Child Development-Community Policing

 The Mecklenburg County Public Health Department, or MCPH, located in Charlotte, NC is submitting this application for it's Child Development-Community Policing Program (CDCP) as a 2023 NACCHO Model Practice.

 The MCPH mission is "To promote and protect the public's health," and the agency is comprised of 940 employees serving a population of 1.2 million, including the City of Charlotte and 6 surrounding towns. MCPH is led by Dr. Raynard Washington, PhD, MPH, a Deputy Health Director, and Four Assistant Health Directors overseeing four divisions: Population Health, Preventive Health, Clinical Services, and Case Management and Health Partnerships. The Department is governed by 9 County Commissioners who serve as the Mecklenburg County Board of Health. The CDCP Program sits within the Case Management and Health Partnerships Division.

 The ACE Study and Mecklenburg County CDCP: Two congruent efforts on opposite coasts. As the grounbreaking Kaiser Permanente study was taking shape between 1995-1997 in California, an effort was underway in North Carolina to address childhood trauma in an innovative way, by harnessing the power of the professionals most acutely aware of violence-impacted children in real time: The police. Before the language of ACEs, this program was simply "The right thing to do for the community." As we came to understand ACEs and the potential lifelong physical and mental health, social, educational, legal impacts of eraly childhood adversity and chronic stress on individuals and families, we knew that the work of CDCP was at that connection point between trauma and all other public health efforts and initiatives. 

The Child Development-Community Policing Program (CDCP) in Mecklenburg County, began in 1996 when a lone social worker from the County and two CMPD supervisors visited New Haven, CT, to learn how the CDCP there was partnering child mental health clinicians from the Yale Child Studies Center with police officers from the New Haven Police Department, to explore a similar program for Charlotte. The project started small, in 5 square miles of the city, serving children impacted by the worst possible violence: Homicides, suicides, weapons assaults, domestic violence, public accidents, and others. One key divergence between Mecklenburg County's CDCP and our "parent" program at Yale, involved Yale's reliance on their Child Truma Clinic at the Child Studies Center. Charlotte was far larger, is impacted by sprawl and public transportation access disparities for many in our community. We knew in order to make this service available to all children and families, our "clinic" would have to be on wheels, and those wheels became police cars. Since that time, the program has received unprescedented support from Mecklenburg County Public Health, the City of Charlotte/CMPD and several town police departments, growing to a robust team of 17 dedicated clinicians who, along with their supervisors and local police officers, are available 24/7/365 when children and families need them, serving them in their own homes. With CDCP, no child waits for expert clinical care and specialized police safety response, no child has a transportation barrier to care, and every family is served free of charge. Our ultimate goal is for families receiving free trauma care from CDCP to receive the absolute best acute trauma care in the nation.

The CDCP model is simple, partner child trauma experts with the professionals most acutely aware of traumatized children: the police. Give these partners what they need to work together effectively, understanding each other's unique role in a family's care. Clinicians employ immediate acute trauma assessment and targeted clinical interventions aimed at decreasing the earliest emerging symptoms and restoring emotional safety, while officer partners focus on physical safety and safety planning for families. This service model is designed to prevent the need for future long-term mental health services, disrupt the cycle of violence, and stabilize families. We aim to neutralize ACEs in their tracks, as they occur, lessening the risk for lifelong impacts on children and families. We know we cannot prevent every ACE, but we absolutely can respond well, offering opportunities for safety and healing. 

Joining with local families in their absolute worst moments is a difficult, challenging job that is not for most mental health workers. CDCP clinicians and officers are there, amid all the fear, the pain, the chaos, providing support, comfort, and acting as an anchor to hope and to the rest of our community. CDCP clinicians and officers communicate to violence-impacted children and families that they are an important part f our community, we care about them, and we aren't going to let the trauma be the end of their story.

CDCP Clinicians utilize age and developmentally-specific acute trauma measures to guide the initial clinical service response, determine the need for clinical follow-ups or inform any long-term therapy referrals that may be needed. Additionally, clinician-officer teams assess for other social determinants of health-based needs, and make community-based referrals to address a variety of concerns ranging from food access to homelessness. Our measures were developed incrementally, first utilizing the early Yale format, then creating proprietary measures to better capture developmental impacts of trauma in the first 30 days and later creating a measure tracking the earliest emergeing symptoms in the first 12 hours post-exposure. Our CDCP Program measures are currently part of a UNCC research project. 

