Addressing Systemic Inequities: An Evaluation of the Resilience Catalysts in Public Health Program.

CONTEXT: Resilience Catalysts (RC) in Public Health provides local health departments (LHDs) with a process and technical assistance (TA) to operationalize the Community Health Strategist (CHS) role, foster equity, and support community resilience through policy, practice, and program change across multiple sectors. OBJECTIVES: This evaluation sought to (1) identify essential elements of the RC process and TA that help LHDs address the systemic drivers of adversity and inequity, and (2) expand understanding of RC's preliminary impact and inform implications for theory, practice, and funding in the post-COVID context. DESIGN: The mixed-methods evaluation incorporated online surveys and semi-structured interviews. Key themes and takeaways were identified using framework analysis, constant comparison analysis, and descriptive statistics. SETTING: The evaluation was conducted in 12 cities and counties across the United States, including California, Colorado, Florida, Iowa, Kentucky, Maryland, Massachusetts, New Jersey, North Carolina, Ohio, Tennessee, and Washington. PARTICIPANTS: Survey participants consisted of 29 representatives of 11 RC sites. Interview participants included 33 individuals: 19 representatives of 9 RC sites and 14 individuals representing RC TA providers and funders. MAIN OUTCOME MEASURES: The evaluation measured outcomes related to collaborative engagement, addressing inequity, systems change, knowledge change, ability to work within a local political and community context, sustainability, and scalability. RESULTS: Evaluation results demonstrate outcomes related to community engagement, expansion of system-level thinking, advancing health and racial equity, clarity and understanding of RC process, building LHD and partners' capacity and skills needed to embody the CHS role. CONCLUSIONS: The RC process prepared LHDs to operationalize the CHS role by providing the knowledge, skills, and capacities needed to understand root causes of adversity and inequity, address structural racism as a public health issue, and develop collaborative plans for addressing root causes.

Community Resilience: A Dynamic Model for Public Health 3.0.

OBJECTIVE: To establish a model for Public Health 3.0 in order to define and measure community resilience (CR) as a method to measure equity, address structural racism, and improve population health. DESIGN: To develop the CR model, we conducted a literature review in medicine, psychology, early childhood development, neurobiology, and disaster preparedness and response and applied system dynamics modeling to analyze the complex interactions between public systems, policies, and community. MAIN OUTCOME MEASURES: The CR model focuses on community and population health outcomes associated with the policies and practices of the housing, public education, law enforcement, and criminal justice sectors as CR measures. The model demonstrates how behaviors of these systems interact and produce outcome measures such as employment, homelessness, educational attainment, incarceration, and mental and physical health. RESULTS: The policies and practices within housing, public schools, law enforcement, and criminal justice can suppress resilience for families and communities because they are shaped by structural racism and influence the character and nature of resources that promote optimal community health and well-being. CONCLUSIONS: Community resilience is relational and place-based and varies depending on the demographic makeup of residents, historical patterns of place-based racism and discrimination, jurisdictional policy, and investment priorities-all influenced by structural racism. IMPLICATIONS FOR POLICY AND PRACTICE: Using system dynamics modeling and the CR approach, chief health strategists can convene partners from multiple sectors to systematically identify, measure, and address inequities produced by structural racism that result in and contribute to adverse childhood and community experiences.

Interactive Case-Based Childhood Adversity and Trauma-Informed Care Electronic Modules for Pediatric Primary Care.

Introduction: Training health professionals for the skills and capacity to respond adequately to children and adults who have been exposed to adverse childhood experiences is recognized as an essential need in health care. Accessible opportunities to educate physicians and physician-trainees are limited. Methods: Four computer-based e-modules were created focusing on addressing childhood adversity and implementing trauma-informed care in the pediatric primary care setting. These childhood adversity and trauma-informed care (CA-TIC) e-modules were designed as an individualized, self-directed experience to allow for distance learning with flexibility to be embedded into existing coursework. To foster an engaging learning environment, we narrated the modules, prioritized images, and included the opportunity for participant interaction via multiple-choice and short-answer questions. Twenty-eight pediatric residents, two medical students, four attending physicians, and one fellow at Children's National Hospital completed the e-modules. Results: Overall, participants rated the CA-TIC e-modules 4.6 (SD = 0.5) out of 5 for design and quality. Using paired t tests and Wilcoxon signed rank tests, we found statistically significant score increases from presession to postsession for participants' knowledge, attitudes, practice, and confidence related to CA-TIC. The most commonly cited learning points and practice changes included asking about trauma in practice and the seven C's of resilience. Discussion: A trauma-informed, strengths-based approach to care can assist health care providers in mitigating the link between adversity and related poor health outcomes. The CA-TIC e-modules provide an opportunity to train health professionals using an innovative, self-directed, and low-resource mechanism.

Becoming Trauma Informed: Validating a Tool to Assess Health Professional's Knowledge, Attitude, and Practice.

To effectively address the negative health effects of early childhood trauma and adversity, healthcare professionals and healthcare institutions must understand the impact of adverse childhood experiences and trauma on health. This study aimed to validate a tool to assess knowledge, attitude, and practice of trauma-informed care among interdisciplinary pediatric healthcare staff. METHODS: A 36-item survey tool, "Knowledge, Attitudes, and Practices of Trauma-Informed Practice," was adopted and modified with permission from the author. We administered the survey electronically to 2,659 staff at a pediatric healthcare institution. To assess the tool's reliability and validity, internal consistency reliability testing, content validity, and construct validity assessments were conducted. RESULTS: A total of 592 surveys were collected, representing a 22.3% response rate. Confirmatory factor analysis revealed that 21 items provided the strongest internal consistency reliability for the overall tool and each factor. The overall Cronbach's alpha for the 21-item tool was 0.86, with 0.84 for the knowledge factor, 0.74 for the attitude factor, and 0.78 for the practice factor. The goodness of fit based on this analysis was good to adequate, with a 0.077 root mean square error of approximation. CONCLUSIONS: Healthcare professionals and organizations are in a unique position to improve the health and well-being of their patients by implementing a trauma-informed approach to minimize the impact of adverse childhood experiences and trauma. This validated tool will allow organizations to identify gaps in knowledge, attitude, and practice among staff to subsequently begin developing pointed strategies to achieve a culture of trauma-informed practice.