Katherine Ortega Courtney

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Katherine Ortega Courtney is an American psychologist and author who co-developed the 100% Community model, a theoretical framework designed to guide the state and local work of preventing two interrelated public health and education challenges: adverse childhood experiences (ACEs) and adverse social determinants of health (SDH). As bureau chief of New Mexico's Child Protective Services Research, Assessment, and Data Bureau and developer of a data-scholars program for child welfare managers across the nation, she saw firsthand child welfare's lack of capacity to implement a data-driven strategy to prevent maltreatment by ensuring families had access to the vital services of medical care, mental health care, food security programs, and safe housing.

Contents

Background on ACEs

The 100% Community model calls for state and local strategies that go upstream to prevent ACEs and ACEs-related trauma before they occur. ACEs are ten forms of abuse and neglect that occur in the home, first identified in The ACEs Study in 1998 by Felitti, Anda and team. [1] ACEs can lead to trauma and substance use disorders linked with low school achievement, lack of job readiness, domestic violence, child welfare involvement, and other lifelong effects. [2] [3] [4] [5]

There are also economic costs that ACEs incur. [6] The ACEs Study called for reforms in public health and providing parents with family services shown to increase family functioning and prevent maltreatment. The study's recommendation did not lead to federal, state, or local policies that would ensure vital services to prevent ACEs. Instead, ACEs became viewed by healthcare providers and educators as a problem that could be addressed after ACEs and ACEs-related trauma occurred, through a practice called trauma-informed practice. The 100% Community model provides to local stakeholders, including elected officials, the strategies to ensure all families have access to the services shown to prevent ACEs and treat ACEs-related trauma, including healthcare.

Background on social determinants of health

The article "A Critical Assessment of the Adverse Childhood Experiences Study at 20 Years" called for promoting an ACEs prevention strategy that was guided by an understanding of the social determinants of health, [7] [8] [9] [10] which is the environment children grow up in and includes the services that determine one's health, safety, education and quality of life.

These services include medical care, mental healthcare, food security programs, affordable housing, transportation, parent supports, early childhood learning programs, fully-resourced community schools [11] [12] [13] [14] [15] with health centers, [16] [17] [18] youth mentor programs, and job training.

The research focused on building the positive social determinants of health identifies not only vital family services but state and local policies that determine environmental health, social justice, cultural and faith-based social supports, and education from pre-K through higher education that aligns with the job market. The social determinants of health is a concept that became popularized in public health circles in the 1970s yet a criticism is that public health leaders have not articulated a blueprint for transforming the adverse social determinants of health (lack of services and policies protecting resident's health) into the positive social determinants of health [19] There exists a problem in policy circles, as the advocates for the positive SDH may lack a cohesive definition of SDH and specific policies that policymakers can support on the federal, state, and local levels. [20] The goal of the 100% Community model is to provide goals and processes for improving vital services that represent the social determinants of health. The model articulates a public policy process that provides a roadmap for elected leaders to follow with policy implementation on every level of government.

Advocacy

Courtney is currently a co-director of the Anna, Age Eight Institute at New Mexico State University, the sponsor of the 100% New Mexico initiative. Her doctorate work at Texas Christian University was in experimental psychology focused on substance abuse treatment and prevention. She is also the co-author, with Dominic Cappello, of Anna, Age Eight: The data-driven prevention of childhood trauma and maltreatment.

Courtney's work focuses on the data-driven prevention of ACEs and SDH guide state and local leadership in their work transforming the adverse social determinants of health into positive ones, thus reducing rates of ACEs, ACEs-related trauma, low school achievement, substance use disorders, and other costly public health and education challenges.

Courtney's work in social change also calls for transparency in government to increase trust, responsiveness, and effectiveness with health and education policy that leads to measurable results. [21] [22] [23] [24] [25] [26]

Books

Related Research Articles

Violence is the use of physical force to cause harm to people, animals, or property, such as pain, injury, death, damage, or destruction. Some definitions are somewhat broader, such as the World Health Organization's definition of violence as "the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, which either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation."