We are so very proud of our ability to quickly offer services to the children who need them most, and to do it effectively, efficiently, and relatively inexpensively. Of the 5000 successfully contacted guardians in FY19, 86% received child trauma psychoeducation, coaching, and support, 72% of children were screened using 1 or more tools, 10% of children completed chort term trauma intervention as the sole clinical service needed, 32% of children were linked with longer-term therapeutic support, 11% of guardians received referrals for their own therapeutic support, and other service linkages included domestic violence services, developmental evaluation services, substance misuse treatment, grief counseling, rape crisis services, homeless shelter services, parenting support, medical and dental care, and more. 

 No child should ever have to wait for the best possible care, and with CDCP, they never have to.    

mecknc.gov/HealthDepartment/CommunityHealthServices/TJP/Pages/CD-CP.aspx

County, City, and other agencies county-wide have been concerned about increasing violence in the Mecklenburg community for several years, gun violence in particular, spawning projects such as the "Violence Prevention Data Collaborative," co-chaired now by the CDCP Program Director/Public Health, and partners representatives from City and County govenment including The Office of Violence Prevention, DSS, the Police, Sherriff's Office, and representatives from both major hospital systems, our local domestic violence services, several local universities and researchers, among others. The goal is to strategize opportunities and design or replicate collaborative projects that can effectively reduce violence in our community usng a public health lense, and reduce, in particular, those impacts on the most vulnerable. CDCP is a critical partner, in identifying the scope of the needs with regard to local children.

The Mecklenburg County CDCP Program has received an average of 637 monthly referrals for families impacted by violence in the first quarter of fiscal year 2023. Our fiscal year 2022 total was 7,783 referred families that included a total of 11,855 children. Of those children, 30% were witnesses to intimate partner violence in their homes, and 30% of all referred families had at least one child age 5 or under. 15% of all referred families speak Spanish as their primary or only language. CDCP's referrals overwhelmingly overlap with what Mecklenburg County refers to as our "Public Health Priority Crescent," a cross-setion of the county most impacted by poverty, food instability and decreased access to fresh healthy food, lower educational attainment, lower rates of livable-wage employment, and higher rates of neighborhoods impacted by violent crime. Parallel initiatives to improve health outcomes in this part of our community in particular, include not only the CDCP program to address childhood trauma, but the creation of the state's first Public Health Office of Violence Prevention, that is looking at large-scale projects for violence interruption and community involvement in the development of viable solutions to community violence, the "Healthy Corner Stores" initiatives engaging the smaller convienence outlets in our identified food deserts to stock fresh vegetables and fruits and participate in the WIC and SNAP programs, and many others.

For Fiscal Year 2022, of the 6,329 families referred and meeting criteria for an immediate clinical response, 80% of those parents/guardians were successfully contacted, with 72% being contacted in 72 hours or less following the violent event. 72% of families accepted one or more clinical tools being used to measure the presence and severity of their children's early and emerging trauma symptoms. 87% of parents received child trauma psychoeducation and coaching around at-home strategies for support. 12% of referred children received short-term acute trauma intervention while 22% needed additional long-term therapy referrals. 10% of guardians were provided with referrals for their own therapy. All of those services were provided by clinican-police officer teams, in a family's own home. All of those services were offered immediately to impacted families, either by on-call clinical contact or through the referral process built directly into the police reporting system, immediately connecting police and public health service providers.

CDCP ensures that ACEs and trauma are addressed immediately, before they can fester into a chain reaction that could include chronic disease and does so prioritizing a diverse staff to serve a diverse community. 24% of CDCP clinical staff are bilingual Spanish-speaking, and 65% of CDCP clinical staff identify as POC. We want to give every violence-impacted family the best opportunity to connect well with our staff and be provided services in their own homes, or wherever they and their children are most comfortable. We reduce the struggles many families face when seeking assistance in our community, due to sprawl and economics, by brigning the trauma clinic to their door, at no cost to any family. Service linkages and referrals are individualized and based on each families situation, reducing impacts of social determinants of health or other risk factors. Families in need of services in a native language other than English or Spanish receive services with their clinician and a live interpreter on the clinician's smart phone. 

