Carver County A Needs Assessment of Programs that Build Resilience against Adverse Childhood ...

73 Pages·2016·1.31 MB·English

A Needs Assessment of
Programs that Build Resilience against
Adverse Childhood Experiences among
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Youth at Waconia and Central School Districts in
Carver County
Carver County, Minnesota
2015
(cid:885)
2016
Prepared by
Prepared by
Kate Gurke, Alison Kirgis, and Bixuan Sun
Ashley Barrett
Students in PA 5721: Energy and Environmental Policy
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Division of Health PolIincsyt aruncdt oMr:a Enlaizgaebmetehn tW inil sPoanrtial Fulfillment of the
Requirements for a Master of Public Health Degree
School of Public Health | University of Minnesota
Prepared on Behalf of
Carver County Community Development Agency
Prepared on Behalf of
Carver County Public Health
2016
This project was supported by the Resilient Communities Project (RCP), a program at the
University of Minnesota that convenes the wide-ranging expertise of U of M faculty and
students to address strategic local projects that advance community resilience and
sustainability. RCP is a program of the Center for Urban and Regional Affairs (CURA) and
the Institute on the Environment.
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Resilient Communities Project:
A needs assessment of programs that build resilience against
adverse childhood experiences (ACEs) among youth at Waconia
and Central School Districts in Carver County, Minnesota
A PROJECT
SUBMITTED TO THE FACULTY
OF THE DIVISION OF HEALTH POLICY & MANAGEMENT OF
THE UNIVERSITY OF MINNESOTA
BY
Ashley Barrett
IN PARTIAL FULFILLMENT OF THE REQUIREMENTS
FOR THE DEGREE OF
MASTER OF PUBLIC HEALTH
September 2016
UNIVERSITY OF MINNESOTA
This is to certify that I have examined this copy of a master’s project by
Ashley Barrett
and have found that it is complete and satisfactory in all respects,
and that any and all revisions required by the final
examining committee have been made.
Ezra Golberstein, PhD, Advisor
Jean Pierson, Community Advisor, Reader
Donna McAlpine, PhD, Reader
September 2016
DIVISION OF HEALTH POLICY & MANAGEMENT
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ACKNOWLEDGEMENTS
Thank you to my committee for all of your time and help. Thank you to Andrew for his constant support
and encouragement.
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Table of Contents
Abstract……………………………………………………………….....5
Background……………………………………………………………...6
Methodology…………………………………………………………...13
Results………………………………………………………………….17
Discussion……………………………………………………………...27
Conclusion……………………………………………………………..33
Appendices……………………………………………………………..36
References……………………………………………………………...69
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Abstract
Adverse childhood experiences (ACEs) are stressful or traumatic experiences in a
person’s life that occur before the age of 18 and can contribute to poor long-term health
outcomes in adulthood. Research has found that how youth respond to adverse experiences is
important in determining their outcomes. A needs assessment using key informant interviews
was done to determine whether youth at two school districts in Carver County, Minnesota have
access to programs that build resilience against ACEs. Programs that build resilience were not
equally available within both school districts. Curriculum-based programs were found at one
school district, but lacking at the other. Community resources were also more available at one
school district than the other. Both school districts were found to have limited access to mental
health services and transportation to after school activities. Both school districts could improve
on increasing parent involvement and helping their students gain access to transportation.
Family-based mental health services would help fill the gap in mental health services and an
activity bus would improve upon the lack of transportation that both school districts experience.
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Background
The earliest years of our lives are crucial in many ways and can set us on paths leading
toward or away from good health (Braveman et al., 2011). Adverse childhood experiences
(ACEs) are stressful or traumatic experiences in a person’s life that occur before the age of 18
and are often recalled as an adult, including abuse, neglect, and a range of household dysfunction
(Minnesota Department of Health, 2011).
The Adverse Childhood Experiences Study (ACEs Study) is one of the largest
investigations ever conducted to assess associations between childhood maltreatment and health
and wellbeing later in life (Centers for Disease Control and Prevention, 2014). The study is a
partnership between the Centers for Disease Control and Prevention (CDC) and Kaiser
Permanente’s Health Appraisal Clinic in San Diego (Centers for Disease Control and Prevention,
2014). The ACEs study “uses the sum of adverse experiences to predict health and
developmental outcomes” (Naramore et al., 2015, p. 3). High-risk ACE scores (reported as 4 or
more) are associated with increased risk of adverse physical and behavioral health outcomes for
adults and adolescents (Naramore et al., 2015, p. 3).
The CDC developed a set of ACE questions for states to use in the Behavioral Risk
Factor Surveillance System (BRFSS) in 2008 (Minnesota Department of Health, 2011). The
BRFSS is used by states to measure the health status of their citizens based on behavioral risk
factors (Minnesota Department of Health, 2011).
The Minnesota BRFSS survey measured nine types of ACEs: “physical abuse, sexual
abuse, emotional abuse, mental illness of a household family member, problematic drinking or
alcoholism of household member, illegal street or prescription drug use by household member,
divorce or separation of a parent, domestic violence towards a parent, and incarceration of
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household member” (Minnesota Department of Health, 2011, p. 6). An ACE score measures the
cumulative exposure to these adverse childhood conditions (Minnesota Department of Health,
2011).
The 2011 BRFSS survey results showed that over half of adults in Minnesota
experienced at least one ACE (Minnesota Department of Health, 2011). The 2011 BRFSS survey
also showed that the five most common ACEs experienced by Minnesotans include: emotional
abuse (28%), problem drinker (24%), separation or divorce (21%), mental illness (17%), and
physical abuse (16%) (Minnesota Department of Health, 2011). The results also showed that
ACEs often occur together with 60% of Minnesotans experiencing two or more and 15%
experiencing 5 or more (Minnesota Department of Health, 2011).

