Colorado’s Family Friendly Workplace Approach

By Tomei Kuehl, Colorado Department of Public Health and Environment

Colorado is one of five Centers for Disease Control and Prevention Essentials for Childhood recipients and chose to focus on employer engagement as one a strategy to address child abuse and neglect prevention and promote safe, stable, nurturing relationships and environments for all children. The Colorado Essentials for Childhood project leveraged partnerships and resources to develop the Family-Friendly Workplace Toolkit, which provides employers with evidence-informed practices and policies that enhance employee health and well-being.

The Colorado Essentials for Childhood project is rooted in a collective impact approach that brings in diverse voices to the issue of child abuse and neglect prevention. A collective engagement of multi-sector partners and stakeholders allowed for the identification of a missing partner at the table: the business sector. A challenge arose in translating our values and purpose from a public health lens to one that was more business sector oriented. Another challenge was developing a set of requests for active participation in child abuse and neglect prevention from the business sector. For example, what is the role of business in child abuse and neglect? Early efforts to engage business highlighted how disparate the language between public health and business is and indicated a lack of readiness on behalf of the public health sector to have these discussions.

As a result of identifying the business sector as a missing partner in child abuse and neglect prevention and understanding the limitations of the public health sector in understanding the connections between business and child abuse and neglect prevention, the state leveraged funding from its Rape Prevention and Education program to hire a researcher to conduct a literature review and develop a toolkit. The literature review identified best practices to support worker health and well-being and the development of Colorado’s Family-Friendly Workplace Toolkit. The toolkit, which is now in its second edition, was developed through partnerships with several organizations including: Executives Partnering to Invest in Children (EPIC), Children’s Hospital Colorado, local public health departments, city governments, and others. The toolkit provides evidence-informed best practices proven to support employees with different needs, and can ultimately lead to better health outcomes for workers and their children. An additional critical partnership developed with Health Links, a program of the Center for Health, Work & Environment at the Colorado School of Public Health, and EPIC resulted in the development of a Family-Friendly Assessment. The Family-Friendly Assessment (FF+) is an organizational tool that businesses can use to identify the needs and priorities of employers in order to create environments that are supportive of families.

An outcome of developing the Family-Friendly Workplace Toolkit has been increased interest from both businesses and local partners in family friendly practices. Over 1800 hard copies of the toolkit have been disseminated to partners across the state, and the electronic toolkit has been shared with national partners as well as agencies from other states. The toolkit also resulted in the creation of business forums where leaders from the business sector, healthcare, public health, education, and others convened to learn about best family friendly practices in their fields. Colorado business leaders have shared ways that they have made their organizations more family friendly. Additionally, 55 businesses have taken the Family-Friendly Assessment offered through Health Links to assess their level of family friendly practices. The Colorado Department of Public Health and Environment (CDPHE) recently took this survey, scored well, and has been highlighted as a family friendly department within the state system. Governor Hickenlooper’s Office is encouraging each department to take the family friendly assessment, discuss variations in results, share best practices related to address equity, and increase family friendliness within the workplace.

The development of the Family-Friendly Workplace Toolkit and the Family-Friendly Workplace Assessment have been successful because they provide a meaningful mechanism to engage with the business sector in child abuse and neglect prevention. The toolkit provides case studies that can be used as a road map for other businesses interested in being more family friendly, and the assessment provides tools and coaching to help businesses implement family friendly practices. Colorado has been approached by other states interested in replicating the toolkit and using customized case studies, which would be a great way to leverage the research already done to individualize the toolkit for a state’s unique context. A lesson learned through this process is how difficult it can be to engage businesses. The Colorado Essentials project is still working to understand how to best engage businesses directly; however the toolkit and the assessment are useful tools to beginning those discussion as we strive towards more concrete business sector involvement.

For more information, visit CDPHE’s Family Friendly Workplace Assessment and Workplace Toolkit webpages.

Translating Child Adversity Data into Actionable Information

By Marissa Abbott, MPH and Steve Wirtz, PhD, California Department of Public Health

The California Essentials for Childhood (EfC) Initiative launched a new set of child adversity and resilience data indicators on Furthermore, the initiative created state and local dashboards to bring together sources of data that represent a broader set of life experiences than originally reflected in the Adverse Childhood Experiences (ACEs) study, such as living in poverty or dangerous neighborhoods. The goal was to make these data widely available and provide training on how to talk about adversity to increase local capacity for preventive action.

