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Executive Committee and Main Task Force

Director Michelle Barnes, Colorado Department of Human Services
Lt. Governor Dianne Primavera
Deputy Manager Barbara Drake, Douglas County
Director Jill Hunsaker Ryan, Colorado Department of Public Health & Environment
Director Kim Bimestefer, Colorado Department of Health Care Policy and Financing
Commissioner Michael Conway, Division of Insurance
Main Task Force
Vincent Atchity, Mental Health Colorado
Denver

Daniel Darting, Signal Behavioral Health Network
Greenwood Village

Raul De Villegas-Decker, RDV Executive Consulting
Grand Junction

Jill Derrieux, Mesa Youth Services, Inc. dba Mesa County Partners
Grand Junction

Rebecca Ela, Delta County Memorial Hospital
Hotchkiss

C. Neill Epperson, University of Colorado School of Medicine
Aurora

Michael Fields, Colorado Rising Action
Parker

Rana Gonzales, WINS
Manitou Springs

Deidre Johnson, Center for African American Health
Denver

Tracy Kraft-Tharp, General Assembly
Denver

Lois Landgraf, General Assembly
Denver

Jennifer Lynn Fanning, Grand County Rural Health Network
Hot Sulphur Springs

Glenn Most, SCL Health
Wheat Ridge

Cory Notestine, Colorado Springs School District 1
Colorado Springs

Patricia Oliver, Oliver Behavioral Consultants
Broomfield

Byron Pelton, Commissioner Logan County
Sterling

Valerie Schlecht, Colorado Cross-Disability Coalition
Denver

Meg Taylor, Rocky Mountain Health Plans
Greenwood Village

Laura Teachout, NAMI Colorado Springs Board Member
Colorado Springs

Brian Turner, Solvista Health
Canon City

Selwyn Whiteskunk, Ute Mountain Tribe
Towaoc
Ex-officio members:
Kate Greenberg, Colorado Department of Agriculture
Brey Hopkins, Colorado Department of Military and Veterans Affairs
Nancy Ingalls, Douglas County Schools (for CDE)
Debbie Oldenettel, Colorado Department of Public Safety
Patty Salazar, Colorado Department of Regulatory Agencies
Dean Williams, Colorado Department of Corrections

State Safety Net Subcommittee

Aubrey Boggs
Denver

Frank Cornelia, Colorado Behavioral Healthcare Council
Denver

Kevin Duffy, Douglas County Sheriff's Office
Castle Rock

Melissa Eddleman, Colorado Department of Health Care Policy & Financing
Denver

Marilyn Fausset
Boulder

Alison George, Colorado Department of Local Affairs
Denver

Kimberly Gonzales, Las Animas Huerfano Counties District Health Department
Trinidad

Joy Hart, Colorado Department of Corrections
Denver

Nancy Jackson, Arapahoe County
Littleton

Carl LoFaro
Aurora

Meighen Lovelace
Avon

Tom Manzione, Attention Homes
Boulder

Mike Nugent, Colorado Department of Public Health & Environment
Denver

John Pickett III, Larimer County Human Services
Loveland

Aisha Rousseau, Denver Office of Disability Rights
Denver

Deb Ruttenberg, Grand County Department of Human Services
Hot Sulphur Springs

Jessica Schart, Kit Carson County Department of Public Health and Environment
Burlington

Richard Simms, Richard S Simms PC
Littleton

Lauren Snyder, Mental Health Colorado
Denver

Sarah Vaine, Summit County Government
Breckenridge

Eva Veitch, Region 10 LEAP
Montrose

Traci Walker, Aurora Municipal Courts
Aurora

Robert Werthwein, Colorado Department of Human Services
Denver
Ex-officio members:
Kristina Daniel, Valley-Wide Health Systems, Inc.
Alamosa

