Child well-being in Louisiana has long lagged behind the nation. We average 49th among the 50 states.
So, while we understand that children living in other states are more likely to fare better, it is also true that children living in other countries will fare better than those in Louisiana.
Supporting kids to grow up healthy and happy requires more than food, a home, and a doctor. Although these are basic necessities, communities in Louisiana struggle to provide them to their children. Louisiana has food deserts, substandard housing, and limited access to healthcare. This cannot continue. Louisiana must build and maintain the necessary Child Well-being Infrastructure that our children require and deserve.
Children thrive in families and communities that are rooted in sound Child Well-being Infrastructure. At every level – homes, neighborhoods, communities, parishes, regions, and the entire state of Louisiana – we have opportunities to improve Louisiana for our children. And, when we do that, we make Louisiana a better state today and secure a better future for all of us.
Methodist Children’s Home’s Center for Child Well-being is developing a comprehensive map, the Seven Domain Model of Child Well-being Infrastructure, to guide our understanding and assessment of child well-being in Louisiana.
Child Well-being Infrastructure
The concept to improve Louisiana for children by focusing on Child Well-being Infrastructure grew out of a January 23, 2023, speech to the Baton Rouge Press Club, in which Rick Wheat, then Chief Executive Officer of the Methodist Children’s Home, advocated for the creation of a Louisiana Office of Children’s Ombudsman. He used the phrase child well-being infrastructure:
“Other states that do better by their children have something we do not. It’s a piece of child well-being infrastructure that we lack. Most states offer ombudsman services for children.”
(See Louisiana Creates an Office of Children’s Ombudsman for the advocacy campaign materials. On June 7, 2023, Louisiana’s Legislature passed Senate Bill 137 to create the Office of Children’s Ombudsman, and on June 21, Governor John Bel Edwards signed it into law as Act 325 of the 2023 Legislature.)
Child Well-being Infrastructure is comprised of the interconnected systems, policies, programs, and supports that are needed to ensure that Louisiana’s children have opportunities to thrive. The concept of Child Well-being Infrastructure allows for a bigger-picture assessment of what children require and helps communities plan to provide it.
Child Well-being Infrastructure encompasses these fundamentals, as well as the broader array of essential resources, services, and programs that support children’s overall well-being and thriving in each Domain of Child Well-being.
In the model we are developing, the Domains of Child Well-being include
- Protection, Justice, and Safety
- Family and Community Environment
- Social and Emotional Development
- Education and Cognitive Development
- Health and Healthcare Access
- Economic Stability
- Recreation and Enrichment Opportunities
Child Well-being Infrastructure refers to the network of support that helps children grow into healthy adults, starting before birth and continuing through their teenage years, ensuring that the needs in all the Domains of Child Well-being are properly addressed. Children may thrive in communities that meet their needs in these seven domains. To the degree that the necessary services exist and are functional, well-being is possible. Unfortunately, the opposite seems to be true as well.
Importantly, in addition to actually existing, all the pieces of a state’s Child Well-being Infrastructure must work together smoothly. Louisiana knows this. In 2010, one of the strong early arguments in support of creating a Medicaid-funded behavioral health system for children was that Louisiana’s state agencies were silos that did not allow coordination of care … hence, the “Coordinated System of Care.
The robust, active elements of Child Well-being Infrastructure don’t merely react to problems, but also seek to prevent them by addressing the systemic reasons why many Louisiana children struggle, such as poverty and adverse childhood experiences.
ACES = Adverse Childhood Experiences
Since the Kaiser Permanente studies in the 1990s, which introduced the concept of Adverse Childhood Experiences (ACEs), many Louisianans have come to accept the idea that what happens to us in childhood largely determines our future health. Dr. Charlie Zeanah introduced the concept of ACEs to a handful of legislators through their participation in Tulane University’s Early Childhood Policy Leadership Institutes. Afterward, one would hear these legislators discuss ACEs in House and Senate health and welfare committees.
While the connection between childhood events and adult health is important, and ACEs are alarming, the ACEs model alone is only predictive and descriptive. It says, “because these things happened to you, it makes sense that you would have these adult health issues.”