While Mecklenburg's CDCP Program is now over 25 years old, responding to child trauma in this way, swiftly and in partnership with law enforcement, is being done in just a few other communities nationally. Mecklenburg's CDCP Program is the largest program of its kind  in the nation, by service volume, and our service delivery model is unique in that we had to make a significant shift from the original program model of our parent program the Yale Child Studies Center/New Haven Police CDCP. Charlotte-Mecklenburg is comprised of 527 square miles, with an urban high-density center surrounded by extended urban sprawl as well as more rural outlying communities, many that lacked access to public transportation at the time of program inception. Public transportation access remains a challenge for many in our Charlotte-area community, as does therapy provider locations that are accessible and affordable to all in our community. The Yale model of immediate trauma response followed by services delivered in a centralized urban trauma clinic was perfect for New Haven, but it was not going to be effective in our community in facilitating equitable access to the service. Our CDCP partners decided to create and committ to an intensive and comprehensive model that took the trauma clinic on the road, in police cars, to every child. And that is what we've done for over 25 years. No child has to wait for the best possible coordinated clinical care or safety response, no child has transportation as a barrier, or a cost. 

One of the unique advantages of a CDCP response for children, is the specialized measures used to determine if the earliest emerging indicators common in the development of longer-term trauma symptoms, are present after an incident, and when they are present, symptom mitigation and parent education and coaching are offered right away, in the hopes of preventing the worsening of symptoms, or need for any longer-term therapy services whenever possible. In order to do this, Mecklenburg County CDCP had to create a measure that did not exist before, based on what is known about how stress impacts the nervous system and other related body systems in the first few minutes and hours post-exposure in children. Clinicians are trained to look for these earliest indicators, make note of them, apply targeted interventions and strategies such as grounding techniques, relaxation breathing, and here-and-now body awareness, coupled with support and parent education and coaching. This "Autonomic Nervous System" or ANS symptom indicatopr tool can be used within the initial 12-hour window post-trauma, and we believe is an effective way to determine which children are more likely to suffer on-going, lenthier symtoms, and attempt to stop them before they start. At the 12-hour point up until the 29th day post-trauma, so still within the acute trauma pre-diagnostic period, CDCP uses another measure that has been updated over many years from the form initially used by the Yale New Haven CDCP program, becomming the CDCP Acute Trauma Questionnaire or ATQ, a series of trauma measures that are age and developmentally specifc, to track the physical, psychological, and behavioral trauma responses most common in children, to help guide our clinical interventions and inform our parent supports. The most common symptoms are looked at specific to the following developmental categories: Infant/Toddler, Preschool, and School-Age, and can be tracked over the course of several days or weeks in order to determine the effectiveness of the interventions, or the need for longer-term therapy referrals or other services. Both the CDCP ANS and ATQ forms are currently under research review by the University of North Carolina at Charlotte with preliminary results showing good reliability and the validity study to follow. 

Our hope is that eventually, responding to childhood trauma as quickly as possible, and doing so in an informed, collaborative way, using a Public Health home vsiting approach, will be the national standard of care for all children impacted by trauma and violence. While nationally, the initial CDCP model has been deemed a "Promising Practice" by the National Child Traumatic Stress Network, and a seperate research review of our Mecklenburg County CDCP trauma measures is underway, we believe that the most simple and effective components of this response: police and clinicians working together to better respond to children and families, in a developmentally appropriate and informed way, is in and of itself a model practice that should become the best first response for all children impacted by violence or other trauma.

Working this way is cost-effective, utilizies the strenghts of multi-disciplinary professionals to the benefit of our most vulnerable community members, and lies at the very heart of the missions of both the Public Health and the Policing professions. This work is collaborative, protective, and preventative. It weaves what we have learned from decades of community-based work into the fabric of families, to strengthen their ability to recover when violence has occurred. With a simple shift towards collaboration, and funding for the needed clinical staff, many communities with committed police agencies and public health departments could make this service model a reality for children and families.

Furthermore, the time is right for this practice model which allows police agencies in particular, a powerful opportunity to communicate through their work, their true committment to the most vulnerable, as their top priority. The participating police agencies in Charlotte-Mecklenburg provide this care to all children and families, regardless of the parent or caregiver's legal history, legal or documentation status, housing status, history of substance misuse, and on and on. This work is done through a trauma-informed lense, with completely open access to all families desiring the help.

