaways from the week’s meeting and how they plan on utilizing the principles taught in their day-to-day lives. The peer groups will serve as social support for participants to allow them to build a safety net of peers who have gone through similar experiences (Von Cheong et al., 2017). The peer groups established in the MHAP will hopefully result in lasting relationships that encourage healthy mental and physical health behaviors long after program cessation.
Public Health Framework:
A robust public health framework will be utilized to ensure the MHAP has the ability to change multiple levels of influences. Research has identified that to be successful, public health initiatives should create interventions geared at the primary, secondary, or tertiary levels of prevention (Scattergood Foundation, n.d.). The MHAP aims to target the secondary level of prevention as the program’s goals are to reduce the impact of ACEs after they already occurred in participants (Scattergood Foundation, n.d.). The MHAP falls under the level of secondary prevention as it offers early screenings and detection of ACEs, through various program activities such as mental health and physical fitness evaluations, to prevent the long-term development of ACEs in the future. The screenings and interventions offered in the MHAP serve as a means for early recognition of possible CVD or adverse mental health disease development.
In addition to targeting multiple levels of prevention, a multidisciplinary approach will be utilized by consulting various agencies and stakeholders to accomplish program goals. To have a successful public health intervention, it is necessary to create an interdisciplinary team to ensure all areas of health are met (Bendowska & Baum, 2023). To accomplish this, the MHAP is proudly partnering with the Miami-Dade Department of Health (MDOH), the Miami-Dade County Department of Recreation (MDR), Fresh Start of Miami-Dade (FSMD), and the Miami Center for Mental Health and Recovery (MCMHR). By recruiting various partner organizations, this allows for a multi-faceted approach to addressing how ACEs and CVD impact the community.
References:
American Heart Association. (2024). What is cardiovascular disease? Retrieved from https://www.heart.org/en/healt...rdiovascular-disease.
American Heart Association. (2019). The relationship between adverse childhood experiences (ACEs) and health: Factors that influence individuals with or at risk of CVD. Retrieved from https://www.heart.org/-/media/...Policy-Statement.pdf.
Bendowska, A., & Baum, E. (2023). The significance of cooperation in interdisciplinary health care teams as perceived by Polish medical students. International Journal of Environmental Research and Public Health, 20(2), 954. https://doi.org/10.3390%2Fijerph20020954.
Centers for Disease Control and Prevention. (2023). Fast facts: Preventing adverse childhood experiences. Retrieved from https://www.cdc.gov/violencepr...n/aces/fastfact.html.
Centers for Disease Control and Prevention. (2023). Heart disease facts. Retrieved from https://www.cdc.gov/heartdisease/facts.htm
Centers for Disease Control and Prevention. (n.d.). The social-ecological model: A framework for violence prevention. Retrieved from https://www.cdc.gov/violencepr...f/sem_framewrk-a.pdf.
Florida Department of Health. (2023). Adverse childhood experiences (ACEs). Retrieved from https://charlotte.floridahealt...periences/index.html.
Florida Department of Health. (2023). Heart disease. Retrieved from https://www.floridahealth.gov/...t-disease/index.html.
Florida State University. (2024). Professional certification in trauma & resilience level one. Retrieved from https://learningforlife.fsu.ed...esilience-level-one/.
Miami-Dade County. (2024). Miami board of health (MBOH). Retrieved from https://www.miamidade.gov/glob...TEGORY=public-safety.
Scattergood Foundation. (n.d.). Trauma-informed philanthropy: A funder’s resource guide for supporting trauma-informed practice in the Delaware Valley. Retrieved from https://www.scattergoodfoundat...formed-philanthropy/.
Substance Abuse and Mental Health Services Administration. (2016). SAMHSA’s trauma-informed approach: Key assumptions & principles. Retrieved from https://www.nasmhpd.org/sites/...inciples_9-10-18.pdf.
Von Cheong, E., Sinnott, C., Dahly, D., & Kearney, P. M. (2017). Adverse childhood experiences (ACEs) and later-life depression: Perceived social support as a potential protective factor. BMJ Open, 7(9), e013228. 10.1136/bmjopen-2016-013228.
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