Be Careful Out There


Whether is was the adage attributed to the days of Julius Caesar of “beware of the Ides of March” or the instruction provided daily by the desk sergeant  to the “beat cops” from “Hill Street Blues” of “Be Careful Out There” we are living in times that demand such attention.  Having said that we are finding ways to continue our work and using flexibility to reschedule events as appropriate.

I always want to start by blogs with the seemingly trite statement of “thank you”, but it says what is necessary, and in today’s environment even more so.  I know that Michigan ACE staff Jennifer Nottingham (MPHI) and Lisa Farnum will be having subsequent messages about specific steps and actions that require your attention—so my message today will be catch up from my last blog and forecast for near future.  First the catch up.

1. Legislative & Policy. We had previously informed you that key lawmakers had introduced separate House and Senate Concurrent Resolutions to designate ACEs as a critical health care issue and to bring the resources and policy of the legislature and administration together to reduce its impact.  Both House Concurrent Resolution 2 (Introduced by Rep. Hank Vaupel, Fowlerville) and Senate Concurrent Resolution 8, (Introduced by Sen. Curt Vanderwall, Ludington) have been enacted and are in process of being forwarded to the Governor’s office.

 We had the opportunity to testify in five different committee hearings in the Michigan House and Senate in support of these resolutions.  Many lawmakers are aware of the impact of ACEs; this awareness is also due to local grassroots efforts that many of you are may be involved with. As a result, we do have many more informed lawmakers, several of whom in the House Representatives that are interested in pursuing a legislative package on ACEs and have asked for our input developing the draft language.

We also need to recognize that the House held a joint hearing on the relationship between ACEs and Human Trafficking in January that exposed lawmakers to ACEs (Thanks to Rep. Vaupel and Whiteford for organizing that hearing), and many may have seen the podcasts by Rep. Whiteford on ACEs in the past month—she has been a very good champion for us.

We will also be updating the overall policy recommendations that were developed last calendar year which would still suggest support for the Children’s Trust Fund, 2-1-1, and for increased provider rates for ACE screening within EPSDT.

My last blog had indicated that Michigan State University would be holding an “invite only” briefing exclusively on ACEs for a select number of members of the House and Senate Policy and Appropriations Committees.  This took place in late January and representatives of the Michigan ACE Initiative were asked to provide the briefing.  Thanks to Michigan ACE Master Trainers:  Dr. Furhut Jannsen, Joe Thomas, J. Munley, and Nicki Britten for agreeing to be part of the presentation as it added to the growing wealth of knowledge on this issue for lawmakers.

We know that locally, Master Trainers often do presentations or hold individual meetings with local lawmakers or staff.  When this happens, it is very helpful to provide a reference to being part of the Michigan ACE Initiative.  This helps lawmakers connect your message with the message we provide in Lansing.

2. Michigan ACE Initiative Annual Conference.  As you know, we had planned for a “2020 Michigan ACE Conference” to take place in May and therefore, earlier this year you received a “save the date” mailing for this event to be held on May 27th.  You should have received notice that this is being postponed and will be rescheduled for Fall 2020.  In addition to responding to the State of Michigan’s request to postpone large gatherings, this reschedule date will allow us to more explicitly design the conference program to meet the needs of our Michigan ACE Initiative network as work on a Master Trainer survey is nearly completed.

We will be looking at keynote speakers that not only can bridge the subject of ACEs and Social Determinants but also begin a conversation on Equity—a major issue that surfaced at last year’s conference and which has growth in its importance related to our work.

3. New Michigan ACE Initiative Master Training Cohort.

As you also may know we had tentatively planned on providing another Cohort of Master Trainers in Detroit during the last week of May and have been working to secure financial support for another cohort of Master Trainers in Grand Rapids area later in this year.  We are rescheduling the Detroit Master Training to Fall 2020, dependent on availability of ACE Interface (Dr. Rob Anda and Laura Porter). We will continue to work toward additional training in Grand Rapids.  These two cohorts of Master Trainers will address one of the strategic objectives that the Michigan ACE Initiative Steering Committee identified as priority for action during this year.

4. Next Steps for Michigan ACE Initiative.  We hear loud and clear from our Master Trainers & Community Champions that the major need following awareness about the impact of ACEs, communities need help navigating “what’s next.”   Working with Michigan Public Health Institute, we are moving into the developmental phase of the creation of modules that will identify best practices to support trauma informed organizations and communities to build resilience.  These modules will be informed in part by the results of a recent survey that the majority of Master Trainers have completed and returned.  The development of these modules is the focus of funding proposals being currently sought by the Michigan ACE Initiative.

 5. Caveats on ACEs History tool  I wanted to end this blog with a similar reminder that I included in my last blog and that is on ACE screening.  I think we all want to retain fidelity to the original ACEs study and results and do not want to inadvertently cause confusion and inappropriate use an ACE score.

We know ACEs screening as we are using it, is a population-based approach and is at the heart of what is now the movement in social determinants of health.  As you will recall there was ample discussion in the Master Training regarding the use of this 10-point questionnaire.  As Dr. Anda had explained, it provides “self-awareness”, an important element in any intervention—its major use is for history for adults and for population-based analysis.  It is  not intended for individual clinical use as  a “diagnostic tool”.  This is why we are having significant work underway by the Pediatric community and others regarding not only the preferred screening tool, but also protocol for its use.

We also know that there is much attention now given to the clinical use of ACEs screening.  Much of this is coming from California and the advocacy of the Center for Youth Wellness and Dr. Nadine Burke Harris (Now California’s Surgeon General).  The CYW effort is aimed at clinical providers; their work was shared with the work being conducted in Michigan by the Michigan Chapter of the American College of Pediatrics (Dr. Teresa Holtrip, a Michigan ACE physician and Master Trainer working in Detroit and her study group).  We attended a meeting convened by the Kresge Foundation to learn more about the Center for Youth Wellness efforts and potential work in Michigan.  The coming months will bring more clarity on this aspect of clinical work and ACEs and we will take our lead by those closest to the patient.

Meanwhile, our work will remain in furthering awareness, creating supportive coalitions, and appropriate interventions to counter the effects of trauma and toxic stress.  That is a big enough agenda with the current challenge of distant learning and interaction.

My final thoughts are for all of our Michigan ACE Network to be safe in the coming weeks and months.   We will rely more on email, Facebook, the Michigan ACE website, and distant learning mediums to sustain our efforts.

Rick Murdock

Michigan ACE Initiative Coordinator