Rickey Gray, Cedar Springs Hospital
Colorado Springs

Kiara Kuenzler, Jefferson Center for Mental Health
Wheat Ridge

Children's Behavioral Health Subcommittee

Morgan Bruss, Harrison School District 2
Colorado Springs

Megan Burch, Eagle County Department of Human Services
Eagle

Sarah Davidon
Denver

Samantha Field, Mental Health Professional
Denver

Martha Fraley, Pediatric Partners of the Southwest
Durango

Brook Griese, Judi's House/JAG Institute
Denver

Jennifer Grote, Denver Health
Denver

Camille Harding, Colorado Department of Human Services
Denver

Rebecca Hea, Denver Children's Home
Denver

Melissa Janiszewski, Office of Children's Affairs
Denver

Dawn Khederian, The Vanguard School
Colorado Springs

John Laukkanen, Colorado Department of Health Care Policy & Financing
Denver

Carol Meredith, The Arc Arapahoe & Douglas
Centennial

Dafna Michaelson Jenet, General Assembly
Denver

Aaron Miltenberger, Boys & Girls Clubs of the San Luis Valley
Alamosa

Lindsey Myers, Colorado Department of Public Health & Environment
Denver

Leslie Patterson
Colorado Springs

Jessica Peck, Jessica K. Peck, Attorney at Law
Denver

Lindsay Reeves, Catholic Charities Diocese of Pueblo
Pueblo

Lenya Robinson, Jefferson Center for Mental Health
Wheat Ridge

Shannon Secrest
Aurora

Shannon Van Deman, Children's Hospital Colorado
Aurora

Stephanie Villafuerte, Office of Colorado's Child Protection Ombudsman
Denver

Kathryn Wells, Kempe Center for the Prevention and Treatment of Child Abuse and Neglect
Aurora

Lisa Zimprich, Fountain-Fort Carson School District 8
Fountain
Ex-officio member:
Jamie Murrary, Cañon City School District
Canon City

Long-Term Competency Subcommittee

Lacey Anne Berumen, TRACKtech LLC
Greenwood Village

Alison Butler, Disability Law Colorado
Denver

Su Coffey, Hollywood Showcase Denver
Denver

Alexis Giese, Colorado Access
Aurora

Brian Gonzales, University of Denver Graduate School of Social Work
Denver

Ravid Moshe "Moses" Gur, Colorado Behavioral Healthcare Council
Denver

Ben Harris, Colorado Department of Health Care Policy & Finance
Denver

Joy Hart, Colorado Department of Corrections
Denver

Daric Harvey, Cañon City Police
Cañon City

Peggy Heil, Colorado Department of Public Safety
Denver

Tim Lane, Colorado District Attorney's Council
Denver

Richard Martinez, University of Colorado School of Medicine
Denver

Lucienne Ohanian, Colorado State Public Defender
Denver

Brenda Pace, Pueblo County Attorney's Office
Pueblo

Sasha Rai, Denver Health
Denver

Cordelia Rosenberg, University of Colorado
Aurora

Jessica Russell, Health Solutions
Pueblo

Carleigh Sailon, Mental Health Center of Denver
Denver

Jonathan Shamis, State of Colorado Judge
Leadville

Rana Shaner
Olathe

Juan Silva, Denver District Attorney's Office
Denver

Cali Thole, SummitStone Health Partners
Fort Collins

Mary Thomas
Longmont

Robert Werthwein, Colorado Department of Human Services
Denver

COVID-19 Special Assignment Committee

Yadira Caraveo, State House of Representatives

Cara Cheevers, Colorado Division of Insurance

Lila Cummings, Colorado Hospital Association

Curt Drennen, Colorado Department of Public Health and Environment, co-chair

Daniel Darting, Signal Behavioral Health Network

Doyle Forrestel, Colorado Behavioral Healthcare Council

Camille Harding, Colorado Department of Human Services

Joy Hart, Colorado Department of Corrections

Brenda Heimbach, El Paso County Public Health Office

DeAnne House, Ute Mountain Ute

Cheri Jahn, Colorado Provider Association

Jan James, Larimer County Human Services

Tracy Johnson, Colorado Department of Health Care Policy and Financing

Kim Nordstrom, Colorado Access

Carrie Paykoc, Office of eHealth Innovation

Rod Pelton, State House of Representatives

Dianne Primavera, Lt. Governor

Susie Walton, Park County Human Services

Robert Werthwein, Colorado Department of Human Services, co-chair

Leon Wittner, Consumer/Parent

Anthony Young, Association of Black Psychologists

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Executive Committee and Main Task Force Director Michelle Barnes, Colorado Department of Human Services Lt. Governor Dianne Primavera Deputy Manager Barbara Drake, Douglas County Director Jill Hunsaker Ryan, Colorado Department of Public Health & Environment Director Kim Bimestefer, Colorado Department of Health Care Policy and Financing Commissioner Michael Conway, Division of Insurance Main Task Force Vincent Atchity, Mental Health Colorado Denver Daniel Darting, Signal Behavioral Health Network Greenwood Village Raul De Villegas-Decker, RDV Executive Consulting Grand Junction Jill Derrieux, Mesa Youth Services, Inc.

