For many of us, it is easy to see how our childhood experiences influence our adult choices, behaviors, and preferences. Perhaps you like basketball because all the kids on your street played together after school. Or you learned to cook by helping a beloved grandparent make special family meals. Years spent in a scouting program can create a lasting love of exploration. Examples of positive experiences are endless and unique to each of us.

In the same way, stressful or traumatic childhood events also have lasting impact. The importance of Adverse Childhood Experiences, or “ACEs”, was first discovered 20 years ago as a result of a large-scale research study led by Kaiser Permanente and the Centers for Disease Control and Prevention. The resulting ACEs screening tool established a way to gauge the cumulative effect of different types of childhood abuse, neglect or stressful events.

While adverse childhood experiences are very common, as the number of ACEs experienced by a child increase, so does that child’s risk for chronic disease as an adult. Unfortunately, as documented in the Indiana Youth Institute’s September data brief, Hoosier youth have a higher prevalence than their peers nationally in eight of out nine ACEs as measured by the National Survey of Children’s Health.

The good news is that the earlier we can identify a child’s ACEs score, the sooner we can connect them to services to prevent, reverse, or heal the effects. Both physicians and educators are building systems to screen and respond to ACEs.

In many cases, positive childhood experiences can mitigate the stressful or traumatic events. All children need adults that support, trust and love them. Caring adults, whether parents, grandparents, teachers, coaches or mentors, are key to helping children build long-term resilience.

Find more information about ACEs from the following resources:
Indiana Youth Institute ACEs Data Brief
Substance Abuse and Mental Health Services Administration
American Academy of Pediatrics

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The cumulative effect of Adverse Childhood Experiences (ACEs) has a lifelong impact on children. As the number of ACEs increases, there is a greater likelihood of negative wellbeing outcomes such as obesity, depression, and other chronic conditions throughout life.

What are ACEs? Adverse childhood experiences are stressful or traumatic events occurring in childhood and are used to assess the long-term impact of abuse and household dysfunction on later-life health.

  • Nearly half (47.3%) of Hoosier children have experienced one or more ACEs.
  • Indiana has a higher prevalence of children experiencing at least one ACE (47.3%) than half of our neighboring states: Illinois (39.7%), Michigan (46.2%), Ohio (49.5%), and Kentucky (53.1%).
  • Hoosier youth have a higher prevalence than their peers nationally in eight of out nine ACEs as measured by the National Survey of Children’s Health.

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Our kids are going back to school and many of us are thinking about backpacks, school supplies and physicals. With bus schedules, class schedules and afterschool activities, our kids can easily get stressed about the beginning of a new school year. For some children, especially teens, this stress and anxiety exists at a dangerous level.

In Indiana suicide is the 2nd leading cause of death for youth ages 15-24 and the 4th leading cause of death for youth ages 5-14. Experts and teens list several reasons for the increase, including insufficient mental health screening, poor access to mental health services and resistance to seeking care. Suicide ideation and attempt rates are also found to be higher during the school year than in the summer.

Sadly, Hoosier youth are significantly more likely to consider or attempt suicide than their peers nationally, and Indiana faces significant disparities in youth suicide among vulnerable groups.

  • 1 in 5 Indiana high school students seriously considered attempting suicide in the past year. The percentage of students who seriously considered suicide increased from 18.0% in 2005 to 19.8% in 2015.
  • Indiana ranks 2nd out of 34 states in the percentage of students who made a suicide plan and ranks 3rd out of 37 states in the percentage of students who seriously considered attempting suicide.
  • Among our neighboring states, Indiana has the highest percentage of students who seriously considered attempting suicide and the highest percentage of students who made a suicide plan.

For more data on Youth Suicide in Indiana, read IYI’s Data Brief.

Based on these pressing needs, the Indiana General Assembly has passed youth suicide prevention legislation in the past two sessions. Effective June 30, 2018, all teachers and educators for students in grades 5-12 are required to participate in at least two hours of youth suicide awareness and prevention training every three years.

For details about the required training, school responses and effective interventions, go to the Indiana Department of Education’s website.