Child abuse and neglect (CAN) (i.e., physical, sexual and emotional abuse, and physical and emotional neglect) make up five of the original 10 ACEs and is a significant public health problem in California. In 2017, there were over 68,000 substantiated cases of CAN for a rate of 7.5 per 1,000 Californian children. In addition, approximately one in five California children live in chronic poverty and unstable housing conditions. These types of severe adversities have been shown to have negative and long-term impacts on child health and well-being. The “toxic stress” associated with these early and cumulative traumatic experiences can disrupt healthy development and lead to emotional, behavioral, and social problems. It can also lead to serious physical and mental health issues in adulthood.

Most prevention and intervention efforts have focused on providing direct services to protect children and strengthen families. Although these are critical services, this approach does not address the overarching social contexts that create the conditions in which families struggle and children are at risk for ACEs. Many California community members and leaders are not fully aware of the growing scientific consensus on the biological processes through which ACEs impact lifelong health and intergenerational outcomes. Professional and community leaders often do not have access to local data on child adversity and resilience that they can use to inform local and state decision-makers about evidence-based policy and program solutions. In addition, local partners often don’t have the communication skills to translate these data to inform local action.

The California Department of Public Health (CDPH) Essentials for Childhood (EfC) Initiative, funded by Centers for Disease Control and Prevention (CDC), aims to promote a public health framework to address child abuse and neglect and adversity by focusing on organizational and community-level change. Our goal is to strengthen efforts to create systems and norm changes that promote safe, stable nurturing relationships and environments for all children. Based on input from multiple partners, (e.g., ACEs Connection, Berkeley Media Study Group (BMSG), CDPH Maternal, Infant and Adolescent Health, First 5 California, Lucile Packard Foundation for Children’s Health, Department of Social Services’ Office of Child Abuse Prevention, Public Policy Institute of California), we developed a plan to address community requests for local child adversity data by bringing together multiple sources that tap into both family and community adversity, increasing the ease of access to these data, and providing hands-on training to increase local capacity to use these data for preventive action. The website was already a well-known, user-friendly website for child health and wellbeing indicators. We added a new “Childhood Adversity and Resilience” data topic to with not only family ACEs information, but also social and community stress indicators such as housing and food insecurity. By providing our local partners with easy access to this broader set of data and providing hands-on skills training to talk about child adversity, we were able to support their efforts to educate communities and leaders about data-informed solutions to address child adversity.

The EfC Data Workgroup has been able to:

  • Expand the trauma-informed lens beyond the original ACEs focus by identifying additional data sources that capture broader socio-ecological risk and protective factors for adversity (e.g., National Survey of Child Health).
  • Build upon the existing platform to add the first new data topic in six years on Childhood Adversity and Resilience, using three data sources to provide better statewide and county level indicators of current child adversity status.
  • Create online state and county–level dashboards with the broader set of family and community adversity and resilience indicators, along with a small list of criteria-driven risk and protective factor indicators across the life course.
  • Conduct outreach to provide hands-on trainings to local communities to disseminate the data and build capacity to use it (including application of framing techniques). Training sessions have been held in Butte (nine rural northern counties represented), Alameda (seven Bay Area counties represented), Fresno, San Bernardino, and Riverside counties.

There have also been multiple ongoing dissemination efforts for the adversity topic and the state and county dashboards on the site as well as on the ACEs Connection website and through conferences and webinars.

The California EfC Initiative is a collective impact project that requires multi-agency collaboration and alignment around a common agenda. The strength of the collaboration has allowed us to partner with ACEs Connection, Berkley Media Studies Group, First 5 California, Kidsdata and others to disseminate data with a broader public health perspective on child adversity and resilience to communities across California. It has also allowed us to focus on systems and norms change. Without these partnerships, it would have been challenging to create the data platform and disseminate adversity-related messages with a wider view of ACES that provides a stronger framework for building community based solutions, rather than simply focusing on individual interventions.

The other major lesson learned is that in order to move this project forward, it was critical to find ways to align the work with our partners’ organizational agendas. By finding opportunities for alignment, we were able to create a process and final product that met the needs of multiple groups. We consider this to be a major success and example of how a state public health agency can collaborate effectively across agencies and sectors to address the goal of safe, stable nurturing relationships and environments.

For more details, visit Kids Data for a summary of childhood adversity and resilience and the California Department of Public Health website.