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An Action Guide for Policymakers: Health and Learning Are Deeply Interconnected in the Body

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An Action Guide for Policymakers: Health and Learning Are Deeply Interconnected in the Body

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policy 3 key messages connecting body and brain

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CO Family Friendly FF Toolkit_Final Digital 2017

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Strengthening Protective Factors in ACEs Prevention With Medicaid 1115 Waivers

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Strengthening Protective Factors in ACEs Prevention With Medicaid 1115 Waivers

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Adverse childhood experiences (ACEs) are potentially traumatic events that can disrupt a child's sense of safety, stability, and bonding, leading to long-term developmental issues and negative health outcomes. State and territorial health agencies (S/THAs) can address this public health issue by enhancing protective factors and reducing risk factors that address structural inequities (e.g., access to basic needs, housing, food, mental/behavioral, and primary healthcare). By promoting systems-level prevention strategies, like strengthening economic support and improving affordable housing approaches for families, S/THAs can prevent ACEs.

Although seen across all populations, the burdens from ACEs and their long-term effects disproportionately impact marginalized communities, such as racial and ethnic minorities and people with lower incomes and educational attainment. States and territories can leverage Medicaid to disrupt the generational impact of ACEs by utilizing a shared risk and protective factors framework to promote safe, stable, and nurturing environments for families to thrive.

Innovate With the Medicaid 1115 Waiver

Medicaid and the Children's Health Insurance Programs (CHIP) are the major sources of healthcare coverage for low-income residents in the U.S., covering almost 80 million individuals in over 51 jurisdictions, including more than half of births in many states. All 50 states, D.C., and five U.S. territories participate in the programs, which is a federal and state/territorial partnership with joint financing and authority. While the federal government mandates that Medicaid beneficiaries receive certain benefits, states and territories generally have wide authority to establish and administer their own programs. Beyond this general flexibility, Medicaid agencies that would like to implement an innovative program that promotes Medicaid's objectives but does not conform with existing federal law can apply for a Section 1115 Demonstration Waiver.

The 1115 waiver empowers states and territories to expand program eligibility, provide services not traditionally covered through Medicaid, and try new service delivery models to improve care. For states and territories to qualify for an 1115 waiver, they must show that the program is budget neutral to the federal government and meets the objectives of the Medicaid and CHIP programs. The Centers for Medicare & Medicaid Services (CMS) also evaluates 1115 waiver applications to determine whether the proposal:

Increases and strengthens health coverage of low-income individuals.

Increases healthcare access for low-income populations.

Improves health outcomes for Medicaid or other low-income populations.

Improves efficiency and quality of care by transforming service delivery networks.

Through the 1115 waiver, states and territories can leverage Medicaid to address ACEs as a way to improve health outcomes for Medicaid recipients and other low-income communities. There has been an increase in the usage of 1115 waivers for behavioral health purposes. Considering that more than five of the leading causes of death, including suicide and overdose, are linked to ACEs, states and territories have the opportunity to leverage the 1115 Waiver to maximize health outcomes.

States Leveraging the 1115 Waiver to Address the Root Causes of ACEs

Alaska is investing in acute care services to prevent more costly downstream health outcomes. The Alaska Longitudinal Child Abuse and Neglect Linkage Project (ALCANLink) is a mixed-design predictive model that prevents ACEs by identifying families at high risk for being involved with child welfare and referring them to services. CMS granted a 1115 waiver submitted by the Alaska Department of Health, which was based on the ALCANLink results and had a primary goal of increasing services for at-risk families and connecting them to early support for healthy childhood development. This was the first submission of its kind, allowing social determinants of health to qualify individuals for services listed under the waiver.