Child Reaching for Hamburger and Fries

Childhood obesity presents a critical and widespread issue for Indiana children.

One in three Hoosier children ages 10-17 are overweight or obese (33.9%). While childhood obesity presents a concern nationally, this issue is especially relevant in Indiana. Hoosier children are 14.9% more likely to be obese than their peers nationwide. This ranks Indiana as the 9th highest rate of childhood overweight and obesity. In comparison to all neighboring states, Indiana has the highest rate.

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Hoosier youth are significantly more likely to consider or attempt suicide than their peers nationally. Indiana faces significant disparities in youth suicide among vulnerable groups.

Youth Suicide Deaths:

  • In 2016, 57 Hoosier youth ages 19 and younger died by suicide. This represents an increase from 55 deaths in 2015 and 52 deaths in 2014.
  • Suicide is the 2nd leading cause of death for youth ages 15-24 and the 4th leading cause of death for youth ages 5-14.
  • 39% of Indiana’s youth suicide deaths are concentrated in 5 counties: Lake, Marion, Allen, Hendricks, and Porter.
  • 59 of Indiana’s 92 counties had zero youth suicide deaths in 2016.

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As parents, caring adults and community leaders, we must create the conditions for healthy kids to thrive. This means recognizing and addressing the dangers children face when they live in unhealthy environments, reducing health-harming behaviors like smoking and substance use by children and around children, and building communities that make it easier for kids and families to make healthy choices about food and physical activity.

Unfortunately, Indiana comes in 35th for overall children’s health in the U.S. Recognizing this, a new statewide collaboration, the Alliance for a Healthier Indiana, is bringing together business and community leaders to address the health of our citizens. The Indiana Youth Institute is joining this important effort to support building a healthier state from the child up.

Growing up in an environment with trauma and abuse creates lasting negative effects on children’s health, including slowing a child’s social and cognitive growth, raising their likelihood for obesity, tobacco and drug use, and inflicting long term consequences to their health and life opportunities. By understanding the co-occurrence and impact of these Adverse Childhood Experiences (ACEs)*, we are better able to create positive interventions and conditions for change.

If we can reduce child and adult smoking rates, we can have a significant effect on Hoosier health. Indiana ranks 41st in the nation for the percentage of smokers, and an estimated 95 percent of adult smokers start smoking before age 21. More than 4,100 Hoosiers under age 18 become new daily smokers each year. In 2017, nine percent of Indiana high school students smoked cigarettes in the past month, and 14.9 percent of Indiana high school students used electronic vapor products. This is especially concerning, as teens who use e-cigarettes are more likely to subsequently take up cigarette smoking.

Governor Holcomb has challenged Indiana to lower its infant mortality rate, as Hoosier kids infants are 24 percent more likely to die before their first birthday than the national average. Smoking is a significant contributor to problems arising during pregnancy and in the child’s development and health. Almost 1 out of every 7 pregnant women in Indiana smokes during pregnancy, a rate that is 68 percent higher than the national average. Smoking while pregnant is associated with a higher risk of miscarriage, low birthweight, premature birth, some birth defects and Sudden Infant Death Syndrome (SIDS).

Our state’s struggle with opioid use disorder is also taking a tremendous toll on our babies and children. Newborns exposed to opioids in utero have a 60-80 percent likelihood of suffering from Neonatal Abstinence Syndrome, a condition which impacts the child’s long-term growth, behaviors, language abilities, cognitive development, and academic achievement. Last year, Indiana had one of the nation’s greatest percentage increases in the number of children being placed in foster care. The Indiana Department of Child Services reported a sizable increase in the number of substantiated cases of abuse or neglect, with over half of the removals due to parental substance abuse.

Parental overdoses have both an immediate as well as a cumulative impact on children in the home. Children double their likelihood of developing addictive disorders when they come from homes where one or more adults abuse alcohol or drugs. While we do not yet know precisely how many Indiana children are living with adults struggling with opioid use disorder, we do know that these children are suffering and that immediate interventions are needed.