<span class="mw-page-title-main">Physical abuse</span> Medical condition

Physical abuse is any intentional act causing injury, trauma, bodily harm or other physical suffering to another person or animal by way of bodily contact. Physical abuse is a type of abuse that involves physical violence, such as hitting, kicking, pushing, biting, choking, throwing objects, and using weapons. Physical abuse also includes using restraints or confinement, such as tying someone up, locking them in a room, or restraining them with drugs or alcohol. Physical abuse can also include withholding basic needs, such as food, clothing, or medical care. In addition to the physical injuries caused by physical abuse, it can also lead to psychological trauma, such as fear, anxiety, depression, and post-traumatic stress disorder. Physical abuse can occur in any relationship, including those between family members, partners, and caregivers. It can also occur in institutional settings, such as nursing homes, schools, and prisons. Physical abuse can have long-term physical, psychological, and social consequences, and can even be fatal.

<span class="mw-page-title-main">Mental health</span> Level of psychological well-being

Mental health encompasses emotional, psychological, and social well-being, influencing cognition, perception, and behavior. According to World Health Organization (WHO), it is a "state of well-being in which the individual realizes his or her abilities, can cope with the normal stresses of life, can work productively and fruitfully, and can contribute to his or her community". It likewise determines how an individual handles stress, interpersonal relationships, and decision-making. Mental health includes subjective well-being, perceived self-efficacy, autonomy, competence, intergenerational dependence, and self-actualization of one's intellectual and emotional potential, among others. From the perspectives of positive psychology or holism, mental health may include an individual's ability to enjoy life and to create a balance between life activities and efforts to achieve psychological resilience. Cultural differences, subjective assessments, and competing professional theories all affect how one defines "mental health". Some early signs related to mental health difficulties are sleep irritation, lack of energy, lack of appetite, thinking of harming oneself or others, self-isolating, and frequently zoning out.

<span class="mw-page-title-main">Preventive healthcare</span> Prevent and minimize the occurrence of diseases

Preventive healthcare, or prophylaxis, is the application of healthcare measures to prevent diseases. Disease and disability are affected by environmental factors, genetic predisposition, disease agents, and lifestyle choices, and are dynamic processes that begin before individuals realize they are affected. Disease prevention relies on anticipatory actions that can be categorized as primal, primary, secondary, and tertiary prevention.

A form of child abuse, child neglect is an act of caregivers that results in depriving a child of their basic needs, such as the failure to provide adequate supervision, health care, clothing, or housing, as well as other physical, emotional, social, educational, and safety needs. All societies have established that there are necessary behaviours a caregiver must provide for a child to develop physically, socially, and emotionally. Causes of neglect may result from several parenting problems including mental disorders, unplanned pregnancy, substance use disorder, unemployment, over employment, domestic violence, and, in special cases, poverty.

<span class="mw-page-title-main">Child abuse</span> Maltreatment or neglect of a child

Child abuse is physical, sexual, and/or psychological maltreatment or neglect of a child or children, especially by a parent or a caregiver. Child abuse may include any act or failure to act by a parent or a caregiver that results in actual or potential harm to a child and can occur in a child's home, or in the organizations, schools, or communities the child interacts with.

Child protection refers to the safeguarding of children from violence, exploitation, abuse, and neglect. It involves identifying signs of potential harm. This includes responding to allegations or suspicions of abuse, providing support and services to protect children, and holding those who have harmed them accountable.

The social determinants of health (SDOH) are the economic and social conditions that influence individual and group differences in health status. They are the health promoting factors found in one's living and working conditions, rather than individual risk factors that influence the risk for a disease, or vulnerability to disease or injury. The distributions of social determinants are often shaped by public policies that reflect prevailing political ideologies of the area.

