Community networks in the state of Washington have been effective in reducing the effects of adverse childhood experiences (ACEs), according to a study released this month by respected policy research firm Mathematica.
ACEs are childhood traumas — such as child abuse and neglect, domestic violence or substance use at home — that can have lifelong health consequences, a connection that was first documented with the groundbreaking 1998 Centers for Disease Control and Prevention study.
The three-year study was organized by ACEs Public-Private Initiative (APPI), a group of government agencies, philanthropic foundations and community organizations in Washington that formed with the hope of finding and promoting effective interventions to address ACEs in the state. The group has built on existing work of the state’s Family Policy Councils in order to cultivate partnerships and leadership around strengthening families and preventing violence.
In looking at efforts to reduce the impact of ACEs in Washington, the study looked at the work of five mostly rural community-based networks there: the Coalition for Children and Families of North Central Washington, Okanogan County Community Coalition, the Skagit County Child and Family Consortium, Walla Walla County Community Network and Whatcom Family and Community Network.
According to Kathy Adams, a member of APPI who has also worked with the Whatcom Family and Community Network, community networks offer an appropriately broad lens to address the plethora of health and well-being issues raised by ACEs.
“There isn’t just one program that’s going to have that impact and address the complexities that are addressed in the ACEs study,” Adams said. “It really takes a community-driven effort that is based on the data in each community to create a culture shift that will lead to a healthier and safer society.”
As part of the most part of the study, the evaluation team looked at how the networks developed capacity to address ACEs in their areas and how well they were able to achieve positive outcomes at the local level.
The report noted evidence of positive changes in addressing ACEs with six strategies:
- The ACEs and Resilience Awareness Campaign in Walla Walla
- Commitment to Community, a community development initiative in Walla Walla
- Lincoln High School, which improved school climate indicators (Walla Walla)
- The Nurse-Family Partnership, which saw an increase in health outcomes for new mothers and babies in Skagit County
- The Omak Community Truancy Board, which was linked to improved attendance in Okanogan
- The Positive Social Norms Campaign, which saw a decrease in alcohol use among teens in Okanogan
Composed of researchers from Mathematica and Community Science, the evaluation team also found that the development of community capacity for ACEs-related work varied across the five sites. Each site had a different model for creating community change, though the three factors that were most aligned with successful outcomes were collective community capacity, community network structure and effective community change strategies.
But all the networks faced major sustainability challenges that hampered their ability to create a comprehensive strategy that addressed the effects of ACEs. Three of the networks operated with a budget of less than $100,000, while two others had around $300,000 on the books, according to study co-author Natalya Verbitsky-Savitz.
Though many of the networks found creative ways to share some resources, the networks all faced sustainability challenges because of small staffs and budgets as well as time-limited grant funding.
“They were constantly scrambling for funding and it limited how much they could plan and their long-term goals,” said Verbitsky-Savitz, a senior researcher at Mathematica. “But these communities were still able to achieve positive outcomes on a low budget. They were really good at leveraging the resources in the community and using the partners’ resources to troubleshoot and figure out solutions. By bringing the right stakeholders together, they were able to make some pretty dramatic improvements in front of their targeted outcomes.”
Verbitsky-Savitz and others are clear about the challenges in assessing the role of community networks to implement strategies to reduce the negative outcomes associated with ACEs. Getting good longitudinal data remains difficult and she says the area is “somewhat understudied” using rigorous research methods. But most of all, it may take patience to create impactful social change around the toxic stress related to the adverse effects of trauma experienced early in life.
“It takes time,” she said. “This is definitely not a one-year or two-year proposition. We’re talking about decades here, thinking about how to explain the idea about why ACEs are important, bringing the stakeholder on board and trying to figure out how to address the problems.”