ecobiodevelopmental theory asserts that:shoprider mobility scooter second hand

Its components emerge in infancy and are dependent on genetic, medical, and environmental factors. The Ecobiodevelopmental Model of Health. In order to develop normally, a child requires progressively more complex joint activity with one or more adults who have an irrational emotional relationship with the child. Eco-biodevelopmental models are advocated by the American Academy of Pediatrics, and these models offer insights into the neurobiological processes associated with environmental factors and the ways in which these processes may be addressed to improve outcomes. In the absence of SSNRs, many different forms of childhood adversity (from catastrophic episodes of abuse or violence to chronic conditions, such as exposure to racism, poverty, and/or neglect) can lead to toxic stress responses that result in changes at the molecular, cellular, and behavioral levels and negatively impact outcomes in health, education, and economic productivity. This toxic stress framework is powerful, because it taps into a rich and increasingly sophisticated literature describing how early childhood experiences are biologically embedded and influence developmental outcomes across the life course.1214 This was the focus of the original technical report on toxic stress from the American Academy of Pediatrics (AAP) in 2012.2 Current threats to child well-being and long-term health, such as widening economic inequities, deeply embedded structural racism, the separation of immigrant children from their parents, and a socially isolating global pandemic, make the toxic stress framework as relevant as ever. Relational health defines the solution. HealthySteps uses a tiered approach to match services with the level of need, and the core components include: (1) child development social-emotional, and behavioral screening, (2) screening for family needs, (3) child development support line (eg, phone, text, e-mail, and online portal), (4) child development and behavioral consultants, (5) care coordination and systems navigation, (6) positive parenting guidance and information, (7) early learning resources, and (8) ongoing, preventive team-based well-child visits. Variations, taking into account individual circumstances, may be appropriate. 13, Thinking Developmentally: Nurturing Wellness in Childhood to Promote Lifelong Health, Resilience to adversity and the early origins of disease, Emotional and behavioural resilience to multiple risk exposure in early life: the role of parenting, A Secure Base: Parent-Child Attachment and Healthy Human Development, Object relations, dependency, and attachment: a theoretical review of the infant-mother relationship, Touchpoints: Birth to 3: Your Childs Emotional and Behavioral Development, Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. 3. In addition to the domains and timing of chaos, ecobiodevelopmental theory argues that the intensity of environmental chaos is important- that adverse environmental experiences which are deep, prolonged, and extensive are more detrimental to children's health and well-being than unfavorable experiences that . A public health approach to promoting relational health should also be integrated horizontally (or across sectors) at the local level.81,82,148 SSNRs are easier to form when safe, stable, and nurturing families are able to live in safe, stable, and nurturing communities.124,149,150 The FCPMH is ideally placed to educate families about what a safe, stable, and nurturing family environment looks like for a child, but doing so will require changes at the provider and practice levels (see Table 2). The challenge, then, is not only to prevent adversity but also (for mothers, fathers, and other engaged adults) to actively promote positive relational experiences throughout infancy and childhood. Similarly, symptomatic children need to be referred to evidence-based treatment programs (eg, ABC, PCIT, CPP, TF-CBT), but these are supplemental to and do not replace either targeted interventions for potential barriers to SSNRs or the aforementioned universal primary preventions. Other investigators have applied the term ACEs to additional adversities known to affect child health, such as poverty, neighborhood violence, and exposure to racism. Encourage them to become leaders in interdisciplinary early childhood systems work and vocal advocates for public policies that promote positive relational experiences in safe, stable, and nurturing families and communities. Early childhood experiences, both adverse and positive, appear to be biologically embedded and influence both disease and wellness across the life course.30 The ecobiodevelopmental model of disease and wellness explains how the ongoing but cumulative and reciprocal dance between ecology and biology leads to changes at the molecular (eg, methylation patterns), cellular (eg, brain