Where do we start our conversations on ACE?
Authored By Rick Murdock, Michigan ACE Initiative Grant Coordinator
Which approach is best?
Bottoms up or Top Down? Where do we start a conversation on ACE? Can we do both? My last blog provided some information regarding the potential that can be gained by reducing adverse childhood experiences in Michigan. Watching as an observer in our first cohort of Master Training for ACE, I heard the lamenting of a failure to have our prime systems (education, health care, welfare, law enforcement) work cohesively to address ACE and the struggles that local representatives of these agencies faced with pulling together an integrative approach that was not in sync with the programmatic objectives coming from the state and federal government. Ultimately, interventions to address ACE will come from the community—but the supporting environment and resource assistance will be a critical role of state government—so my answer to the question is “we must do both.” Bottoms up with focus on interventions, and top down with focus on outcome and flexibility.
Kudos to those who made in work, but they recognized that those solutions only lasted if they could put energy into them. They also knew the problem was not any insensitivity of the need, but was the long standing categorical approach to our problems: it’s a public health problem—so fund it via public health, or it’s an education issue so fund it through education, etc. The pursuit and demand for accountability is in part the problem. Outcome or value of the investment of resources may also be an issue. That would suggest that we should develop a statutory framework for changing the culture and conversation on Adverse Childhood Experiences. But as I will note in the following comments, that job is already done—we just need to use the legislative process that is in place.
Public Health Code
The broader debate on ACE would be facilitated through the process in the public health code. It would simply take the willingness of the Michigan Department of Health and Human Services (MDHHS) to advance a proposal, within the framework of the public health code (MCL 333.2301). This framework requires input from broad participation of individuals and organizations to identify the priority health problems of this state based on data and statistics. There is ample reason to believe that the data identified in my previous blog does identify Adverse Childhood Experiences as “the priority health problem”—and it has been described as such by the U.S. Centers for Disease Control. MCL 333.2302 goes on to describe a process for the MDHHS to submit as part of budget request to the legislature. The process is then picked up in the Legislature each year. Legislature boilerplate describes each year what the “priority health problems” are and below is the list in the current Executive Budget with the suggested addition of ACE:
The department shall include, but not be limited to, the following in its annual list of proposed basic health services as required in part 23 of the public health code, 1978 PA 368, MCL 333.2301 to 333.2321:
(a) ADVERSE CHILDHOOD EXPERIENCE INTERVENTIONS AND TRAUMA INFORMED CARE (recommended addition to this list for FY 19)
(c) Communicable disease control.
(d) Sexually transmitted disease control.
(e) Tuberculosis control.
(f) Prevention of gonorrhea eye infection in newborns.
(g) Screening newborns for the conditions listed in section 5431 of the public health code, 1978 PA 368, MCL 333.5431, or recommended by the newborn screening quality assurance advisory committee created under section 5430 of the public health code, 1978 PA 368, MCL 333.5430.
(h) Health and human services annex of the Michigan emergency management plan.
(i) Prenatal care
Imagine, the power of adding that one phrase to this part of the appropriations process. This would elevate program development and support in the communities of Michigan, increase the awareness within the legislature (important in our term limited environment). Similar language could be incorporated in the education and corrections budgets.
Last year, a new State Medicaid policy was adopted, effective February of 2017, (Medicaid Bulletin Number: MSA 16-46), that enables the use of the ACE screening tool as part of EPSDT—a required benefit for children in the Medicaid program.
This was an objective of the Michigan ACE Initiative and our efforts are now dedicated to assist provider in awareness of this new policy.
In each of these efforts, additional resources are not the focus—rather, it is the elevation of awareness of Adverse Childhood Experience and its impact on the citizens of Michigan that is important as well as the need for a coordinated approach—and not a siloed, budget driven approach. Our advocacy and education efforts will focus on this aspect of public policy.
Stay tuned for more
My next blog will highlight the master training efforts by Michigan Ace Initiative, the number of showings of the documentary “Resilience” and related public discussion, and the increasing awareness due to our social media and communication efforts—with suggestions for how to participate.
The MAHP Foundation received funding from the Michigan Health Endowment Fund to support the Creating Healing Communities: A Statewide Initiative to Address Adverse Childhood Experiences (ACEs) in Michigan. Learn more here.