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 Kidsdata.org. 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 Kidsdata.org 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 Kidsdata.org 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 Kidsdata.org 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 Kidsdata.org 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.