Prioritizing Possibilities for Child and Family Health: An Agenda to Address Adverse Childhood Experiences and Foster the Social and Emotional Roots of Well-being in Pediatrics
Prioritizing Possibilities for Child and Family Health: An Agenda to Address Adverse Childhood Experiences and Foster the Social and Emotional Roots of Well-being in Pediatrics
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DOI：
10.1016/j.acap.2017.06.002
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发表时间：
2017-09-01
影响因子：
3.1
通讯作者：
Simpson, Lisa A.
中科院分区：
文献类型：
--
作者：
Bethell, Christina D.;Solloway, Michele R.;Simpson, Lisa A.
目的：许多科学学科的理论和经验证据汇聚在一起，揭示了通过解决不利的童年经历(ACE)、促进复原力、促进养成以及儿童健康发展和终身健康的社会和情感根源，促进儿童和家庭福祉亟需改善的前所未有的可能性。在这篇文章中，我们综合了来自系统的、多年的现场建设和研究、政策和实践议程设置过程的建议，以解决儿童健康服务中的这些问题。方法：从2013年春季到2017年冬季，现场建设和议程设置过程直接涉及500多个人，包括79项不同的议程设置和现场建设活动和过程，包括：4次面对面会议；4轮在线众包，涉及10个利益相关者群体；文学和环境扫描，记录美国儿童中的高手、复原力和保护因素的出版物，以及委托制作本期学术儿科特刊；8个面对面倾听论坛和31个与利益攸关方的教育会议；以及与新出现的社区努力一起开展的一系列行动研究工作。采用改进的德尔菲过程和扎根的理论方法，并对输入进行迭代和结构化的综合，以识别主题、优先事项和建议。结果：参与者认识到足够的科学发现支持形成实用的儿童健康服务研究和政策议程。议程出现了四个压倒一切的优先事项：1)将王牌、复原力和培育关系的科学转化为儿童卫生服务；2)培养跨部门合作的条件，以激励行动和解决结构性不平等；3)恢复和奖励促进安全和养育关系以及个人、家庭和社区的充分参与，以治愈创伤、促进复原力和预防王牌；以及4)推动“启动和学习”研究、创新和实施努力。四个研究领域成为在短期内推进这些优先事项的核心。这些涉及：1)以家庭为中心的临床方案，2)评估对结果和成本的影响，3)能力建设和责任，以及4)提供者自我护理对护理质量的作用。最后，我们确定了16项短期行动，以利用现有的政策、做法和结构来推进议程优先事项和研究优先事项。结论：需要努力解决ACE对儿童健康的高流行率和负面影响，包括广泛和具体的理解和战略，以促进意识、韧性以及安全、稳定和培育关系，作为儿童健康发展和终身可持续福祉的基础。需要在个人、组织和集体的心态、政策和实践中进行范式转换的演变。转变将强调人际关系的中心以及情绪和压力对大脑发育和整体健康的调节。他们将提升以关系为中心的方法，让个人、家庭和社区参与到与A级、压力、创伤相关的自我护理中，并建立科学表明是幸福根源的韧性和培育关系。研究结果反映了预防、缓解和治愈与ACE相关的个人、代际和社区创伤的明显希望，并提供了做到这一点的路线图。
OBJECTIVE: A convergence of theoretical and empirical evidence across many scientific disciplines reveals unprecedented possibilities to advance much needed improvements in child and family well-being by addressing adverse childhood experiences (ACEs), promoting resilience, and fostering nurturance and the social and emotional roots of healthy child development and lifelong health. In this article we synthesize recommendations from a structured, multiyear field-building and research, policy, and practice agenda setting process to address these issues in children's health services.METHODS: Between Spring of 2013 and Winter of 2017, the field-building and agenda-setting process directly engaged more than 500 individuals and comprised 79 distinct agenda setting and field-building activities and processes, including: 4 in-person meetings; 4 online crowdsourcing rounds across 10 stakeholder groups; literature and environmental scans, publications documenting ACEs, resilience, and protective factors among US children, and commissioning of this special issue of Academic Pediatrics; 8 in-person listening forums and 31 educational sessions with stakeholders; and a range of action research efforts with emerging community efforts. Modified Delphi processes and grounded theory methods were used and iterative and structured synthesis of input was conducted to discern themes, priorities, and recommendations.RESULTS: Participants discerned that sufficient scientific findings support the formation of an applied child health services research and policy agenda. Four overarching priorities for the agenda emerged: 1) translate the science of ACEs, resilience, and nurturing relationships into children's health services; 2) cultivate the conditions for cross-sector collaboration to incentivize action and address structural inequalities; 3) restore and reward for promoting safe and nurturing relationships and full engagement of individuals, families, and commu'lilies to heal trauma, promote resilience, and prevent ACEs; and 4) fuel "launch and learn" research, innovation, and implementation efforts. Four research areas arose as central to advancing these priorities in the short term. These are related to: 1) family centered clinical protocols, 2) assessing effects on outcomes and costs, 3) capacity-building and accountability, and 4) role of provider self-care to quality of care. Finally, we identified 16 short-term actions to leverage existing policies, practices, and structures to advance agenda priorities and research priorities.CONCLUSIONS: Efforts to address the high prevalence and negative effects of ACEs on child health are needed, including widespread and concrete understanding and strategies to promote awareness, resilience, and safe, stable, nurturing relationships as foundational to healthy child development and sustainable well-being throughout life. A paradigm-shifting evolution in individual, organizational, and collective mindsets, policies, and practices is required. Shifts will emphasize the centrality of relationships and regulation of emotion and stress to brain development as well as overall health. They will elevate relationship-centered methods to engage individuals, families, and communities in self-care related to ACEs, stress, trauma, and building the resilience and nurturing relationships science has revealed to be at the root of well-being. Findings reflect a palpable hope for prevention, mitigation, and healing of individual, intergenerational, and community trauma associated with ACEs and provide a road map for doing so.