A frustration with the ACEs model is that it does not speak on prevention or resolution. It describes the impact of childhood events, but does not address ways to prevent adverse childhood experiences, nor does it offer guidance on how to respond to prevent their long-term health consequences.
ACES = Adverse Community Experiences
The Building Community Resilience (BCR) work is being conducted at the Redstone Center at the Milken Institute School of Public Health at George Washington University. BCR is based on the Pair of ACEs model, and seeks to improve the health of children, families, and communities by stirring up grassroots community services and government and private endeavors to develop protective buffers against ACEs (Adverse Childhood Experiences) that occur in ACEs (Adverse Community Environments) – hence, the Pair of ACEs model.
The Pair of ACEs was described in 2017 in research by Ellis & Dietz, titled “A new framework for addressing adverse childhood and community experiences: The building community resilience model,” published in Academic Pediatrics.
The diagram used to describe the Pair of ACEs is a tree-like structure with branches and a root system. The branches represent the seven types of Adverse Childhood Experiences, and the tree’s roots represent types of Adverse Community Environments, including poverty, discrimination, community interruption, lack of opportunity, economic mobility & social capital, violence, and poor housing quality & affordability. The Pair of ACEs model posits that children have experiences in communities, so we find the roots of adverse childhood experiences in adverse community environments.
The Pair of ACEs model explains the impact of communities on the well-being of their children and families. The BCR collaborative has developed a four-step approach for communities based on four central components:
a. Creating shared understanding of childhood and community adversity – Pair of ACEs;
b. Assessing system readiness;
c. Developing cross-sector partnerships; and
d. Engaging in a collaborative effort to prevent and address the Pair of ACEs.
BCR’s Pair of ACEs model, which explains why adverse childhood experiences occur within adverse community environments, makes much more sense than the Adverse Childhood Experiences model alone. Additionally, by identifying the features of Adverse Community Environments, the potential for prevention becomes more feasible.
In my own mind, the Pair of ACEs model is much more helpful, but it is still not quite complete. The roots of an Adverse Community Environment must become healthy to produce healthy experiences for children and families. Healthy roots require good soil.
Putting the Pieces Together
If Adverse Childhood Experiences grow from Adverse Community Environments, then we must ensure that our Pair of ACEs trees are planted in the good soil of sound Child Well-being Infrastructure. Soil determines the health of a plant. The soil’s mixture of organic and inorganic matter, its specific chemistry, the amount of moisture it can hold, and its texture determine whether a plant’s roots can thrive and extract the nutrients it requires for its health.
Like poor soil, inadequate Child Well-being Infrastructure produces weak roots that lead to poor outcomes for children. A robust, well-maintained, and comprehensive Child Well-being Infrastructure provides the resources communities need to create healthy community experiences and reduce adverse childhood experiences.
As we continue to develop our ideas about Louisiana’s Child Well-being Infrastructure, our concepts align with the work others are doing elsewhere. Their work is good evidence for our thoughts about improving Louisiana for children. Interestingly, after reading George Washington University’s work on the Pair of ACEs and the Building Community Resilience process, I learned that the Louisiana Department of Health’s Whole Health Louisiana endeavors were initially focused on reducing Adverse Childhood Experiences. Their August 2022 Statewide ACEs Discovery Report includes a description of the Pair of ACEs.
From that report’s Executive Summary: “This Discovery Report was produced by Trepwise, a growth consulting firm, in collaboration with Whole Health Louisiana, a coordination effort spearheaded by First Lady Donna Edwards ‘Louisiana First Foundation, the Louisiana Department of Health, and the Picard Center at (the) University of Louisiana Lafayette. The primary goal of the report is to discover the steps needed to create statewide change.”
With a documented 36-year average rank of 49th in the nation for child well-being, Louisiana is only just beginning to understand and appreciate the critical role that Child Well-being Infrastructure plays in creating a state where our children thrive because they have the healthy soil necessary for their sound growth and development. By protecting the well-being of our children, ensuring they have what they need and deserve, we protect Louisiana’s future.
Rick Wheat
Director
Center for Child Well-being