The prevalence of substance use disorder has captured recent headlines, but Indiana’s struggle with obesity is a longstanding problem that we have yet to effectively address. Indiana is the 10th worst state for adult obesity rates, and 1 in 3 Indiana youth ages 10-17 are overweight or obese. According to Julie Burns, CEO of Jump IN for Healthy Kids, in central Indiana the obesity/overweight rate is 25 percent higher than the national average, and three times higher than the goal of 15 percent. Burns stresses the importance of focusing on young children, as habits around food and physical activity are developed by age 5.

Healthy kids grow up with greater chances to be healthy adults, and are more likely to become productive and successful citizens. Far too many Hoosier children face the issues caused by ACEs, smoking, opioid use, obesity and are lost due to infant mortality. We support and applaud the efforts of the Alliance for a Healthier Indiana. Local events to improve Hoosier health are taking place across the state, and we encourage everyone to find a way to contribute by going to www.healthierindiana.org. By collectively dedicating ourselves to these efforts, and by taking a multi-generational approach, we hope to increase the health and success of all Indiana residents.

The well-being of mothers and infants determines the health of the next generation.

In the 2018 State of the State address, Governor Eric Holcomb set the goal for Indiana to become the best state in the Midwest for infant mortality rates by 2024, challenging us to work together to improve conditions for infants. The governor labeled our current infant mortality rate as “unacceptable.” In 2016, 623 Hoosier children died before their first birthday. Indiana ranks 41st nationally for infant mortality, with our babies being 24% more likely to die before their first birthday than infants nationally. Indiana has lagged behind the national average for the past two decades.

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The scene from Marjory Stoneman Douglas High School in Parkland, Florida is one we have seen far too often: terrified students fleeing a school, parents frantically searching for their children, law enforcement swarming a campus. While our immediate concern is for those directly involved in these tragedies, instinctively we also wonder if our own children are safe. Safety is the top school-related concern of parents, above academic performance, student services, facilities or educator quality. Parents must have an accurate understanding of the safety plans in place in our schools. We also must work to ensure that students, and their families, feel that their schools are safe.

School administrators are keenly aware of the need to protect students, with the range of threats including not only active shooters but also weather and natural disasters, noncustodial parent abductions, and everyday issues like bullying and fighting. Although mass school shootings understandably garner intense media coverage, all threats to school safety are cause for concern. Research shows that any instance of crime or violence at school not only affects the students directly involved but can also negatively impact bystanders, the larger school environment and the community.

The good news is that Indiana is leading the nation in school security and safety planning. Indiana is one of only two states with a school safety specialist law, and is the only state in which the program is fully implemented. Every public school corporation in Indiana is required to have a certified school safety specialist, and 88% of districts have two or more specialists.

David Woodward has worked at the Indiana Department of Education (IDOE) for over 20 years and is architect of the state’s School Safety Academy. Started in 1999, the Academy’s five-day basic training covers national and state best practices on topics such as cyberbullying, digital threats, active shooters, safe and effective drills, student suicide and school entrance security.  Each district specialist must also complete two additional days of training annually and are tasked with starting the multi-step process of updating and implementing their district’s safety plan. As Woodward notes, “The threats to our schools are always changing, so our response always needs to be updated.”

Although our state is proactive in addressing the safety needs of schools, challenges remain. Fear at school can contribute to an unhealthy school climate and lead to negative student behavior. Students who feel unsafe at school are more likely to miss days of class, and students who witness school violence are more likely to experience health problems, social and emotional difficulties, and poor academic performance. According to the National Survey of Children’s Health, 78.1 percent of Indiana parents say they “definitely agree” that their child is safe at school. This is compared to the Healthy People 2020 initiative’s goal that 95 percent of parents will consider their children to be safe at school. We all have a role to play in creating and sustaining a climate of safety through our schools.

At the leadership and policy level, more can be done to increase both the actual and perceived levels of safety. In late February, State Superintendent of Public Instruction Dr. Jennifer McCormick called on the General Assembly and our Congressional Delegation to pass additional school safety policies. Her two main requests were increased resources for mental and behavioral wellbeing, and ensuring that our private and charter schools all have the same requirements to keep our schools and students safeLate in the legislative session, Governor Holcomb requested a $5 million increase in the state’s school safety grant fund, but the bill died in the final minutes of this year’s session. The May special session will be a time to finalize additional school safety actions and funding.