Illinois is strengthening its housing services by supporting low-income individuals, individuals with behavioral health needs, high risk of homelessness or institutionalization, and/or frequent users of emergency department services with pre-tenancy and tenancy supports. Tenancy supports can include education on tenant rights and responsibilities and coordination with services for primary care, behavioral health, mental health, and employment support. Their waiver allows the state to more effectively use data to match eligible individuals with resources and explore capital investment strategies to acquire and develop affordable housing. ACEs are a major risk factor for adult homelessness, so strengthening tenancy supports can improve a family's ability to meet children's basic needs, coordinate mental health and behavioral health care, and increase financial stability.

North Carolina is financing evidence-based non-medical services that target social determinants of health. The Healthy Opportunities Pilot aims to test the impact on health outcomes and healthcare costs by using Medicaid funds to pay for non-medical services, such as housing, food, transportation, and interpersonal safety. The lack of these basic resources are risk factors for ACEs. The pilot prioritizes beneficiaries with at least one physical or behavioral health condition (e.g., children 0-21 experiencing three or more ACEs) and a social condition (e.g., experiencing insecurity in housing, food). Lastly, the pilot aims to enhance mechanisms for payers, providers, and human service organizations to have the tools and infrastructure needed to integrate these non-medical services into the health care of eligible beneficiaries.

Looking ahead to future trends in 1115 wavier usage, some states have also used 1115 waivers to extend coverage to former foster care youth who aged out of the system, a population disproportionately impacted by ACEs.

States and territories can leverage 1115 wavier flexibilities to customize their Medicaid programs to prevent ACEs and their root causes, which can also strengthen access to services and basic needs for the most marginalized beneficiaries, such as those with food insecurity, housing instability, and unsafe households. To integrate an 1115 waiver into their social and behavioral health work, S/THAs can work with their Medicaid administrators and ACEs prevention teams to brainstorm how the jurisdictions' Medicaid program could be customized to better prevent ACEs. From there, S/THAs can identify the specific waiver and expenditure authority needed to implement the proposed project, along with a clear description of how to evaluate the proposed change for success.

More details on the 1115 Application Process are on the CMS website, including ways to connect with CMS to discuss a proposed waiver project. For S/THAs that have already implemented an 1115 waiver, information to extend it for an additional five years is on the CMS website. ASTHO will continue to monitor the 1115 wavier landscape and highlight trends in its use for ACEs prevention.
Jes Lyons, MPH, is a senior analyst of social and behavioral health at ASTHO
Grace Deleon is an intern of social and behavioral health at ASTHO
Maggie Davis, JD, MA, is director of state health policy at ASTHO

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Adverse childhood experiences (ACEs) are potentially traumatic events that can disrupt a child's sense of safety, stability, and bonding, leading to long-term developmental issues and negative health outcomes. State and territorial health agencies (S/THAs) can address this public health issue by enhancing protective factors and reducing risk factors that address structural inequities (e.g., access to basic needs, housing, food, mental/behavioral, and primary healthcare).

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Key Takeaways

Adverse childhood experiences (ACEs) can increase a person's risk of health, social, and economic problems throughout life.

In 2017, ACEs among Tennessee adults led to an estimated $5.2 billion in direct medical costs and lost productivity from employees missing work.

ACEs are associated with risky health behaviors and poorer health outcomes even after accounting for other factors.

Over half of adult Tennesseans reported at least one ACE between 2014 and 2017, and about 17% had experienced 4 or more.

Adverse childhood experiences (ACEs) can disrupt healthy brain development in ways that affect health later in life. Abuse, neglect and household dysfunction can cause chronic and severe stress during childhood that is especially toxic to the developing brain. (7) (8) Studies show that as the number of ACEs increases, so does the risk of long-term health, social, and economic problems - including chronic disease, decreased work performance, and risky health behaviors. (9) (10)

The effects of ACEs are widespread and costly for individuals, families, and communities. Nationally, child abuse and neglect alone cost an estimated $124 billion in 2008 and $80 billion in 2012. These costs are shared across many sectors including health care, taxpayer-funded social services, law enforcement, and special education. (9) (11)

To better understand how ACEs affect Tennesseans and Tennessee's economy, this study estimates the economic impact of ACEs-related health outcomes and behaviors in our state. The findings offer insight into the potential economic upside of efforts to prevent and mitigate ACEs.