Healthy People is a program of a nationwide health-promotion and disease-prevention goals set by the United States Department of Health and Human Services. The goals were first set in 1979 "in response to an emerging consensus among scientists and health authorities that national health priorities should emphasize disease prevention". The Healthy People program was originally issued by the Department of Health, Education and Welfare. This first issue contained "a report announcing goals for a ten-year plan to reduce controllable health risks. In its section on nutrition, the report recommended diets with fewer calories; less saturated fat, cholesterol, salt, and sugar; relatively more complex carbohydrates, fish and poultry; and less red meat." Though this recommended diet consisted of more processed foods rather than fresh produce, the report advised for consumers to "be wary of processed foods". The goals were subsequently updated for Healthy People 2000, Healthy People 2010, Healthy People 2020 and Healthy People 2030.

Dominic Cappello is a strategist, writer, designer, and educator. He is the creator of the Ten Talks book series published by Hyperion in 2000 and 2001. Ten Talks received national attention when Oprah Winfrey created a show around the book on sex and character in October 2000, featuring parents who had used the books' approaches to family communication.

Childhood trauma is often described as serious adverse childhood experiences (ACEs). Children may go through a range of experiences that classify as psychological trauma; these might include neglect, abandonment, sexual abuse, emotional abuse, and physical abuse, witnessing abuse of a sibling or parent, or having a mentally ill parent. These events have profound psychological, physiological, and sociological impacts and can have negative, lasting effects on health and well-being such as unsocial behaviors, attention deficit hyperactivity disorder (ADHD), and sleep disturbances. Similarly, children whose mothers have experienced traumatic or stressful events during pregnancy have an increased risk of mental health disorders and other neurodevelopmental disorders.

Child neglect, often overlooked, is the most common form of child maltreatment. Most perpetrators of child abuse and neglect are the parents themselves. A total of 79.4% of the perpetrators of abused and neglected children are the parents of the victims, and of those 79.4% parents, 61% exclusively neglect their children. The physical, emotional, and cognitive developmental impacts from early childhood neglect can be detrimental, as the effects from the neglect can carry on into adulthood.

<span class="mw-page-title-main">Transgenerational trauma</span> Psychological trauma

Transgenerational trauma is the psychological and physiological effects that the trauma experienced by people has on subsequent generations in that group. The primary modes of transmission are the uterine environment during pregnancy causing epigenetic changes in the developing embryo, and the shared family environment of the infant causing psychological, behavioral and social changes in the individual. The term intergenerational transmission refers to instances whereby the traumatic effects are passed down from the directly traumatized generation [F0] to their offspring [F1], and transgenerational transmission is when the offspring [F1] then pass the effects down to descendants who have not been exposed to the initial traumatic event - at least the grandchildren [F2] of the original sufferer for males, and their great-grandchildren [F3] for females.

<span class="mw-page-title-main">Nadine Burke Harris</span> Pediatrician and first Surgeon General of California

Nadine Burke Harris is a Canadian-American pediatrician who was the Surgeon General of California between 2019 and 2022; she is the first person appointed to that position. She is known for linking adverse childhood experiences and toxic stress with harmful effects to health later in life. Hailed as a pioneer in the treatment of toxic stress, she is an advisory council member for the Clinton Foundation's "Too Small to Fail" campaign, and the founder and former chief executive officer of the Center for Youth Wellness. Her work was also featured in Paul Tough's book How Children Succeed.

Adverse childhood experiences (ACEs) include childhood emotional, physical, or sexual abuse and household dysfunction during childhood. The categories are verbal abuse, physical abuse, contact sexual abuse, a battered mother, household substance abuse, household mental illness, incarcerated household members, and parental separation or divorce. The experiences chosen were based upon prior research that has shown to them to have significant negative health or social implications, and for which substantial efforts are being made in the public and private sector to reduce their frequency of occurrence. Scientific evidence is mounting that such adverse childhood experiences (ACEs) have a profound long-term effect on health. Research shows that exposure to abuse and to serious forms of family dysfunction in the childhood family environment are likely to activate the stress response, thus potentially disrupting the developing nervous, immune, and metabolic systems of children. ACEs are associated with lifelong physical and mental health problems that emerge in adolescence and persist into adulthood, including cardiovascular disease, chronic obstructive pulmonary disease, autoimmune diseases, substance abuse, and depression.