Mecklenburg County CDCP recently was awarded the 2022 North Carolina GlaxoSmithKline Foundation Child Health Recognition Award, in support of the program's desire to ensure clinican access to a variety of the nation's best evidenced-based trauma intervention training and education opportunities. Interventions such as EMDR, Brainspotting, A.R.T., TF-CBT, and others can be costly, and this year's award will support our long-standing belief that children receiving our immediate, no-cost response should be getting an expert level of care equal to, or better than, any other avaialbale in our community. If our aim is to prevent potential long-term, even lifelong symptoms and life-altering negative consequences of ACEs in our community, we have to be the best. 

nctsn.org/interventions/child-development-community-policing-program

The Mecklenburg County CDCP Program's primary  goal is that no child should have to wait for expert clinical care and specialized police safety services following a violent or traumatic event, nor should cost or location ever be a barrier. By providing specialized/individualized services as quickly as possible, children avoid having to experience longer-term and often worsening trauma symptoms that may not come to the attention of helping professionals until much later in life, or possibly never. While we cannot prevent every new ACE a child may experience, we do have the power to respond as a community to the best of our ability, and by including a unique multidisiplinary approach, we can more effectively meet the needs of vulnerable families and provide stabilization in the midst of crisis.

In 1991, this model of pairing a mental health clinician with a police officer on behalf of children impacted by violence, was conceptualized by Dr. Steven Marans  of the Yale Child Studies Center and the Chief of Police in New Haven, CT. In 1995, Mecklenburg County and the Charlotte-Mecklenburg Police Department sent representatives to New Haven to explore an opportunity to replicate this unique service model in our community. The resulting 1996 Pilot started off slow, in a small police district of 5 square miles within Charlotte's most violence-impacted neighborhoods. The results were clear: The need was ever-present and the model was reaching those who needed it most. Over the years, the clinical arm of the program has been housed within several areas, but none so impactful than it's last and final home: Mecklenburg County Public Health. Within Public Health, the CDCP prgram has received unprescedented support for continued growth and expansion into an additional 6 more local police departments, comprised of the 6 Town jurisdictions in the North and South ends of Mecklenburg County. Additionally, through a partnership between Mecklenburg County Public Health and the University of North Carolina at Charlotte, research is underway to look at our proprietary acute child trauma measures, and their efficacy for expanded use in other similar programs or for future expansions of this work. Mecklenburg County has supported the clinical work by providing the additional needed clinical personnel each and every time a new service area was on-boarded. On the police end, both CMPD and our local Town Police Departments have committed to taking the trauma clinic to the homes of thousands of local children each year, whether their officers numbered in the thousands or under 100. This is a very different challenge depending upon the size of the police department, and we have been so very lucky to have the full support of each new department as we expand our capacity to serve. Our police officers committed to cross-training with clinicians, learing about child trauma and it's impact on a developing child's brain, behavior, and health outcomes. Officers learned about ACEs and public health strategies to mitigate long-term impacts. Most importantly, officers learned about the best possible trauma-infromed responses to children and families impacted by violence. Clinicians, conversely, learn about the challenges of providing effective, immediate trauma care in an often fluid environment. Charlotte's CDCP is not in a sterile, controlled clinic. We are in the community, inside families' homes, amongst multiple generations, and often amid the other challenges familes may be facing: poverty, illness, neighborhood violence, and on and on.

Children come to the attention of CDCP simply by being present when someone called 911 for help. There is not other criteria necessary to receive service. All services are free of charge, available in a child's own home, 24/7/365. By reducing the barriers of cost, or transportation, of complex family situations, we are able to make this care available to all who need it and accept the service. Additionally, clinicians help link families to other community resources and provide concrete items families may need in a crisis such as food, clothing, safety hardware items or portable emergency alarms, referrals for housing assistance, and more.