The Economic Cost of ACEs in Tennessee

In 2017, ACEs among Tennessee adults led to an estimated $5.2 billion in direct medical costs and lost productivity from employees missing work ( Figure 1). (1) (2) (3) (4) (5) (6) These costs are associated with eight ACEs-related health outcomes and behaviors. Among these, cigarette smoking ($2.1billion) and depression ($923 million) were the most costly ( Figure 2).

The calculation of these estimates includes an adjustment to account for the other known factors and behaviors/conditions that are associated with increased prevalence of these health outcomes.

Implication for Tennessee's Economy

These estimates begin to shed light on how ACEs shape Tennesseans' health and influence our state's economy. By affecting our health outcomes and behaviors, ACEs increase health care costs in taxpayer-funded programs like TennCare, raise employers' costs for health care and productivity loss, and shrink earnings for employees who miss work. Efforts to prevent ACEs and mitigate their effects could potentially reduce those expenses. The details and costs of any such efforts fall outside this report's scope.

Our Method

This study estimates the ACEs-related direct medical and worker absenteeism costs associated with eight health outcomes and behaviors. After determining the prevalence of ACEs reported by Tennessee adults between 2014 and 2017, we estimated the percentage of each health outcome or behavior that is connected to ACEs. This percentage is known as the population attributable risk (PAR).

We adjusted the PAR for other known associated factors like education, income, exercise habits, age, and overlapping chronic diseases. This serves to isolate the effects of ACEs from the effects of other factors. The adjusted PARs were then applied to annual estimates of Tennessee-specific direct medical costs and absenteeism for each health outcome and behavior.

See the Methods Appendix for a more detailed discussion of our methods.

The Prevalence of ACEs in Tennessee

Over half of adult Tennesseans reported at least one ACE between 2014 and 2017, and about 17% had experienced four or more ( Figure 3). (1) Of the 60% of people who reported at least one ACE, the most common were divorce or separation (52%) and emotional abuse (49%) ( Figure 4).

The Link Between ACEs and Health Outcomes and Behaviors

ACEs are associated with risky health behaviors and poorer health outcomes among Tennesseans, even after accounting for other factors. As the number of ACEs increases, so do rates of risky health behaviors like smoking ( Figure 5) and poor health outcomes like depression ( Figure 6), diabetes, obesity, poor/fair self-rated health status, cardiovascular disease (CVD) and chronic obstructive pulmonary disease. (1)

If all ACEs were eliminated, for example, we would expect 49% fewer adult Tennesseans with depression and 32% fewer adult cigarette smokers ( Figure 7). (1)

ACEs Are Fact, Not Fate

Exposure to ACEs does not guarantee that negative outcomes will follow. Some people with adverse childhood experiences do not have negative health and social outcomes. Likewise, not everyone with negative health outcomes was exposed to ACEs.

ACEs should be viewed from a population health perspective. Science has demonstrated the relationship between ACEs and adverse outcomes - along with the benefits of preventing and mitigating ACEs. Individual differences in environment, genetics, and other experiences also affect outcomes. Further research can help inform policies, resources, and programs that can effectively prevent and mitigate the effects of ACEs. (12)

Parting Words

Chronic, severe stress during childhood can disrupt healthy brain development. These adverse childhood experiences (ACEs) increase a person's risk of health, behavioral, and social problems throughout life.

The negative health effects of ACEs carry significant economic costs for Tennessee. Efforts to prevent ACEs and mitigate their negative effects could potentially improve Tennesseans' health and well-being while reducing economic costs of medical care and worker absenteeism.

References

1. U.S. Centers for Disease Control and Prevention (CDC). Chronic Disease Calculator. [Online] [Cited: February 2, 2018.] https://www.cdc.gov/chronicdisease/calculator/index.html.

2. Tennessee Department of Health, Office of Policy, Planning and Assessment Surveillance, Epidemiology and Evaluation. The Burden of Tobacco in Tennessee. [Online] June 25, 2008. [Cited: February 2, 2018.] https://hit.health.tn.gov/Reports/ATOD/BurdenTobaccoTN.pdf.

3. U.S. Centers for Disease Control and Prevention (CDC). Smoking-Attributable Mortality, Morbidity, and Economic Costs (SAMMEC). [Online] [Cited: February 2, 2018.] https://chronicdata.cdc.gov/Health-Consequences-and-Costs/Smoking-Attributable-Mortality-Morbidity-and-Econo/ezab-8sq5/data.