<span class="mw-page-title-main">Surgeon General of California</span> Public health official in California, US

The Surgeon General of California is the leading spokesperson on matters of public health within the State of California. The Surgeon General is one of only five State Surgeons General in the United States. The office was created on January 7, 2019, by Governor Gavin Newsom and requires confirmation from the California State Senate.

<span class="mw-page-title-main">Apryl A. Alexander</span> American professor in clinical and forensic psychology (born 1983)

Apryl A. Alexander is an American clinical and forensic psychologist who is an associate professor at the University of Denver. Alexander directs students at the Denver Forensic Institute for Research, Service and Training, and engages in clinical psychology practice. She is co-founder of the University of Denver's Prison Arts Initiative where incarcerated individuals engage in a therapeutic, educational arts curricula.

The influence of childhood trauma on the development of psychopathy in adulthood remains an active research question. According to Hervey M. Cleckley, a psychopathic person is someone who is able to imitate a normal functioning person, while masking or concealing their lack of internal personality structure. This results in an internal disorder with recurrent deliberate and detrimental conduct. Despite presenting themselves as serious, bright, and charming, psychopathic people are unable to experience true emotions. Robert Hare's two factor model and Christopher Patrick's triarchic model have both been developed to better understand psychopathology; however, whether the root cause is primarily environmental or primarily genetic is still in question.

Adverse childhood experiences (ACEs) are identified as serious and traumatizing experiences, such as abuse, neglect, exposure to violence, substance use, and other harmful events or situations that occur within a child's household or environment. Unfortunately, exposure to ACEs within the child's community is all too common in low-income households and neighborhoods, with close to 43% of children in the United States (U.S.) living in low-income families. ACEs were first identified by the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente's Adverse Childhood Experiences Study conducted from 1995 to 1997, where ACEs were examined and correlated with later-life well-being. With one in four children experiencing or witnessing a potentially traumatic event, children who grow up in an unsafe environment are at risk for developing adverse health outcomes, affecting brain development, immune systems, and regulatory systems.

Trauma-informed care (TIC) or Trauma-and violence-informed care (TVIC), is a framework for relating to and helping people who have experienced negative consequences after exposure to dangerous experiences. There is no one single TIC framework, or model, and some go by slightly different names, including Trauma- and violence-Informed Care (TVIC). They incorporate a number of perspectives, principles and skills. TIC frameworks can be applied in many contexts including medicine, mental health, law, education, architecture, addiction, gender, culture, and interpersonal relationships. They can be applied by individuals and organizations.

