2020 Initiatives

Annual Meeting
September 12, 2018
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Addressing Toxic Stress in Infancy

and Beyond
Heather Campbell, MD
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• Ecobiodevelopmental framework explains

how early childhood adversity can lead to
significant lifelong consequences
Psychosocial Risk Factors: Adverse development:

• Parental mental illness • Mental illness

• Parental substance abuse
• Family violence
• Parent isolation
• Poverty
• Racism
• Parental incarceration
• Obesity
Toxic stress • Chronic medical problems
Epigenetic changes • Poor school performance
Brain remodeling • Cognitive impairment
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Johnson et al. Pediatrics 2013.

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Goal: To implement the use of a standardized

Family Well-Being Assessment (WBA) tool in
both well-baby and intensive care nurseries in
NC
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Goal: To implement the use of a standardized

Family Well-Being Assessment (WBA) tool in both
well-baby and intensive care nurseries in NC

Key Measures:
• Percentage of women who deliver at eligible
hospitals who complete the assessment tool
• Percentage of women who complete the WBA
tool and have a referral indicator who are then
referred to services
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Target population: Mothers of infants born in

participating PQCNC well-baby and intensive
care nurseries in North Carolina
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The Family WBA tool will…

• Improve our ability to recognize and refer
families at risk to existing community
resources
• Create a rich database that allows
communities to understand the specific
psychosocial needs of local women and their
families and target future investments
accordingly
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Family Well-Being Assessment
Tool
• Modeled after tool used by Oregon Perinatal
Collaborative
– 5 sections:
• Basic information
• Assets and resources
• Emotional health and wellness
• Substance use
• Relationship health
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Family Well-Being Assessment
Tool
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Family Well-Being Assessment
Tool: Addressing Red Flags
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Family Well-Being Assessment
Tool: Addressing Red Flags

• Can utilize NCCARE360 for assistance with

referral to community resources
– NC Resource Platform currently under
development
– Statewide tool making it easier to connect
providers, insurers, and community-based
organization to community resources
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Summary
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• Standardized Family Well-Being Assessment

tool will help at-risk families get the services
and support they need
• Data collection will help us understand
population-level needs and invest in new
social support resources in the future
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Questions?
Contact Information:
Heather.Campbell@unchealth.unc.edu
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References
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• Center on the Developing Child at Harvard University (2016). From Best Practices to Breakthrough
Impacts: A Science-Based Approach to Building a More Promising Future for Young Children and
Families. Retrieved from www.developingchild.harvard.edu.
• Garner AS, Shonkoff JP; Committee on Psychosocial Aspects of Child and Family Health; Committee on
Early Childhood, Adoption, and Dependent Care; Section on Developmental and Behavioral. Early
childhood adversity, toxic stress, and the role of the pediatrician: translating developmental science into
lifelong health. Pediatrics. 2012;129(1):e224- e231
• Shonkoff, Jack. Capitalizing on Advances in Science to Reduce the Health Consequences of Early Childhood
Adversity. JAMA Pediatrics, 2016. 170(10): 1003-1006.
• Shonkoff JP, Garner AS; Committee on Psychosocial Aspects of Child and Family Health; Committee on
Early Childhood, Adoption, and Dependent Care; Section on Developmental and Behavioral Pediatrics. The
lifelong effects of early childhood adversity and toxic stress. Pediatrics. 2012;129(1):e232- e246.