The Mecklenburg County Public Health's Strategic Business Plan for FY 23-25 includes CDCP program implementation in the last couple of remaining Town police departments. Conversations have been had with the leadership in those departments and both are excited about the work that is to come. The current CDCP model and funding has come a long way from our late 1990's roots, when the program was functioning with one police division and volunteer clincians. In 2001, the program receivied it's first two dedicated full-time, salaried, clinical staff. One was funded in part by a grant from Smart Start of North Carolina. Today, the program's clinical services are fully staffed with a robust team of 17 clinicians and two full-time clinical supervisors, who maintain a 2-clinician 24/7/365 on-call response rotation as well as new daily referral coverage. What began with a training and technical assistance grant from the Office of Juvenile Justice and Delinquency Prevention to fund that initial training trip to Yale, and later started with 2 full-time clinicians, now sits within Mecklenburg County Public Health's Trauma & Justice Partnerships, where it is the largest of 3 programs in an area with an almost 3 million dollar total budget. CDCP co-locates our clinical staff, with the police departments providing work spaces for our clinicians as well as the in-kind support of the officer's pay when partnershing with clinicians in the field. The biggest expense of the program is simply the salary and benefits of the 17 clinicians and 2 supervisors. The Licensed Clinician salary range is from $59,442.94-$89,164.42, plus benefits.

Mecklenburg's CDCP program has had a customer satisfaction survey for many years now, however in 2022 the program updated our client access to include a QR code, and feedback cards for distribution to client families as well as placing the code on every brochure, mailer, and email our clinicians send. Our goal is to give clients as much access to opportunities to tell us how we are meeting or not meeting our goals as possible. 

Mecklenburg County's CDCP Program is currently in the process of a multi-part evaluation in partnership with UNC Charlotte and APHI: The Academy of Population Health Innovation. AAPHI's mission is to "Develop innovative solutions to address the Charlotte area's most pressing community health needs and priorities. We do this by supporting innovation and implementation of evidenced-based community health practices, coordinating training programs and professional education, securing external funding for research, and expanding MCPH's ability to systematically collect, analyze, and interpret health-related data needed for the implementation and evaluation of public health practice."

The initial CDCP evaluation planning and strategizing began in 2019 with a plan for an observation model and quickly shifted to a process evaluation strategy that was interview driven instead, due to COVID-related impacts. Qualitative, semi-structured interviews were conducted with CDCP clinical leadership, management, frontline clinical and police staff interviews that were then recorded and coded. Current research underway includes child trauma measurement instrument reliability and validity analysis, and future research planned for 2023 will levaluate program outcomes through an analysis of administrative, assessment, and client outcome data.

CDCP Evaluation Part I: Process Evaluation Aim and Method

Aim: To interview stakeholders and inquire into their perceptions of CDCP's purpose, processes, impacts, areas for growth, and diverse benefits. 

Method: Semi-structured interviews. The interview guide was developed collborativelly, followed by content analysis conducted by two coders recording interrater agreement and theme development.

Sample: 21 stakeholders ointerviewed, including 14 frontline clinicans and police officers as well as 7 supervisors and administrators both clinical and law enforcement professionals. 

Process Evaluation Findings:

Themes included: Universal precaution, prevents development of trauma, immediate response of support, connecting families to resources, access to mental health professionals, increased officer awareness and knowledge of mental health, changes officer's approach to policing, supportive culture and environment, collaborative relationships, immediate responses enhance engagement of families, reuction of barriers to service access, emphasis on self-care practices from top-down.

Instrument Reliability and Validity: Cronbach alpha for the CDCP Acute Trauma Questionanaire (ATQ) underway, preliminary findings:

- ATQ Infant: Cronbach a = .72

- ATQ Preschool: Cronbach a = .67

- ATQ Child: ronbach a = .86

Current review of inter-item correlation matrices is underway, and future research will include performing a split sample EFA and CFA for each version of the CDCP ATQ. 

2023 Quantitative Evaluation plans include a study of the intial referred incident, contact of clinical team, and efficiency and effectiveness of the initial response, followed by the type of assessment used, whether a CDCP Autonomic Nervous System (ANS) cues checklist used within the first 12 hours post-incident, the Acute Trauma Questionnaire used between 12 hours and 29 days post-incident to track early emergeing symptoms and symptom reduction, or a Trauma History Questionnaire (THQ) assessing for chronic stress and/or polyvictimization often indicating a need for a specilaized therapy referral. This piece will be followed by looking at the type of service or services provided including any brief trauma imtervention and symptom mitigation work, education and coaching, support services and referrals both therapeutic and those to address other social determinants needs. Outcomes assessed will include assessment, symptom reduction, collaboration, engagement, referrals and service linkages.

A full report should be available by the end of 2023.