References

  1. ↑ Felitti, V. J.; Anda, R. F.; Nordenberg, D.; Williamson, D. F.; Spitz, A. M.; Edwards, V.; Koss, M. P.; Marks, J. S. (May 1998). "Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study". American Journal of Preventive Medicine. 14 (4): 245–258. doi: 10.1016/S0749-3797(98)00017-8 . ISSN   0749-3797. PMID   9635069.
  2. ↑ Wood, David L.; Pascoe, John; McGuinn, Laura; Garner, Andrew S.; Earls, Marian F.; Dobbins, Mary I.; Siegel, Benjamin S.; The Committee on Psychosocial Aspects of Child and Family Health, Committee on Early Childhood; Garner, Andrew S. (2012-01-01). "The Lifelong Effects of Early Childhood Adversity and Toxic Stress". Pediatrics. 129 (1): e232–e246. doi: 10.1542/peds.2011-2663 . ISSN   0031-4005. PMID   22201156.
  3. ↑ Grey, H.R.; Ford, K.; Bellis, M.A.; Lowey, H.; Wood, S. (April 2019). "Associations between childhood deaths and adverse childhood experiences: An audit of data from a child death overview panel". Child Abuse & Neglect. 90: 22–31. doi: 10.1016/j.chiabu.2019.01.020 . S2CID   73432221.
  4. ↑ Scully, C.; McLaughlin, J.; Fitzgerald, A. (21 May 2019). "The relationship between adverse childhood experiences, family functioning, and mental health problems among children and adolescents: A systematic review". Journal of Family Therapy. 42 (2): 291–316. doi:10.1111/1467-6427.12263. S2CID   181895223 . Retrieved 7 June 2023.
  5. ↑ Shonkoff, J.P.; Garner, A.S.; Siegel, B.S.; Dobbins, M.I.; Earls, M.F.; McGuinn, L.; Pascoe, J.; Wood, D.L. (1 January 2012). "The lifelong effects of early childhood adversity and toxic stress". Pediatrics. 129 (1): 232–246. doi: 10.1542/peds.2011-2663 . PMID   22201156. S2CID   535692 . Retrieved 7 June 2023.
  6. ↑ Fang, X.; Brown, D.S.; Florence, C.S.; Mercy, J.A. (February 2012). "The economic burden of child maltreatment in the United States and implications for prevention". Child Abuse & Neglect. 36 (2): 156–165. doi:10.1016/j.chiabu.2011.10.006. PMC   3776454 . PMID   22300910.
  7. ↑ McEwen, Craig A.; Gregerson, Scout F. (2019). "A Critical Assessment of the Adverse Childhood Experiences Study at 20 Years". American Journal of Preventive Medicine. 56 (6): 790–794. doi:10.1016/j.amepre.2018.10.016. PMID   30803781. S2CID   73499502.
  8. ↑ "Social Determinants of Health". Healthy People 2020. Retrieved 7 June 2023.
  9. ↑ Cappa, C.; Giulivi, S. (15 November 2019). "Adolescence and Social Determinants of Health: Family and Community". Adolescent Health and Wellbeing. Springer, Cham. pp. 205–229. doi:10.1007/978-3-030-25816-0_10. ISBN   978-3-030-25816-0. S2CID   210553568 . Retrieved 7 June 2023.
  10. ↑ Carey, G.; Crammond, B. (14 July 2015). "Systems change for the social determinants of health". BMC Public Health. 15 (1): 662. doi: 10.1186/s12889-015-1979-8 . PMC   4501117 . PMID   26168785.
  11. ↑ Anderson, J.A.; Chen, M.E.; Min, M.; Watkins, L.L. (18 December 2017). "Successes, challenges, and future directions for an Urban Full Service Community schools initiative". Education and Urban Society. 51 (7): 894–921. doi:10.1177/0013124517747032. S2CID   149061327 . Retrieved 7 June 2023.
  12. ↑ Anderson-Butcher, D. (October 2004). "Transforming Schools into 21st Century community learning centers". Children & Schools. 26 (4): 248–252. doi:10.1093/cs/26.4.248 . Retrieved 7 June 2023.
  13. ↑ Biag, M.; Castrechini, S. (3 June 2016). "Coordinated Strategies to Help the Whole Child: Examining the Contributions of Full-Service Community Schools". Journal of Education for Students Placed at Risk. 21 (3): 157–173. doi:10.1080/10824669.2016.1172231. S2CID   147782892 . Retrieved 7 June 2023.