North Carolina Essentials for Childhood

By Catherine Joyner & Michelle Reis, North Carolina Department of Health and Human Services, Division of Public Health

In 2014, the North Carolina Institute of Medicine, in partnership with the North Carolina Department of Health and Human Services (NCDHHS) Division of Public Health (DPH), convened a statewide Task Force on Essentials for Childhood, tasked with developing a collaborative, evidence-based, public health initiative to address child abuse and neglect prevention and family well-being in North Carolina. The Task Force issued 15 recommendations aimed at improving collaboration and ensuring safe, stable, and nurturing relationships and environments for North Carolina’s children. Continue reading

Faith-Based Community Establishes Church Policies to Battle Cardiovascular Disease Health Disparities in Omaha, Nebraska

Black churches are answering the call to action to reduce racial and ethnic health disparities associated with cardiovascular disease by establishing Policy, System and Environment (PSE) changes. Through an expanded partnership with the Omaha Million Hearts® 2022 in Municipalities Project, the Omaha faith-based community will be able to sustain efforts in reducing cardiovascular disease. Continue reading

NACCHO Exchange Summer 2018: Breastfeeding

The summer 2018 issue of NACCHO Exchange showcases the ways in which local health departments are implementing policy, systems, and environment changes to increase breastfeeding rates in their communities. Below is an excerpt from the issue.

By Emily Bernard, IBCLC, NACCHO Consultant; Harumi Reis-Reilly, MS, LDN, CHES, IBCLC, Lead Program Analyst, Breastfeeding Project, NACCHO; and Nikia Fuller-Sankofa, MPH, MPA, Director, Breastfeeding Project, NACCHO

Breastfeeding in the Community: Using Policy, Systems, and Environmental Change Strategies to Facilitate Continuity of Care

Leading health agencies in the United States recognize breastfeeding as a public health priority, including the American Academy of Pediatrics, the American Public Health Association, the Centers for Disease Control and Prevention (CDC), and the U.S. Department of Health and Human Services. Suboptimal breastfeeding has significant public health implications. Because human milk contains unreplaceable immunomodulation properties and live substances including antibodies, hormones, and enzymes that are not found in breast milk substitutes, infants who are not breastfed do not receive the same protection against illnesses.1 Not breastfeeding also increases the mother’s risk of several diseases, including breast cancer, ovarian cancer, cardiovascular diseases, and type 2 diabetes. Infants who are not breastfed have higher rates of diarrhea, necrotizing enterocolitis, otitis media, sudden infant death syndrome, obesity, and childhood leukemia.2 Annually, suboptimal breastfeeding contributes to 3,340 excess deaths, with medical costs totaling $3 billion and the costs of premature death totaling $14.2 billion.3 Continue reading

Florida Epidemiologists Combating HAIs by Becoming CIC Certified

By Luz Caicedo, MPH, CPH, CIC and Danielle Walden, MPH, Florida Department of Health in Orange County

In 2018, the Florida Department of Health (Department), Health Care-Associated Infections (HAI) Infection Prevention Program, in collaboration with the Florida Department of Health in Orange County (DOH-Orange), established the HAI Certification in Infection Prevention and Control (CIC) Study Group.

The Centers for Disease Control and Prevention (CDC) recently reported that in 2011 there were an estimated 722,000 HAIs in U.S. acute-care hospitals. Approximately 75,000 of those patients with HAIs died during hospitalization. Public health surveillance, prevention and response are key to reducing the number of HAIs in local communities. Currently, health department involvement in HAI prevention is primarily through surveillance of reportable diseases and conditions as well as HAI outbreak response. According to CDC, outbreaks in health care settings are often attributed to failures in infection control practices or contaminated equipment or medications. It is important for public health staff to be knowledgeable in infection prevention and control. One of the key challenges for HAI prevention and response for public health staff is access to education and training on infection control. Based on a recent survey, 10 out of 104 (9.6%) epidemiology public health staff members in the Department hold the CIC credential. This low prevalence illustrates the need to implement a strategy to increase education and training in infection control for public health staff. Continue reading

Fostering Agency Through Local Public Health

By Grenadier, Andrea, BA; Holtgrave, Peter, MPH, MA; Aldridge, Chris, MSW, NACCHO

This article originally ran in the Journal of Public Health Management and Practice.

When public health departments support all aspects of the public’s well-being—beginning with striking at the roots of health inequity—it can create transformational change. Part of this process is encouraging people in communities to determine their own futures, to express agency; something that is rooted in action and power. So, how does local public health get there? Continue reading