American Academy of Pediatrics
American Academy of Pediatrics
Tuesday, June 17, 2014
Acting Assistant Secretary Mark Greenberg
Thanks, I appreciate having the opportunity to join in this afternoon. At the Administration for Children and Families, our focus is on improving the well-being of the most vulnerable children and families in the United States. We have responsibility for a wide range of programs and initiatives, including but not limited to Head Start, child care, child welfare, TANF, trafficking, refugee assistance, domestic violence, marriage and fatherhood, runaway and homeless youth, and more.
So we’re very glad to engage in these conversations on preventing toxic stress and promoting resilience — this work has a direct impact on the children and families that we serve. At ACF, we are working on building the research agenda, engaging in internal education of our staff, identifying opportunities across ACF programs, and strengthening our external communication around this work. I want to focus today on what we are doing at ACF and why we think this work is so important.
We know that early life experiences influence health and well-being across the lifespan. We’re very mindful of the research on adverse childhood experiences, trauma, and toxic stress over the past decade showing the damaging effects early adversity can have on lifetime health and well-being. This research underscores the importance of reducing both catastrophic and routine stressors on the children and families we serve, and also of helping children and families cope with these experiences.
We recognize the crucial need for public policies that can reduce the stressors routinely faced by poor and at-risk children and those growing up in communities of concentrated poverty. And, at the same time, we also know that parents and caregivers play a vital role in the impact that stress has on children. Research findings highlight the need for improved parent training programs, parent engagement in interventions, interventions that are designed to fit their needs and culture, and high-quality training of staff carrying out interventions.
New research is also emphasizing that the effect of early adversity on children’s outcomes may differ depending on multiple factors including individual differences in vulnerability, types of stressors, and developmental timing. For children exposed to early adversity, research can help us to understand the pathways that may increase or moderate risk for developing negative outcomes. This base of knowledge that we have, and that you have spent time discussing here at this meeting, underscores the importance of the need to continue building the knowledge base while we are acting on what we do know.
At ACF, we are conducting research on early adversity to help inform our work. The Buffering Toxic Stress Consortium is a set of six cooperative agreements that are evaluating promising parenting interventions in Early Head Start settings. These grants are identifying children and families most vulnerable to stress, supplementing Early Head Start services with parenting interventions aimed at diminishing the effects of chronic stress on children’s development, and advancing applied developmental science, and testing the impacts of these efforts.
Another set of projects is our Head Start University Partnerships focusing on Dual-Generation Approaches. These projects will implement and evaluate promising dual-generation approaches that combine intensive, high quality, child focused programs with intensive, high quality, adult focused services to support both parent well-being and children’s school readiness within the context of Head Start. Results of these studies are expected to provide valuable information that can guide programs in their decisions regarding strategies for improving parent well-being in ways that will ultimately result in positive child outcomes.
We also have a forthcoming integrated series of reports on the Impact of Toxic Stress on Self-Regulation and Implications for ACF Programs. For the purpose of these reports, self-regulation includes regulation of emotion and executive cognitive functioning, which encompass abilities like impulse control, working memory, mental flexibility, and attention. We understand that self-regulation may be a key mechanism linking early adversity, poor educational outcomes for children, and poor employment outcomes in adulthood. These reports will emphasize the importance of self-regulation to health, school success, and economic security from early childhood to young adulthood, describe how early adversity impacts the development of self-regulation across developmental periods, provide a systematic literature review of self-regulation interventions for various age groups, and consider the value and feasibility of implementing encouraging self-regulation interventions within existing ACF program infrastructure.
ACF has also been working to address early adversity and toxic stress in the programs we administer.
The Head Start Program has taken many steps to educate grantees and the pregnant women and families they serve on the role of adverse childhood experiences and toxic stress. We have hosted webinars and created materials to educate programs about the impact of trauma and toxic stress on early brain development. We have also developed and implemented a training on trauma, toxic stress and resiliency, which we have provided at conferences throughout the country and made available on our Early Childhood Learning and Knowledge Center. AAP has collaborated with Head Start on this topic as well, including developing a video on toxic stress with the Head Start National Center on Health that we are providing as part of our trainings and hosting the Toxic Stress Workshop at the recent National Indian Head Start Directors Association meeting. We have really valued our partnership with AAP on this important issue. By providing Head Start and Early Head Start programs and the families they serve with the services and resources they need, we hope to reduce the likelihood that their children will experience toxic stress.
Child Welfare is another ACF program that has worked on addressing adversity. The Children’s Bureau has established a priority to promote social and emotional well-being for children and youth receiving child welfare services. Children in the child welfare system have often been exposed to multiple traumatic or adverse events — abuse and neglect, experience with violence, or exposure to drug and alcohol addiction. This trauma and related toxic stress can contribute to instability, and lead to a greater risk for mental and behavioral health problems. In turn, if the necessary services and supports are not provided, these children are at greater risk for experiencing poor placement and permanency outcomes and decreased overall well-being.
