Muskegon Youth and Family Health Initiative

Abstract

Problem:

Leading studies have demonstrated a direct link between traumatic experiences individuals encounter as youth (often referred to as Adverse Childhood Experiences, or [ACEs]) and chronic health problems, substance abuse, and mental illness throughout life. This is an issue that hits close to home. Within Muskegon County, the rate of residents reporting three or more ACEs is higher than the national rate. In fact, the rate of residents reporting four or more ACEs is more than twice the national rate. Predictably, Muskegon County has lower health outcomes, in comparison to state and national statistics, including, but not limited to, suicide deaths, deaths related to diabetes, drug overdose deaths, and opioid subscription rates. Additionally, ACEs have been found to strongly correlate with lower economic outcomes. This too is experienced within Muskegon County which has a higher rate of poverty than the State, with concentrated rates of poverty within the cities of Muskegon and Muskegon Heights. These negative health and economic outcomes create a cyclical pattern of ACEs within families as children realize the trauma of living with parents with mental and physical health issues alongside the impact of living in poverty. Further, the disproportionate impact of the COVID-19 pandemic on populations of color and those living in poverty threaten to further exacerbate the prevalence of ACEs among Muskegon County's most vulnerable populations.

Goals and objectives:

Muskegon Family Care (MFC) is planning and implementing the Muskegon Youth and Family Health Initiative to improve the health and wellbeing of Muskegon County's children and families. In order to accomplish this purpose, MFC will fulfill the following goals and objectives :

• Goal 1: Improve identification, prevention, and treatment of ACEs in Muskegon's youth and parents impacting mental, behavioral, and/or physical health.
  • Objective 1.1: Develop a hybrid ACEs screening tool and protocols for youth 0-12, adolescents 13-17, and adults by the end of Year 1.
  • Objective 1.2: Implement new screening protocols within MFC's Pediatrics Department to assess children and parents as part of well child visits, serving at least 1,000 families/children annually.
  • Objective 1.3: Implement training for 30 MFC pediatricians, nurses, and support staff in regard to assessment tools, cultural competency, and trauma informed care by the end of Year 2.
    
  • Objective 1.4: Deliver individual and group therapies to families identified with one or more behavioral/mental health risk factors annually.
    
  • Objective 1.5: Conduct annual evaluations of families who are served as part of the Muskegon Youth and Family Health Initiative to identify if there are reductions in ACEs risk factors.
• Goal 2: Improve access to community resources to address social determinants of health among Muskegon's at-risk children and families.
  • Objective 2.1: Execute memorandums of understanding with at least 20 referral partners that provide community services which address one or more social determinants of health associated with ACEs by end of Year 1.
    
  • Objective 2.2: Connect each family with an identified need regarding an ACEs-linked social determination of health served annually.

Methodology:

Early identification of ACEs, or situations which could create ACEs, has been found to be effective in addressing conditions which could lead to traumatic experiences and address potential mental, behavioral, or physical issues which may result. As a Federally Qualified Health Center (FQHC), MFC is the healthcare home for Muskegon County's most vulnerable residents who lack health insurance or who are underinsured. As such, MFC serves a population that is more diverse and more impoverished than the County's population as a whole. Therefore, MFC can be at the forefront in early identification of ACEs and coordination of interventions to address social determinants of health and evidence of trauma within youth and adults as a family unit. MFC will implement new screening protocols within its Pediatrics Department as part of regular well child visits utilizing a new screening tool which will be developed by MFC medical and behavioral health staff with input from Advisory Board members. The new screening tool will be a hybrid of the Life Events Checklist for DSM-5 (LEC5), PEARLS for Children & Adolescents screening tool (Child [Parent-Caregiver Report] and Teen [Self-Report]), and ACEs Questionnaire for Adults. Screening protocols will be differentiated for children under the age of thirteen, adolescents aged 13 to 17, and adults.

Further, quality of Pediatric care at MFC will be ensured by further aligning services to the American Academy of Pediatrics' Bright Futures Guidelines, with an emphasized focus on addressing social determinants of health, care for children and youth with special health care needs, and delivering care with cultural competence. This approach focuses not just on the potential trauma experienced by the child and/or parent alone, but rather treats the family as a unit with complex challenges that must be addressed for the health and benefit of all members. Through further integration between MFC's Pediatrics and Behavioral Health Departments, a Behavioral Health Case Manager will be brought in to help families who need additional support to navigate interventions. These interventions may include trauma informed care, cognitive behavioral therapy, play therapy, group therapy, and/or parenting group therapy. Additionally, a Case Manager will assist families in accessing community resources to address social determinants of health (e.g., housing, food, employment, basic needs, education support, and other forms of government assistance). A Case Manager will follow-up with families, in the home when possible, to ensure they take advantage of the community referrals given and further identify additional assistance/intervention needed. As a result of this initiative, the negative health outcomes which are closely tied to ACEs will improve in children and parents MFC serves.

Coordination:

The prevalence of ACEs and associated health issues is a community challenge that requires a community response. By expanding community partnerships with local nonprofit, faith-based, and governmental organizations, MFC will build-out a support network ready, willing, and able to serve families. This coordination will begin with formation of a Project Advisory Board comprised of representatives who have lived experience with ACEs and community interventions, medical professionals from MFC, representatives from community organizations designed to address social determinants of health, and County and State health professionals. This group will inform how this response can be inclusive of all stakeholders which share in MFC's desire to serve children and families at risk.

Evaluation:

MFC will implement a comprehensive evaluation plan which will measure the outcomes and impact of the initiative and allow the organization to oversee quality control of implementation. A combination of family health and community data will be reviewed in aggregate, pulling from not only MFC but also community partner organizations which address social determinants of health. Through implementation of the evaluation plan, MFC will be able to measure changes in community health indicators, changes in community environmental factors which impact ACEs, changes in family behaviors over time, and changes in community service delivery leading to a holistic approach to addressing community health.