4. U.S. Centers for Disease Control and Prevention (CDC). The Behavioral Risk Factor Surveillance System: Complex Sampling Weights and Preparing 2017 BRFSS Module Data for Analysis. [Online] July 2018. https://www.cdc.gov/brfss/annual_data/2017/pdf/Complex-Smple-Weights-Prep-Module-Data-Analysis-2017-508.pdf.

5. Columbia University Mailman School of Public Health. Adjusted Attributable Fractions. [Online] [Cited: February 2, 2018.] https://www.mailman.columbia.edu/research/population-health-methods/adjusted-attributable-fractions.

6. Santerre, Rexford E and Neun, Stephen P. Health Economics: Theory, Insights, and Industry Studies. Mason : South-Western CENGAGE Learning, 2010.

7. Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Overview: BRFSS 2017. [Online] July 16, 2018. [Cited: January 25, 2019.] https://www.cdc.gov/brfss/annual_data/2017/pdf/overview-2017-508.pdf.

Featured photo at top by Brian Smith

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The Economic Cost of Adverse Childhood Experiences in Tennessee

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Adverse childhood experiences (ACEs) can increase a person's risk of health, social, and economic problems throughout life. In 2017, ACEs among Tennessee adults led to an estimated $5.2 billion in direct medical costs and lost productivity from employees missing work. ACEs are associated with risky health behaviors and poorer health outcomes even after accounting for other factors.

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PHRASES: Public Health Reaching Across Sectors

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If public health agencies want to truly impact long-term health outcomes, we have to go beyond our traditional approaches and recognize our place as part of a multi-sector system.- Jeff Kuhr
Director of Public Health, Mesa County, Colorado
PHRASES Fellow

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Home - PHRASES: Public Health Reaching Across Sectors

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If public health agencies want to truly impact long-term health outcomes, we have to go beyond our traditional approaches and recognize our place as part of a multi-sector system. - Jeff Kuhr Director of Public Health, Mesa County, Colorado PHRASES Fellow

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Public Health Reaching Across Sectors (PHRASES) - de Beaumont Foundation

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Communications toolkit to support cross-sector partnerships

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Need to think about the language we use (e.g., socio emotional development can be seen as character devl that should be taught at home); need to be mindful what terms are politically hot and how to adjust

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Need to appeal to business sense before human sense

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Need to appeal to business sense before human sense

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Understand $

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Need to consistently share health impact to public and community; need public pressure!

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Developed in partnership with Colorado's Department of Public Health and Environment (CDPHE), this Toolkit provides the most up-to-date information available on family-friendly workplace policies and practices. It is available in print and online and includes examples of employer best practices to support working families.

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Will target business and educators in awareness campaign; importance of business friendly policies

Will pull together businesses in a similar way with commissioners

Look at health councils for leg; diverse public/private institutions from the local community

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Haven't had much evaluation, definitely an opportunity around this area in particular.

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Legal epidemiology as a potential resource

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Legal epidemiology as a potential resource

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Look at policies to analyze the health impact and helps build the evidence base

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What It Means to be a Better Messenger for Health

Resources

Scholarship
Baker EL. Crafting Richer Messages and Being More Credible Messengers. Management Moments with Public Health Leaders. Burris S, Matthews G, Gunderson G, Baker EL. Becoming Better Messengers: The Public Health Advantage. Journal of Public Health Management and Practice. 25(4); 402-303, 2019. Healy Boufides C, Corcoran E, Matthews GW, Herrick J, Baker EL. Matthew G, Burris S, Ledford SL, Gunderson G, Baker EL. Matthew G, Burris S, Ledford SL, Baker EL. Burris S, Ashe M, Blanke D, Ibrahim J, Levin DE, Matthews G, Penn M, Katz M. Better Health Faster: The 5 Essential Public Health Law Services. Public Health Reports. 13(6): 747-753, 2016. Advocacy for Leaders: Crafting Richer Stories for Public Health. Journal of Public Health Management and Practice. 22(3): 311-315, 2016. APHA 2018 Advocacy for Leaders - Becoming Better Messengers: The Public Health Advantage Crafting Richer Public Health Messages for a Turbulent Political Environment Crafting Richer Messengers: The Public Health Advantage . Journal of Public Health Management and Practice. 23(4): 420-423, 2017. Millennials as New Messengers for Public Health Crafting Richer Public Health Messages-Gaining Broad Policy Support in Politically Polarized Times . Journal of Public Health Management and Practice. 25(2); 197-200, 2019. Messaging Sexual Violence Prevention
Interviews
Public Health Messaging in a Politicized Pandemic
Introducing Management Moments with Public Heath Leaders: An Interview with Gene Matthews, JD, hosted by Edward Baker, MSc, MD, MPH on JPHMP Direct. Aired October 24, 2018.
Rooted in Faith & Community: Messaging for Leaders to Advance Health Equity
New voices: Millennials and the future of public health: An Interview with Lizzie Corcoran and Brian Castrucci, hosted by Mark Miller. Public Health News Wire, October 9, 2018.