connectivity patterns), and behavioral levels (eg, tobacco, alcohol, or other substance use).2,17 These changes are either adaptive or maladaptive depending on the context, and they are either benefits or risks to future health, academic success, and economic productivity.75. The ecobiodevelopmental model suggests that, to improve the likelihood of positive developmental outcomes across the life span, efforts should be made to improve the salient features of the childs environment. Periods of Development 1. Developmental science is only beginning to understand the way relational health buffers adversity and builds resilience, but emerging data suggest that responsive interactions between children and engaged, attuned adults are paramount.1,16,114,115 Not only are infants programmed to connect socially and emotionally with adult caregivers,116 but the brains of parents of newborn infants appear to be reprogrammed to connect with their infants.117 Imaging studies of new parents demonstrate changes in several major brain circuits, including a reward circuit, social information circuit, and emotional regulation circuit.117,118 The reward circuit includes the striatum, ventral tegmental area, anterior cingulated cortex, and prefrontal cortex, where dopamine and rising levels of oxytocin interact to make social interactions more rewarding, thereby encouraging more parental engagement in infant care.118,119 The social information circuit includes structures such as the anterior insula, inferior frontal gyrus, superior temporal gyrus, and supplemental motor area, which support internal representations of what others may be experiencing and more empathic responses to infant behaviors.118,119 Finally, the emotional regulation circuit includes the amygdala, superior temporal sulcus, temporoparietal junction, and prefrontal cortex, which promote social cognition and a downregulation of the stress response.118,119 The convergent conclusion from these preliminary imaging studies of the parental brain is clear: much like the infant brain, the parental brain is programmed to connect. Identify and address potential barriers to SSNRs. Three indicators of flourishing are amenable to parental report and are rough markers of executive function: (1) the child shows interest and curiosity in learning new things, (2) the child works to finish tasks he or she starts, and (3) the child stays calm and in control when faced with a challenge.59 In analyses of data from the 20162017 National Survey of Childrens Health, the prevalence of flourishing children increased in a graded fashion with increasing levels of family resilience and connection.59 In fact, a higher percentage of children with high adversity (ACE scores 49) but high family connection and resilience were flourishing (30.5%) than children with low adversity (ACE score of 0) but low family resilience and connection (26.8%).59 Approaches to minimizing toxic stress that only look at measures of adversity (such as ACE scores or biomarkers) will miss out on opportunities to support the relational health that promotes flourishing despite adversity. Relational health explains how SSNRs buffer adversity and promote the skills needed to be resilient in the future. Scientists now theorize that toxic stress causes epigenetic changes that allow trauma to be transmitted over the generations. However, FCPMHs are also called to advocate for policies at the federal, state, and local levels that promote safe, stable, and nurturing communities. Feminist theory asserts that gender is a social construct and that the unequal treatment of women is a result of patriarchal norms and values. Driving this transformation are advances in developmental sciences as they inform a deeper understanding of how early life experiences, both nurturing and adverse, are biologically embedded and influence outcomes in health, education, and economic stability across the life span. An ecobiodevelopmental framework sheds new light on the biological basis for persistent disparities in education, poverty, and health. Psychology - 9.2: Lifespan Theories by CNX Psychology is licensed under CC BY 4.0. Acronym for the social determinants of health; SDoHs refer to conditions where people live, learn, work, and play (like socioeconomic status, social capital, or exposure to discrimination or community violence) that are known to affect health outcomes across the life span. Acknowledge that a wide range of adversities, from discrete, threatening events to ongoing, chronic life conditions, share the potential to trigger toxic stress responses and inhibit the formation of SSNRs. Foster strong, trusted, respectful, and effective collaborations with the community partners who are well-positioned to provide the individualized prevention, intervention, and treatment strategies. Primary preventions in the toxic stress framework are focused on how to prevent the wide array of adversities