Cross-Cutting Health

Priority: Support professionals and families to implement best practices in addressing Adverse Child Experiences (ACE)

SPM. Number of programs trained in screening and care of families impacted by Adverse Child Experiences (ACE)

Objective 1. Increase the number of families screened for ACEs in supportive programs

     -Strategy: Partner with the Early Childhood Education and Care Department

ESM. Number of planning meetings coordinated between Title V and the Early Childhood Education and Care Department

Objective 2. Support families with access to nutritious food and lactation support

  -Strategy: Continue to expand and adapt WIC nutrition and breastfeeding         programs

ESM. Number of families added to the WIC caseload or peer counseling breastfeeding programs

Objective 1. Increase the number of families screened for ACEs in supportive programs; establish a baseline in NM by 2021

The need to coordinate care for NM families struggling with poverty, housing, violence and drug misuse is clear, and the negative impacts of ACE are well documented. However, the pathways to effective program coordination are less charted. The creation of the new Early Childhood Education and Care Department (ECECD) offers NMDOH/Title V and other partners new opportunities to execute collective impact in New Mexico. ACE intersects with many social determinants of health and with trauma. Not every child who has an adverse experience in their household or neighborhood has a traumatic childhood, and not all children with ACE have deleterious health outcomes or chronic disease in adulthood. That is why it is important to provide tools to assess the needs of families in different contexts.

There is a standard, short ACE tool, and it can be used in many clinical and childcare or parent support settings. It is one of many ways to address the need for a ‘score’. Some pediatric settings use the survey of wellbeing of young children (SWYC), and we have incorporated this tool as an indicator assessment in the NM toddler study, Helping Us Grown Strong survey (HUGS). This helps us form an expectation about the number and characteristics of families requiring support in the early childhood period, but it does not currently assess how many families receive screening or assessment for support.

Moving forward, we will establish a baseline among NMDOH and ECECD programs (case management, early intervention, Children’s medical Services, Families FIRST, Family Connects, Early Head Start, home visiting) and coordinate planning meetings across both departments.

 Analysis and policy briefs developed with the UNM Center for Development and Disability during the 2020 needs assessment https://www.cdd.unm.edu/pdfs/health-equity-cyshcn-policy-brief-10-23-19.pdf revealed the disproportionate burden of ACE among families with children and youth with special healthcare needs. These findings reinforce the importance of medical home and primary care, coordinated specialty care, as well as behavioral and developmental services. The linkage between the two departments is crucial to addressing this disparity and helping families identify supportive activities and resources.

Objective 2. Support families with access to nutritious food and lactation support

Supporting families in food access and infant feeding choices helps address ACE, and it acknowledges the reclamation of food sovereignty across New Mexico. Just one generation ago many people in urban and rural areas had a land base or access to farming, and in many places fresh food was available in abundance. Two generations ago housing and food were often paired with available childcare, healthy exercise and fewer working hours required to raise a family. Changes in land base, the economy and separation from extended family have introduced many challenges to food choices, and it has changed the nature of infant feeding options.

As a strength identified in the NM needs assessment, both state and Tribal WIC and breastfeeding programs are located in communities across the state, and place-based expertise offers breastfeeding peer counseling and access to certified lactation specialists at delivery and at home.

Telephonic and remote support have evolved quickly in the COVID-19 pandemic, giving way to innovative and creative partnerships to help families navigate complicated birthing and inter-conception healthcare. Title V staff partner with the NM Breastfeeding Taskforce to connect with COVID-positive women and children and offer resources in social, medical and housing. Bilingual counselors are available to make telephonic contact and referrals for breastfeeding concerns both during pregnancy and postpartum. Although peer counselors often do provide both in-person and telephonic support, they continue to support people remotely during the pandemic.

Title V has a long-standing relationship with state and Tribal WIC programs and with the NM Breastfeeding Taskforce, which will continue to thrive in a new environment. Efforts to promote and support breastfeeding have paid off visibly in increasing bf initiation and duration rates. And WIC is the perfect safety net for families not able to or not choosing to breastfeed. In a related objective to connect WIC and Medicaid expecting families to services prior to delivery (maternal health section), telephonic navigation will be the primary tool. Referring and connecting families to regional and local health/WIC offices is a direct and tangible method of bolstering food security and providing families with an array of important services.