By Kristen Mitchell
A George Washington University doctoral student has developed a process for improving the health of communities by bringing together resources for children facing adversity, such as abuse, poverty and parental drug addiction. The process is designed to develop resilience in communities that promotes improved health and life outcomes for children and their families. The initiative, known as Building Community Resilience (BCR) is currently being implemented in five test cities.
The BCR collaborative, an initiative at the Sumner M. Redstone Global Center for Prevention and Wellness, aims to connect community resources, like a church health ministry or food pantry, with larger systems, such as health care, education and law enforcement. The BCR process helps align these resources through partnerships around a shared understanding of adversities in the community, including lack of opportunity or violence. These partnerships help develop resilience that supports healthy children, families and communities.
BCR was developed by Milken Institute School of Public Health doctoral student Wendy Ellis and was launched in May 2015. Improving community health through collaboration is the future of public health, Ms. Ellis said. The Michael and Lori Milken Public Health Scholar leads the collaborative alongside William Dietz, chair of the Sumner M. Redstone Global Center for Prevention and Wellness.
Many adverse childhood experiences have not historically been viewed as medical problems, but they have a direct impact on childhood development, Dr. Dietz said. For example, a child who lives in a Dallas housing project prone to flooding might develop asthma, which leads to frequent hospitalizations and school absences. A child who lives in a neighborhood impacted by violence might not be able to play safely outside, which could increase the risk of chronic diseases like diabetes or obesity later in life.
“These experiences are often transgenerational,” Dr. Dietz said. “These exposures are not limited to specific ethnic groups or impoverished groups, but there may be less resilience in areas of need that are characterized by unemployment and joblessness.”
About 25 percent of adults have been exposed to three or more types of adverse childhood experiences, including things like violence, verbal abuse, homelessness or parental disruption through divorce, death or incarceration.
“You cannot possibly address and build resilience through medical care alone. The medical systems are where these problems tend to land, but that’s just the tip of the iceberg,” Dr. Dietz said.
The BCR process is currently being used in Dallas; Cincinnati; Portland, Oregon; Wilmington, Del.; and Washington, D.C. The collaborative recently received an $800,000 grant from the Kresge Foundation, an organization that works to expand opportunities through social investment. The grant matches $800,000 awarded by the Doris Duke Charitable Foundation last year to support the BCR work.
For Ms. Ellis, her research on adverse childhood experiences is personal. Her father was abusive, and early on she had four grandparents who stepped in to raise her. They relied on the community for youth sports and faith-based activities and never worried about having enough to eat.
“I wasn’t raised by just four people—I was raised by four people who had a community who often very much supported them,” she said. “[The BCR process] is very much a personal message, but it’s informed by the science and understanding of what goes on from a public health approach and a community health approach of how to support children and families.”
Ms. Ellis started forming BCR as an incoming student and was connected to Dr. Dietz through SPH Dean Lynn Goldman who recognized their mutual interest in adverse childhood experiences. Ms. Ellis credits GW and SPH’s emphasis on advocacy with the success of the BCR collaborative so far.
"Bill and Wendy have a real intellectual chemistry—it's the type of student-faculty collaboration I want our academic institution to nurture and support," Dr. Goldman said. "Their shared interest in the short- and long-term impacts of adversity experienced in childhood is translating into work that I hope can truly advance public health and improve child and community outcomes."
Each test community in the BCR centers around different local concerns in partnership with the individuals and families living there. The BCR team in Cincinnati, for example, is implementing a regional approach to address the opioid crisis. They work with Cincinnati Children’s Hospital, the local health department, schools and parenting services in nearby Kentucky and Indiana.
The BCR team has embedded parenting coaches in pediatric offices who can make immediate connections to resources and who document contacts in electronic medical records. BCR in Cincinnati has also begun to introduce trauma-informed approaches in schools, as well as advocating for resources in light of potential Medicaid cuts.
“[Opioid use] is a particular threat to an already stretched and overburdened state and local networks,” Ms. Ellis said.
In Portland, researchers are focusing on the cost of housing. Portland attracts thousands of new residents every year, which has driven up the cost of living. Cost of living is a social justice issue in places like Portland where gentrification is pricing long-time residents out of the community, Ms. Ellis said.
In Washington, D.C., researchers have been working closely with MedStar Georgetown University’s Medical Center, Children’s National Health System, and Unity Health Care on targeted efforts that will bring more parental engagement to vulnerable families. This effort includes understanding broader community context like financial literacy, Ms. Ellis said.
“D.C. and Dallas understand it’s not just about resilience in the face of the one in 100 years storms or a terrorist attack, it’s the chronic disaster that is happening in our cities on a day to day basis,” she said.
The City of Dallas has incorporated the BCR process into its Office of Urban Resilience. The D.C Office of the City Administrator has highlighted BCR through its Office of Resilience. Both cities are part of the Rockefeller Foundation-funded 100 Resilient Cities effort.
Ms. Ellis’ team works with congressional staffers to increase understanding and education on best health practices and aims to expand involvement from federal partners. BCR recently co-hosted a briefing at the U.S. House of Representatives on childhood trauma and the educational and foster care systems. Rep. Danny Davis (D-IL) introduced the Trauma-Informed Care for Children and Families Act, with a companion bill in the Senate introduced by Sen. Dick Durbin (D-IL) and Sen. Heidi Heitkamp (D-ND).
“It’s not enough to do great work in the five cities we’re in,” Ms. Ellis said. “We want to have this approach adopted as widely as possible.”