  14. ↑ Caldas, S.J.; Gómez, D.W.; Ferrara, J.A. (2020). A comparative analysis of the impact of a full-service community school on student achievement. doi:10.4324/9781003010388-2. ISBN   9781003010388. S2CID   242737923.
  15. ↑ Daniel, J.; Malone, H.L.S.; Kirkland, D.E (14 October 2020). "A Step Closer to Racial Equity: Towards a Culturally Sustaining Model for Community Schools". Urban Education. 58 (9): 2058–2088. doi:10.1177/0042085920954906. S2CID   225135506.
  16. ↑ Arenson, M.; Hudson, P.J.; Lee, N.H.; Lai, B. (19 February 2019). "The evidence on school-Based Health Centers: A Review". Global Pediatric Health. 6: 2333794X1982874. doi:10.1177/2333794x19828745. PMC   6381423 . PMID   30815514.
  17. ↑ Bersamin, M.; Garbers, S.; Gold, M.A.; Heitel, J.; Martin, K.; Fisher, D.A.; Santelli, J. (January 2016). "Measuring Success: Evaluation Designs and approaches to assessing the impact of school-based health centers". Journal of Adolescent Health. 58 (1): 3–10. doi:10.1016/j.jadohealth.2015.09.018. PMC   4693147 . PMID   26707224 . Retrieved 7 June 2023.
  18. ↑ Dunfee, M.N. (21 June 2020). "School-Based Health Centers in the United States: Roots, reality, and potential". Journal of School Health. 90 (8): 665–670. doi:10.1111/josh.12914. PMID   32567122. S2CID   219975227 . Retrieved 7 June 2023.
  19. ↑ Dyar, O.J.; Haglund, B.J.; Melder, C.; Skillington, T.; Kristenson, M.; Sarkadi, A. (8 September 2022). "Rainbows over the world's public health: determinants of health models in the past, present, and future". Scandinavian Journal of Public Health. 50 (7): 1047–1058. doi: 10.1177/14034948221113147 . S2CID   252160816.
  20. ↑ Exworthy, M. (September 2008). "Policy to tackle the social determinants of health: using conceptual models to understand the policy process". Health Policy and Planning. 23 (5): 318–327. doi:10.1093/heapol/czn022. PMID   18701553 . Retrieved 7 June 2023.
  21. ↑ Alt, J.E.; Lassen, D.D.; Skilling, D. (25 January 2021). "Fiscal Transparency, Gubernatorial Approval, and the Scale of Government: Evidence from the States". State Politics & Policy Quarterly. 2 (3): 230–250. doi:10.1177/153244000200200302. S2CID   17515954 . Retrieved 8 June 2023.
  22. ↑ Cucciniello, M.; Nasi, G. (6 November 2014). "Transparency for trust in government: How effective is formal transparency?". International Journal of Public Administration. 37 (13): 911–921. doi:10.1080/01900692.2014.949754. S2CID   154461512 . Retrieved 8 June 2023.
  23. ↑ Fenster, M (15 September 2015). "The transparency fix: Advocating legal rights and their alternatives in the pursuit of a visible state". University of Pittsburgh Law Review. 73 (3). doi:10.2139/ssrn.1918154. SSRN   1918154 . Retrieved 8 June 2023.
  24. ↑ Khurshid, M.M.; Zakaria, N.H.; Rashid, A.; Ahmad, M.N.; Arfeen, M.I.; Faisal Shehzad, H.M. (21 July 2020). "Modeling of open government data for public sector organizations using the potential theories and determinants—a systematic review". Informatics. 7 (3): 24. doi: 10.3390/informatics7030024 .
  25. ↑ Lyrio, M.V.; Lunkes, R.j.; Taliani, E.T. (8 February 2018). "Thirty Years of studies on transparency, accountability, and corruption in the public sector: The State of the art and opportunities for future research". Public Integrity. 20 (5): 512–533. doi:10.1080/10999922.2017.1416537. S2CID   148820178.
  26. ↑ Matheus, R.; Janssen, M. (4 December 2019). "A systematic literature study to unravel transparency enabled by Open Government Data: The window theory". Public Performance & Management Review. 43 (3): 503–534. doi: 10.1080/15309576.2019.1691025 . S2CID   214262871.
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