Public Health Significance
Adverse Childhood Experiences (ACEs) are a major public health problem in that they
contribute to poor long-term health outcomes, which therefore influence quality of life,
longevity, healthcare spending, productivity, and more. Experiencing one or more ACEs
increases an individual’s risk of various negative health behaviors or conditions later in life,
including smoking, obesity, alcohol abuse, drug use/dependence, depression, anxiety disorders,
early intercourse, job problems and memory disturbances (Minnesota Department of Health,
2011). ACEs have been linked to “poor physical and mental health, chronic disease, lower
educational achievement, lower economic success and impaired social success in adulthood”
(Minnesota Department of Health, 2011, p. 8).
It is important to emphasize prevention of ACEs and also to promote resilience by
increasing protective factors that can help mitigate the harmful effects of adverse childhood
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experiences. Research has found that how youth respond to adverse experiences is much more
important than the experience itself in determining their outcomes (Center for the Study of Social
Policy, 2016). Resilience is “the process of adapting well in the face of adversity, trauma,
tragedy, threats or significant sources of stress” (American Psychological Association, 2015, p.
1). Resilience means, “bouncing back” from difficult experiences—such as adverse childhood
experiences (ACEs).
Previous efforts to improve child and adolescent health have focused interventions on
specific health risk behaviors, such as tobacco use, alcohol and drug use, gang violence, and
early sexual initiation (Centers for Disease Control & Prevention, 2009). However, a growing
body of research has found that a greater health impact might be achieved by also enhancing
protective factors that help children and adolescents avoid behaviors that have negative
consequences on health and education (Centers for Disease Control & Prevention, 2009).
Protective factors are “individual or environmental characteristics, conditions, or behaviors that
reduce the effects of stressful life events; increase an individual’s ability to avoid risks or
hazards; and promote social and emotional competence to thrive in all aspects of life now and in
the future” (Centers for Disease Control & Prevention, 2009, p.3).
The National Longitudinal Study of Adolescent Health observed the impact of protective
factors on the health and well-being of 36,000 7th through 12th graders (Centers for Disease
Control & Prevention, 2009). The study found that factors related to individual, school, and
family influenced health behaviors. School-connectedness was found to be the strongest
protective factor for boys and girls against substance use, school absenteeism, early sexual
initiation, violence, and risk of unintentional injury (Centers for Disease Control & Prevention,
2009). School connectedness was ranked second in importance after family connectedness as a
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