Workshops
New Voices in the Public Health Workforce: A Dialogue with Millennials
For the fourth year in a row, our team was invited by APHA Government Relations staff to conduct a workshop and discussion as part of the pre-meeting Advocacy for Leaders workshop. Presenters engaged the audience with self-reflection questions before sharing an overview of Moral Foundations Theory and discussing strategies for improving messages and becoming more trusted messengers. New this year, we explained the Public Health Advantage and its implications for public health communication, and we spoke directly to millennials and their managers about millennials' unique challenges and opportunities as messengers. Learn more.
The Public Health Advantage: Crafting Richer Messages & Becoming Better Messengers
Hosted by leaders at the North Carolina Institute for Public Health (NCIPH) at the UNC Gillings School of Global Public Health in April 2018, this workshop sought to transform this challenge into an opportunity to improve community health and explore deeper methods for communicating our public health messages. The workshop intentionally brought together an audience that was diverse politically, geographically, generationally and racially. Also included were public health and organizational leaders at the local, state and national levels, leadership development experts from the private sector and elected officials. Learn more.

Webinars
Crafting Richer Messages: Moral Foundations Theory and Communication Strategies for Public Health
Designed for public health practitioners, lawyers, researchers and scientists, government and healthcare officials, and business and community leaders, this three-part Network webinar series explores the interdisciplinary messaging teamwork necessary to fashion legal and policy interventions in these politically polarized times. Using concepts and frameworks adapted from both Moral Foundations Theory and the Five Essential Public Health Law Services, the presenters describe fresh approaches and practical examples for convincing lawmakers and the public to adopt new policies during these challenging times.

The Association of State and Territorial Health Officials (ASTHO) webinar, "Messaging Sexual Violence Prevention," discusses framing and messaging techniques to educate policy makers on sexual violence prevention. The Network of Public Health Law and colleagues discussed the framework of Moral Foundations Theory, messaging lessons learned from millennials about social media usage (including the #MeToo movement), and communicating with policy-makers to advance sexual violence prevention efforts.
Baker EL. JPHMP Direct: Leadership Library. Journal of Public Health Management and Practice.
Communicating about COVID-19 Response Measures in a Volatile Environment
Effective messaging is essential in order to make the legal, policy, or fiscal changes demanded by this pandemic. COVID-19 is top of mind for citizens, public health, health care and local policy makers alike, but people with different political perspectives view COVID differently. In this challenging time, it's crucial that public health professionals be able to speak productively and meaningfully with people who hold different political perspectives and view complex health issues differently. This session will present research that shows the relationship between our political views and the foundational moral values with which we resonate. Though all of us confront numerous divides ranging from generational to political, the public health workforce can bridge these differences to become trusted messengers and further the health of their communities during this pandemic. This session is designed to benefit both frontline public health workers and organizational managers engaging in law, policy and/or fiscal change.