At the community level, effective communication is critical. Although schools understandably cannot publish their specific safety plans, they can and should talk with parents and community members about the steps they are taking to ensure students are safe. Experts suggest directly calling your school principal with safety concerns, noting that many people erroneously first call local law enforcement.  Student voice is also important in shaping and maintaining a safe school environment. Ask your school how they are supporting student engagement in their safety planning. Finally, do not underestimate the impact these national traumas have on our students’ sense of safety.

The horrific mass shooting in Florida has once again heightened our concerns for school safety. Indiana has proactively taken steps to ensure our schools have updated safety plans in place and yet even the best plans are not guarantees. All Hoosier parents and families should have a clear understanding of what is going on at the state and local levels, especially inside their individual schools. Students are understandably and admirably stepping up to not only regain their sense of safety but also to call for increased action. But as community leaders, parents and citizens, it is our shared responsibility to provide safe learning environments for all of our educators, administrators and, most importantly, our students.

Urgent, complex challenges affect children across Indiana, including high infant mortality rates, persistent achievement gaps, and the soaring impact of parental opioid use. There are successful prevention and intervention programs operated by youth-serving organizations throughout the state, many of which engage government, philanthropic and corporate partners. The complexity of many social problems, such as preparing all children for success beyond high school, calls for shared community investments of time and treasure that are beyond the scope of any single sector. Solving these complex problems will require expansion of partnerships and collaborations and reduction of siloed services. A growing body of evidence shows the key to lasting improvements in the well-being of Indiana children will be the proliferation of prolonged cross-sector partnerships.

The collective impact approach holds potential for tackling large-scale social problems. First defined by the Stanford Social Innovation Review in 2011, this framework brings together multi-sector stakeholders with a shared desire to address a large-scale social problem. It has been received with enthusiasm and widespread, rapid adoption. But with implementation and effectiveness varying greatly across initiatives, many question whether “collective impact” is simply a trendy update to the term “collaboration.” David Shapiro, CEO of MENTOR, notes, “Once something gets popularized and trendy, it also gets watered down and given a million meanings.”

The collective impact framework offers a fundamentally different approach based on discipline, high performance and constant adaptability. Stanford’s model outlines five key conditions that differentiate the approach from other collaborations or partnerships: a common agenda, shared measurement systems, mutually reinforcing activities, continuous communication, and the presence of a backbone organization.

Experts stress that three conditions must be in place before launching a collective impact initiative: an influential area champion, adequate financial resources and a sense of urgency for change. There must also be a core understanding that collective impact work takes time, patience and financial resources. Having worked with successful collective impact initiatives centered on youth mentoring, Shapiro stresses the importance of coming together around a critical issue. He states, “We are all trying to solve very hard problems. No one is saying that you are failing because you haven’t solved them the way that you’ve been trying to solve them. We’re just trying to figure out if there are new ways to continue to push on the solutions together.”

Promise Indiana, a nonprofit based out of Wabash, functions as the backbone organization for community-driven efforts to instill the hope, culture and habits needed to create pathways for all children to go to college. This initiative engages many sector partners including: government, nonprofits, schools, higher education institutions, community foundations, businesses, philanthropic partners and individual donors. In fact, the community applies to the program as a unit. Clint Kugler, Promise Indiana’s founder, explains that the program succeeds by “connecting current systems and creating a network of community champions.” To date, 17 Indiana communities have committed to this collective impact project, with several more planned to join in 2018.

Policymakers and funders can support increased impact by encouraging a collective impact approach to large-scale social issues. Stakeholders from all sectors must be invited to the table, and they must arrive with a learning mindset and a willingness to compromise in service of the overarching goal. The best collective impact initiatives include space to customize for local context. In addition to leaders from the public and private sectors, it is important to engage individuals who are directly impacted by the issue being addressed, those with the lived experience. As individual community members, we can all attend school board meetings, city council meetings and community gatherings to offer our perspectives and generate that critical, shared sense of urgency.