that might precipitate a toxic stress response. A public health approach that cuts across traditional silos and funding streams; a horizontally integrated public health approach also includes the educational, civic, social service, and juvenile justice systems. For children at higher risk for toxic stress responses, targeted secondary interventions with tiered services (eg, HealthySteps84,85) may be needed. This title is accompanied by a complete teaching and learning package. Relational health, in the form of at least one SSNR, is a universal, biological imperative for children to fulfill their potential; to be healthy and resilient; to be successful academically, economically, and socially; and, perhaps most importantly, to be the caregivers that value and build SSNRs with subsequent generations. Learning Objective: Describe the structure and function of genes. Build the therapeutic alliance; surveil for possible barriers to SSNRs; champion screening at practice level; endorse referral resources. Embrace an ecobiodevelopmental model for understanding how both adverse and positive relational experiences in childhood become biologically embedded and impact both negative and positive outcomes across the life course. Understanding, practicing, and reinforcing executive functions and self-regulation skills (eg, managing strong emotions, ensuring adequate sleep, and getting regular exercise) is essential because all caregivers need these skills to create the kinds of environments in which children thrive.16,37,59 Whether an adult coaching or skill-building component is incorporated within a FCPMH or connected to it in a collaborative manner, the essential role that these programs play in promoting the healthy development of children is clear, especially for those who are the most disadvantaged.1,16. This wide spectrum of adversity underscores the fact that ACE scores and other epidemiologically derived risk factors at the population level are not valid or reliable predictors of outcomes at the individual level.56 Toxic stress, by contrast, refers to an individuals physiologic response to these adversities, and biomarkers of this physiologic response have the potential to be more sensitive and specific measures of experienced adversity at the individual level.37 Validated biomarkers also offer transformational potential as measures of responsiveness to specific interventions.37,57 With these applications in mind, the pediatric research community is hoping to develop clinic-friendly, noninvasive biomarkers for different forms and degrees of adversity. Recent research suggests that this dyadic need to connect promotes the development of biobehavioral synchrony between parents and infants.119,120 Feldman119 states, Such coordination is observed across four systems: the matching of nonverbal behavior; the coupling of heart rhythms and autonomic function; the coordination of hormone release [eg, oxytocin following contact with both mothers and fathers]; and brain to brain synchrony [eg, coordinated brain oscillation in alpha and gamma rhythms]. Because the human brain is so immature at birth, the infant is dependent on this biobehavioral synchrony not only for survival but also for laying the foundation for future self-regulation and social-emotional skills. Both genetic and epigenetic factors interact with. The coronavirus pandemic has highlighted the urgent need to provide all children with the SSNRs that buffer unexpected adversities and build the skills necessary to be resilient. These techniques come from family therapy, cognitive therapy, motivational interviewing, family engagement, family-focused pediatrics, and solution-focused therapy. Arwa Abdulhaq Nasir, MBBS, MSc, MPH, FAAP, Sharon Berry, PhD, LP, ABPP Society of Pediatric Psychology, Edward R. Christophersen, PhD, ABPP, FAAP , Kathleen Hobson Davis, LSW Family Liaison, Norah L. Johnson, PhD, RN, CPNP-BC National Association of Pediatric Nurse Practitioners, Abigail Boden Schlesinger, MD American Academy of Child and Adolescent Psychiatry, Rachel Segal, MD Section on Pediatric Trainees, Amy Starin, PhD, LCSW National Association of Social Workers, Peter J. Smith, MD, MA, FAAP, Chairperson, Carol Cohen Weitzman, MD, FAAP. Copyright American Academy of Pediatrics. Prepare residents to work as part of the interdisciplinary teams144 that transform FCPMHs into hubs for medical neighborhoods.161. Help Me Grow National Center. Proposing that the public health approach also be integrated horizontally across multiple public service sectors (eg, health care, behavioral health, education, social services, justice, and faith communities) because SSNRs are promoted in safe, stable, and nurturing families that have access to safe, stable, and nurturing communities with a wide range of resources and services. In the past decade or so, biomedical researchers have proposed an ecobiodevelopmental framework for studying health and