COVID-19 continues to impact our communities. Public health, community, and faith leaders need to effectively communicate with each other, elected officials and the public, from both sides of the political divide, to advance a unified response. As the nation waits the arrival and distribution of a COVID-19 vaccine, we need to leverage this special moment in time to lead work upstream and address inequities and use our voices to promote vaccine uptake and access in our communities. This training will examine the relationship between our political views and the foundational moral values with which we resonate. We can become better advocates by understanding which foundational moral values resonate with us and why it is important to recognize, appreciate, and learn to speak to other people's values.
Niemi L, Young L. Wolsko C, Arceaga H, Seiden J. Red, white, and blue enough to be green: Effects of moral framing on climate change attitudes and conservation behaviors. Journal of Experimental Social Psychology. 65(1): 7-19, 2016. When and Why We See Victims as Responsible: The Impact of Ideology on Attitudes Toward Victims. Personality and Social Psychology Bulleting. 42(9): 1227-1242, 2016.
Presentations

This session at the 2018 APHA Annual Meeting is inspired by conversations about Millennials that don't always include Millennials in the context of public health workforce and the future of public health. There is currently a growing gap in the public health workforce, as previous generations workers leave and retire, while disproportionately fewer new workers and graduates enter the public health workforce. The gap in the workforce comes at a time with concurrent trends in public health education, public health discourse, a national workforce training needs agenda, and public health challenges such as chronic disease, violence, and opioids. We need a nuanced and refreshed perspective on the younger generations to fully engage them in the workforce and successfully pass on generational knowledge and experience. Ultimately, we will hear directly from Millennials in public health on strategies to effectively engage and capitalize on the contributions of Millennials, closing the workforce gap and advancing the field of public health.

The well-established model of the Five Essential Public Health Law Services cannot function without the use of effective messaging to support modifying existing laws, regulations, policies or appropriations. Building upon the framework of Moral Foundations Theory, this session from the 2018 Public Health Law Conference explores how everyone in public health can craft better messages and come better messengers. Attendees learn about ways in which liberals and conservatives resonate differently to fundamental intuitive moral values, and how public health actually has an advantage in their turbulent political environment. In particular, how can we engage and learn from Millennials now entering out public health workforce about messaging in the age of social media.

Network Blog Posts

Effective messaging of public health issues and solutions is essential to public health practice and especially to developing public health laws and policies in a polarized political environment. A number of strategies presented in the workshop were grounded in Moral Foundations Theory, which offers insights into moral psychology and decision-making that are helpful for understanding how value judgments are made.

Additional Resources

Woodruff AE. Are Public Health Schools Politically Diverse? Public Health Post. January 24, 2019.

Amin AB et al. Association of moral values with vaccine hesitancy. Nature of Human Behaviour. 1: 873-880, 2017.

YourMorals.org Collaboration. Moral Foundations Theory. January 30, 2016.

Haidt J. The Righteous Mind: Why Good People Are Divided By Politics and Religion. New York, NY: Pantheon Books, 2012.

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Becoming Better Messengers - Network for Public Health Law

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Effective messaging of public health challenges and interventions is essential to public health practice and especially to implementing public health laws and policies in a polarized political environment. It is easy for public health leaders to become consumed with the ongoing political and resource shifts taking place in public health and health care.

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Health dept has lots of pediatricians in leadership; build off of Building Strong Brains

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How to make the message to get it through the entire state system; beyond the legislators?

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How to engage the stakeholders who are oppositional to BSB?

Two  less developed areas: 1) Faith based leaders; 2) business - engaging chambers of commerce in BSB private sector committee (would like to increase more business presence)

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Very robust engagement from stakeholders, policymakers, community grassroot organizations, etc.

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Precipice of foundations piece and implementation; over the last 5 years policy has emerged from building strong brains (big P and med P policy) to be inclusive of TI response, resiliency, and ACEs.

Foundation 1) leg did not take a chunk of ACEs funding this year when they expected it to be taken; 2) BSB work has led to positive early childhood leg; expanded TANF $ to home visiting; increased public will for safe baby courts 0-3; and other TI leg; have started making changes at every level of policy;

challenges: no one will be surprised that the bill farms that are talking to leg that many of the early childhood leg is against their interest (e.g., increase attack on social emotional devl/kicking kids out of school); the ideology is stronger than the logic (can talk all day long about the $)

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Foundational work has been done. Drafting proposals to the health department to spend that money. Currently, we have a lot of pediatricians and Commissioner understands the importance of ACEs but the foundation laid by brain development initiative was critical.

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look at where people are at with ACEs so we can see the similarities to craft things into a policy that is supported by child serving agencies

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Hope: BSB does not just target leg makers; goal: empower public for lasting culture change and lead to long term change