CDCP is a model where there is no singular, indivudal,  heavy-lifting in the budget for organizations who can partner well to provide a collaborative service. Just as we show our clients that they are not alone in their suffering, we do not have to do this difficult work alone. Working this way affords the CDCP program a more effective response, in a more fiscally-responsible way, due to the multi-disciplinary nature of the collaboration and the collective commitment to serving and sharing the cost. One very budget-friendly, cost-saving factor unique to this collaboration is it's ability to maximize an existing resource to the benefit of children and families, through the ability of the police to immediately recognize the need and join with partners to provide an enhanced, specialized, developmentally-appropriate, trauma-informed, person-centered response. Police officers are already working, 24/7/365, round the clock, responding to emergencies. They are already paid for by our communities. We do not need additional officers to do this work, we simply need the officers who are already there to work differently. This model involves a shift in police response, and a shift in how officers think about their roles. Once that shift occurs, half of the work is done, within a department's existing budget. 

On the public health side of this program model, employing licensed mental health clinicians with specialized training in serving children and families impacted by acute trauma achieves multiple universal goals: Preventing the worsening of symptoms and multitude of potential lifelong health and social impacts of ACEs on individuals, providing equitable and accessible expert care to everyone in our community, utilizing preventive-based care strategies to apply lower-cost care options early and often, preventing the future need for expensive, longer-term care or care for chronic and debilitating health conditions. We can pay a little now, or a lot more later. The bulk of the finacial committment is for clinician salary and benefits. Funding the clinical positions within a public health organization or setting is the absolute right place to house this type of service. It should be immediate. It should be accessible. It should be universal. It should be free of charge. It must be public health. We cannot, as a country, (Especially now with our unnaceptable rates of gun violcence) afford not to do this work within every public health or community health organization financially able.

One of the key lessons learned is that starting small is ok, slow and steady growth can often be best when attempting new multi-disciplinary partnerships that require good relationships for sustainability. CDCP has survived based on shared committments between City and County governments, between agencies, and at it's heart, between police officers and child trauma clinicians. We cannot effectively engage the community if we do not have relationships at our bedrock. Like any solid, sustainable relationship, this takes time, intention, energy, commitment, and a lack of fear to address opportunities to change, improve, and grow over time.

Partnering outside of our comfort zones can be challenging on both sides. Police officers have high-stress jobs that involve multiple tasks be completed simultaneously during a response to a violent incident. The task of partnering with a clinician is often one that officers come to acknowledge the benefits of, only after having been involved in the process and participating in the positive outcomes for children. Initial police leadership vision and commitment is imperative. For clinicians, the CDCP role is not for everyone. Home visitation alongside police officers at crime scenes is difficult, and serving children and families in the midst of a crisis is very different work than serving them months or years later. CDCP clinicians often say that this is the absolute hardest professional role of their careers, and also their most rewarding. Sustainability on the clinical or public health side requires more than just financial committment, it too requires leadership committment and a committment to supporting staff who have incredibly important and difficult jobs. Here at MCPH, we have attempted to renew our committment to staff through an emphasis on professional growth opportunities, cultivating and prioritizing opportunities for them ro relax and rejuvinate as well as gathering monthly as a team to celebrate them and their good work, and to have fun and fellowship.

We have been very lucky to have had, now for over 26 years, constant support from our Police and City leaders as well as our County and Public Health leaders. We have grown little by little, over time, into a community staple and a safety net for our children. We have created an entire generation of police officers and public health clinicians who work alongside one another without question, as if we had always responded this way, and served this way. Protected this way. Our local police officers can ask all of the trauma screening questions by heart, and our clinicians know their next referral when they hear the calls go out on the police radios. 

Just today I received a text message from a police officer about to retire from 30 years of service. His text was a photo of a young man in a US Army uniform, holding an adorable, chubby-cheeked baby boy. The young man in uniform was a former CDCP client we responded to several times together, over 15 years ago. Now a proud young father, showing off his beautiful son to the officer who had helped him and stayed in touch with as he moved through life. In addition to solid relationships between partners, the long-term "Sustainability" of CDCP lies in that young man's family, and the thousands of others like him. In the father he can be, having received the help he received, when he needed it most. The sustainability of our program lies in both the immediate response to traumatized children and and the potential impact on future generations by their ability to be their children's best support in the midst of adversities they may face. In their potential to be their community's best support as their neighbors face adversities. We know we cannot prevent every ACE for every child. But one child at a time, one family at a time, we can face down trauma and we can build each other up. Generation after generation.