Changing the Culture in Tennessee:

Promoting ACEs Philosophy and Transforming Organizations

Presented by:

Sissie Hadjiharalambous, PhD

Emily McCutcheon, MSSW, MBA, LMSW

Linda Daugherty, MPA

Prepared by the University of Tennessee College of Social Work Office of Research and Public Service

What are ACEs and why do they matter?

The Adverse Childhood Experiences Study

(1998)

Vincent Felitti, et.al.

Prepared by the University of Tennessee College of Social Work Office of Research and Public Service

(Source: CDC)

Early Life Stress Impacts Life-long Health & Development

Prepared by the University of Tennessee College of Social Work Office of Research and Public Service

(Source: CDC)

Prepared by the University of Tennessee College of Social Work Office of Research and Public Service

(Source: CDC)

Tennessee's Response: BSB Initiative

ACEs Coordinating Team

Representatives from public and private sectors

Public Sector Steering Group

Representatives from key state departments:Children’s Services; Education; Health; Human Services; Intellectual and Developmental Disabilities; Mental Health and Substance Abuse Services; and from the TennCare Bureau; and Commission on Children and Youth

Private Sector Steering Group

Representatives of:ACE Awareness Foundation; Casey Family Programs; Healing Trust; Health Care Funders; Key Service Providers; Medical Community; ReadyNation – Tennessee; Provider Organizations; Trade Associations; United Ways

INNOVATION TEAMS

Prepared by the University of Tennessee College of Social Work Office of Research and Public Service

Prepared by the University of Tennessee College of Social Work Office of Research and Public Service

BSB KEY STRATEGIES

•Knowledge Mobilization

• Investing in Local Solutions for Innovation

•Measurement of Impact

Prepared by the University of Tennessee College of Social Work Office of Research and Public Service

Strategy 1: Knowledge Mobilization

• Translating Brain Science using metaphors that are easily understood to raise awareness• Brain architecture

• Serve and return

• Toxic stress

• Air traffic control

• Creating common language to inform action across sectors

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Use of Metaphors - Resilience

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Prepared by the University of Tennessee College of Social Work Office of Research and Public Service

Strategy 2: Support Innovative Solutions

• Competitive application process under guidance of Three Branches Institute• 13 innovations funded in 2017

• 8 new innovations funded in 2018; 8 continued from FY17

• Identify most effective strategies for preventing and mitigating ACEs that can be replicated

Prepared by the University of Tennessee College of Social Work Office of Research and Public Service

ACEsEDUCATION

**

*

TARGETED REFERRALS

DIRECT

INTERVENTION/ ***SERVICE PROVISION

* *

**

CURRICULUM DEVELOPMENT

*

*

*

ACEs SCREENING

SECTORS:• Medical• Education• Early

Childhood/ Childcare

• Community• Academia

Innovations

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Frontier Health - Cultivate Hope, Educate Resilience, Identify Supports, Heal (CHERISH)

ACEsEDUCATION

DIRECT INTERVENTION/SERVICE PROVISION

TARGETED REFERRALS

Prepared by the University of Tennessee College of Social Work Office of Research and Public Service

Baptist Memorial Hospital for Women - ACE Healthcare Provider Educational Program

ACEsEDUCATION

TARGETED REFERRALS

CURRICULUMDEVELOPMENT

ACEs SCREENING

Prepared by the University of Tennessee College of Social Work Office of Research and Public Service

Discover Together - Chronic Absenteeism Community Ambassador

DIRECT INTERVENTION/SERVICE PROVISION

TARGETED REFERRALS

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Strategy 3: Measure Impact

• Evidence from FY17 funded innovations

• Public awareness baseline survey

• How people and organizations are using ACEs message and brain science to transform culture

Prepared by the University of Tennessee College of Social Work Office of Research and Public Service

Evidence from 13 Innovations

•What has worked well?

• Early involvement of key stakeholders and identification of champions• Enhancing or augmenting existing programs•Clarifying targets, goals, underlying logic

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What were challenges?

• Lack of formal agreements

• Logistical challenges

• Lack of integration of program evaluation activities in program operations

Prepared by the University of Tennessee College of Social Work Office of Research and Public Service

Results from Public Awareness Baseline Survey

56%

16%

14%

6%

3%5%

Level of Familiarity with ACEs

Not at all A little Somewhat

Very Extremely Not sure

75%

14%

6%6%

Level of Familiarity with BSB

Not at all Somewhat Very Not sure

Prepared by the University of Tennessee College of Social Work Office of Research and Public Service

Trends Across Demographic Groups

• Persons over the age of 64 were more aware of the impact of childhood experiences on adult well-being. However, they were not as aware of the impact of ACEs on brain development.

• Females more likely than males to recognize impact of ACEs on brain development and adult well-being.

• African Americans and persons living in low-income households were more likely to disagree that ACEs impact high school graduation rates, divorce rates, and future reliance on public assistance.

Prepared by the University of Tennessee College of Social Work Office of Research and Public Service

Using a "New Lens" - Inclusion of ACEs Philosophy and Information for all Staff Training and Development

Prepared by the University of Tennessee College of Social Work Office of Research and Public Service

“Because of the training and awareness ... in relation to ACEs, the court has

focused even greater attention to

investigating what is happening to the children who come into our court and

what type of service can we provide to break the cycle of ACEs in that family.”

“I utilize it to help staff

think about how they are supporting one another -- building

safety, emotional safety in the work environment.”

“I trained Client Representatives who work directly with TANF clients. The Client Reps have told me that this was

the most valuable training that they have had in directing their approach and interactions with their clients.”

Integrating ACEs Philosophy into Organizations and Work with Communities

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"We are more mindful that our audience may have experienced

ACEs or work with those who have experienced ACEs so that

we are intentional in our approach to training events.”

“We have talked about the level of ACEs for each of our preschool students and the

toxic stress that they may be experiencing.

We changed how we relate to them and the words we use to help them identify

their feelings and resolve conflict.”

“Knowledge about the long term health implications resulting from

ACEs prompted our Board to adopt prevention/mitigation of ACEs as one of the two primary issue areas for our new

advocacy grants program.”

Integrating ACEs Philosophy into New Programs & Standard Operating Procedures

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“We administer the ACE at intake and use it to

guide our services.”

“Providers and clinicians now discuss information about ACEs when determining treatment planning for

clients.”

“Resident pediatricians are recognizing

that asking about ACEs is important when assessing behavior problems.”

Continuing to Raise Awareness

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Disseminating Practical Ideas for Everyone – Preventing & Mitigating ACEs• Embed ACEs information on your organization's website

• Create a peace corner for children who are feeling overwhelmed

• Equip community/congregation/organization leaders with information about ACEs

• Volunteer to assist new parents or new mother

• Tutor children in an afterschool program

• Find ways to connect with children to provide safe, stable, nurturing relationships and environments – sports, scouts, theater

Prepared by the University of Tennessee College of Social Work Office of Research and Public Service