Opinion: We Need a Safety Net for Children Experiencing Toxic Stress

Black mother embraces little preschool daughter sitting on couch together at home.
Photo credit: iStock.

We need to invest in the safety-net institutions that serve and support our most vulnerable now and during times of crisis.

COVID-19 is decimating our fragile, unfunded and outdated safety net, and the vital links between families and their local economic, health and social supports. The pandemic has made “underlying conditions” the new code phrase for the social and health inequities disproportionately impacting black and brown communities. Shelter-in-place policies are compounding the isolation, stress, distrust, misinformation and trauma that are common to many communities of color and low-income populations.

My organization, the Center for Youth Wellness, works to try to eliminate the impact of Adverse Childhood Experiences (ACEs). Traumatic events like violence, food insecurity and homelessness that occur in childhood can cause a toxic stress response which not only affects brain development, but can cause behavioral problems, learning difficulties and chronic health issues such as diabetes and heart disease if left untreated. 

We partner with communities to identify pathways, build capacity, and remove barriers to the care and treatment of children and families exposed to ACEs and toxic stress. This work has never been more important. 

Now, we are asking ourselves: How do we reimagine a post-COVID-19 safety net that prevents ACEs and toxic stress? How do we design a system of care that strengthens access to relational health? We know that a positive, nurturing relationship with even one engaged adult can help a child cope with adversity. We want to foster resiliency and positive childhood experiences post-COVID-19.

Health care systems are rapidly evolving and finding new ways to use their technological capabilities in this crisis. COVID-19 has demonstrated how quickly policymakers and health care providers can implement new systems, including via digital technologies. 

In 2009, hospitals received nearly $20 billion to adopt electronic health record platforms. Unfortunately, there was no concomitant effort to upgrade the digital infrastructure of the nonprofit organizations that support many vulnerable patients and families in their homes and communities. Those who lack access to technology — internet service and smart devices — are left out of the system and do not get the care they need. 

The digital transformation of health care providers and personalized health services is placing some of our most vulnerable neighbors, and the community-based organizations they rely upon, on the wrong side of a new digital divide.

Even more concerning: those with ACEs live with their effects every day. COVID-19 has exacerbated their stress by forcing families and children suffering with ACEs to shelter in place, in many cases cutting them off from the relational care and supportive services they need to heal.

The only way to effectively treat people with ACEs is to create an ecosystem of care that addresses the whole person — their social, emotional and physical wellbeing.

We believe the answer lies in how we restart the economy. For many families, reopening child-care centers, schools and after-school programs is essential for families to return to work. How can we align the repopulation of these foundational systems with a new ACEs-informed model of care that can be scaled and sustained across communities?

We are designing a prototype model that focuses on high-risk children and integrates medical providers with mental health and social support services to facilitate the family healing process and remove barriers to long-term health.

Using technology to improve care coordination to those in need is in its infancy when it comes to creating a complete system of care. Yet, current models give us hope when it comes to helping those with ACEs. Alliance for HealthAunt BerthaOne Degree and Unite Us all represent a variation of whole-person health care service. Ultimately, in order to bring such models to scale, long-term government investment is needed.

The silver lining of this pandemic is that it has removed many perceived constraints around how we access care — especially mental health — and how we deliver supportive services. Now is the time to reimagine how we deliver whole-person, ACEs-informed care and live up to our social compact.

Jim Hickman is the CEO of the Center for Youth Wellness in San Francisco’s Bayview-Hunters Point district.

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