ACF is engaged on a number of levels to ensure that children who are victims of maltreatment and children who are in foster care receive the resources and supports they need. We have funded three cohorts of trauma-focused demonstration grants. These grants focus on three areas: integrating trauma-informed and trauma-focused practice in child protective service delivery; improving access to needs-driven, evidence-based and evidence-informed mental and behavioral health services in child welfare and; promoting well-being and adoption after trauma
We are also currently funding 10 infrastructure-building grants for Child Welfare-Early Education Partnerships to Promote Protective Factors for Children with Child Welfare Involvement. These are collaborative initiatives between child welfare and early childhood to maximize enrollment of children ages 0-5 into comprehensive and high-quality early care and education programs.
Additionally, ACF has been involved in ongoing collaborations with CMS and SAMSHA to support States in developing sustainable funding strategies to ensure access to the right services to children who have experienced trauma. In July of 2013, we issued a tri-agency letter to State Directors to encourage the integrated use of trauma-focused screening, functional assessments, and evidence-based practices for the purpose of improving child well-being.
We have also been actively engaged in work to decrease psychotropic medication use among this population. Mental and behavioral needs for children in the child welfare system are often a result of trauma and exposure to toxic stress. The President’s 2015 budget includes a five-year collaborative demonstration involving ACF and CMS that is designed to encourage states to build capacity in evidence-based psychosocial interventions and reduce the inappropriate use and over-prescription of psychotropic medications.
Another ACF program that is taking steps to address adversity and stress is the Family Violence Prevention and Services Program, the primary funder for the National Center on Domestic Violence, Trauma & Mental Health. The center offers resources, training, and technical assistance related to the intersection of trauma, domestic violence, mental health, and substance abuse and focuses on building the capacity of domestic violence programs to become trauma-informed organizations and offer trauma-focused services for domestic violence survivors and their children. Every year, nearly 300,000 children are served in domestic violence shelters across this country. Through parent-child trauma interventions, domestic violence programs can reinforce a child’s natural resilience and build on the most critical protective factor in their lives, the presence of a supportive and nurturing parent.
For runaway, homeless and street youth served by ACF’s Basic Center, Street Outreach and Transitional Living Programs, limited or non-existent positive adult relationships or permanent connections is a common thread. Youth served in these programs report significant histories of abuse, neglect, personal and familial mental health issues, personal and familial substance abuse issues, sexual exploitation and being forced from homes- in a word, trauma. Our Runaway and Homeless Youth Training and Technical Assistance Center has responded with significant emphasis on trauma informed care; building permanent connections and healthy relationships; and, responding to the emotional needs of youth. The center offers webinars, day trainings and three day intensive trainings on implementing a trauma informed culture within social service programs. More than 100 agencies have received intensive training, and additional training events are scheduled in the next 6 months. We are also working with the Runaway and Homeless Youth Training and Technical Assistance Center to create training on toxic stress and trauma informed care specifically designed for staff of our Maternity Group Home grantees. This training will include specific techniques to help young adolescent parents understand the impact of their parenting behaviors on their children, as well as the importance of not repeating the cycle of abuse and disconnection that many of these youth have suffered in their own lives.
We have also begun to apply what we know on issues of toxic stress and executive function to our work with TANF recipients and participants in our Healthy Marriage and Responsible Fatherhood programs. This effort includes coordinating a plenary and workshop for practitioners and frontline case workers focusing on toxic stress, cognitive health, and mental well-being at the next annual grantee meeting for the Healthy Marriage and Responsible Fatherhood program.
We also recently held a webinar for these grantees that addressed toxic stress in low-income families and its impact on long-term social and economic outcomes. And we are working with regional offices to plan a series of technical assistance activities targeted to TANF programs using evidence-based assessment and case management models to address those with cognitive challenges, toxic stress, and executive functioning barriers. This technical assistance will be coordinated with human services offices and TANF programs throughout the country and will be geared toward frontline case workers and assessment specialists. In July, we will host the third in a series of informational brown bags that will focus on toxic stress among men and boys of color and provide practitioners with practical strategies for addressing the needs of this underserved population.
In summary, ACF’s vision is one in which children, youth, families, individuals and communities are resilient, safe, healthy, and economically secure. In order to achieve this vision, we understand our programs must address toxic stress and early adversity in a meaningful way, and we strive to use our increasing knowledge about toxic stress and trauma as a key context in which we deliver services, training, and technical assistance to our grantees. Thank you for letting me speak with all of you today about such an important issue for our country.