P0079 - Policy Mapping Analysis of Adverse Childhood Experiences Prevention Policies in California

Background: With an estimated 63% of adults having at least one of the 10 Adverse Childhood Experiences (ACEs), the associated health and economic burden of ACEs is high in California. ACEs increase the risk of physical and mental health problems both in childhood (e.g. asthma and drug abuse) and later in adulthood (e.g. ischemic heart diseases and cancer). California aims to reduce ACEs prevalence to 45% or lower by 2022.

Objectives: To develop a framework to map the landscape of and assess equity of ACEs-related policies in California.

Methods: We developed our initial framework from Peiro et al.’s Haddon matrix adaptation for rapid appraisal of “health for all” policy, which analyzed policy by prevention time, action level, and equity. The “3 Realms of ACEs” from ACEs Connection was adapted as the indicators for the action level axis. We refined the framework by applying it on three California Department of Public Health (CDPH) ACEs policy initiatives: 1) ACEs Aware which offers Medi-Cal providers training and funding to screen, 2) California Home Visiting Program (CHVP) which offers parenting support via a home visiting model, and 3) First 5 California that includes improving parental engagement, sustaining family resource centers, increasing access to health care, early screening for learning programs, ensuring quality early learning programs, and promoting ACEs policy funding. In addition, we assessed whether policies were in accord with evidence, primarily via search of systematic reviews.

Progress: In the final framework, interventions were categorized according to prevention timing (primary, secondary, tertiary), action level (individual, household, community), and equity for underserved immigrant populations via three indicators: legal accessibility, language barriers, and cultural appropriateness.

Existing policies equally focus on primary and secondary prevention levels, with the majority having effect at the household level. With regards to equity, the services are available to underserved immigrants. They are available in multiple different languages, or interpreters are made available. However, it is difficult to determine whether cultural relevance has been adapted into their use.

Our preliminary findings indicate that most interventions were aligned with evidence from quality systematic reviews except for: 1) the ACEs Aware screening tool not being fully validated, 2) breastfeeding counseling (First 5 California initiative).

Discussion: This framework provides a tool to systematically and rapidly map key areas of ACEs policies, with potential implication for other public health policies. Notably, our preliminary analysis did not identify many tertiary level ACEs interventions in CDPH, and although the interventions are available to underserved immigrants, barriers to health care utilization due to cultural appropriateness remains. Future direction will include expanding the framework and adapting components of Glasgow et al.’s RE-AIM model to include three additional areas: intervention implementation, maintenance barriers, and coverage gap.