Collective impact is not simply a new buzzword to describe collaborations and partnerships of all types. Instead, if implemented with intention, the framework holds potential to create lasting change. Leaders are recognizing that solving complex social problems is more effective when isolated programs and interventions become systems of shared vision and coordinated effort. Collective impact work is time-intensive, messy and sometimes uncomfortable. Yet when we are talking about the well-being of our future workforce and leaders – our kids – collective impact is also an approach that can provide the insights, connections, energy and optimism needed to tackle our biggest challenges.

We all benefit when the next generation is healthy, safe, well-educated and economically secure. Indiana can be a wonderful place to be a child, but when we look at overall child well-being, it ranks as the 28th state in the nation. A deeper look at the data shows the disproportionate challenges and barriers to success faced by some children.

The Indiana Youth Institute (IYI) recently published the 24th annual KIDS COUNT Data Book, part of a national effort to measure childhood well-being at the local, state and national levels using data in areas including health, education, economics, safety and family.

The 2018 Indiana KIDS COUNT Data Book shows improvements over last year in children’s health insurance coverage and teen pregnancy rates. Meanwhile, significant challenges remain in the areas of economics, safety and education. Furthermore, substantial inequities appear in most indicators when the data is disaggregated by race, place and income.

In his 2018 State of the State address, Gov. Eric Holcomb set the goal for Indiana to become the best state in the Midwest for infant mortality rates by 2024, challenging us to work together to improve conditions for infants. The governor rightly labeled our current infant mortality rate as “unacceptable.” Indiana is ranked 41st nationally, with our babies being 24 percent more likely to die before their first birthday than infants nationally.

Indiana’s black infants are twice as likely as white babies to die before their first birthday, with this disparity widening over the prior year. Tony Mason, CEO of the Indianapolis Urban League, says “There are many socio-economic and health factors that put black infants at a higher risk of infant mortality than white infants. On a state level we need to address the issues of food access and quality care.” Jeni O’Malley, director of public affairs for the Indiana Department of Health, highlights numerous programs aimed at infant health, including the new Liv pregnancy mobile app launched in November.

Child maltreatment is also rising with increasing substantiated cases of abuse and neglect, hotline reports and placements in foster care. Over the past five years, Indiana has seen a 58 percent increase in the number of children in foster care with 58 percent due to parent drug and/or alcohol abuse.

Leaders in government, education and community services all stress the importance of collective efforts, purposeful and consistent partnerships, to increase educational outcomes for all kids. Superintendent of Public Instruction Jennifer McCormick says “Math and reading growth and proficiency impact student success, which is why we have placed an important focus on these subjects in Indiana. Compared to our sister states, we have made great strides.” Yet students of color and those with low incomes and other risk factors, such as homelessness, have lower educational proficiency rates. As Gov. Holcomb states, “We need to move those kids who are at the back of the line—the most disadvantaged among us—to the front of the line,” beginning with increasing access to quality pre-K programs.

Clearly, the conditions necessary for children to thrive are complex. Children growing up in poverty are significantly more likely to experience stress and deprivation that hinders development and school readiness, health and other outcomes. Indiana’s child poverty rates decreased, with 19.5 percent of Hoosier children living in poverty as of 2016, down from 20.9 percent in 2015.

Jennifer Walthall, secretary of Indiana’s Family and Social Services Administration, says her agency believes a two-generation approach provides the best solutions for reducing child poverty because it” addresses the needs of both children and adults in their lives together.” Mason points to providing youth with access to quality education and employment skills as key to breaking the cycle of poverty. Access to such multi-faceted interventions is vital for children of color, as black Hoosier children are three times more likely to live in poverty than their white peers (42.2 percent vs. 13.9 percent).

To ensure all Hoosier children have the opportunity to reach their full potential and become productive and responsible adults, we must understand and work together to improve the conditions that support their success. Our goal with the 2018 KIDS COUNT Data Book is to spark conversations and action throughout the state. Whether working in a region, county, city, school district or neighborhood, the data can help further such efforts.

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(Tami Silverman is the president and CEO of the Indiana Youth Institute. She may be reached at iyi@iyi.org or on Twitter at @Tami_IYI)

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