disease across the life course . culturally effective: the family and child's culture, language, beliefs, and traditions are recognized, valued, and respected. : Working Paper No. For example, expanding family leave policies154 could reduce family stress and promote positive childhood experiences. Executive functions are core life skills, and they include capacities like impulse inhibition, working memory, cognitive flexibility, abstract thought, planning, and problem solving. Finally, the diverse conditions included in a broader spectrum of adversity make the formation of SSNRs more difficult. A public health approach that includes primary universal preventions to promote wellness (like promoting positive parenting practices), secondary targeted interventions for those deemed to be at risk for poor outcomes (like using biomarkers both to identify those at higher risk and to monitor the effectiveness of various interventions), and tertiary evidence-based treatments for the symptomatic (like referring to providers trained in TF-CBT). Acronym for the Video Interaction Project; VIP uses video-taped interactions of parent-child dyads to teach parents how to be more engaged, attuned, and responsive to their childs developing behaviors. Theories that support a relationship-based framework 1. An FCPMH is not a building or place; it extends beyond the walls of a clinical practice. It was heralded as a good thing. Drawing on a framework produced by the Center on the Developing Child at Harvard University,192 this policy statement highlights the following 3 science-informed principles to prevent toxic stress responses and to build healthy, resilient children. Young children are more li Advocate that health systems, payers, and policy makers at all levels of government align incentives and provide funding to promote the universal primary prevention work discussed in this policy statement. To determine an individuals ACE score, see http://acestoohigh.com/got-your-ace-score. Simply put, public policies, social constructs, and societal norms that divide, marginalize, alienate, and isolate are clear threats to the well-being of all children. Tertiary preventions in the toxic stress framework are focused on the evidence-based practices that treat toxic stress-related morbidities such as anxiety, depression, oppositional defiant disorder, posttraumatic stress disorder, and substance abuse disorder. Acronym for Parent-Child Interaction Therapy; PCIT is an evidence-based intervention to change the patterns of parent-child interactions to improve the parent-child relationship. Dara's parents both work for a corporation that expects them to work for 50 hours a week. Trainees need to understand all of these many facets so they are prepared to be effective advocates for their patients and families. In the original ACE Study, 10 categories of adversity were examined: emotional, physical, and sexual abuse; 5 measures of household dysfunction, including the mother being treated violently (intimate partner violence), household substance abuse, household mental illness, parental separation or divorce, and incarcerated household member; and emotional or physical neglect. Fortunately, adversity in childhood is only half the story, as positive experiences in childhood are associated with improved outcomes later in life. Tertiary preventions in the relational health framework are focused on the evidence-based practices such as ABC, CPP, or PCIT that repair strained relationships and assist them in becoming more safe, stable, and nurturing. If nothing else, pandemic-mandated stay-at-home orders should increase our collective awareness of the distress associated with being socially isolated or vulnerable. 7. Policy statements from the American Academy of Pediatrics benefit from expertise and resources of liaisons and internal (AAP) and external reviewers. Author Biography Andrew S. Garner, MD, PhD, is a primary care pediatrician with University Hospitals Medical Practices, and Associate Clinical Professor of Pediatrics at Case Western Reserve University School of . This emphasis on universal primary preventions is congruent with the fact that more children are mentally and socially well and flourish as adults, regardless of their level of childhood adversity, if they also are afforded positive relational experiences and high family resilience and connection during childhood.59,121 Relational health includes more than nurturing in its traditional, spoken sense (eg, verbal warmth or responsivity); it also includes the activities that support the relationship more broadly (eg, reading aloud and a prescription to play), and research has documented that nurturing words and actions are inextricably linked.137 Although there are both practice-based (eg, Reach Out and Read [ROR],129,138,139 the Video Interaction Project [VIP],66,72 HealthySteps84,85) and community-based programs (eg, positive parenting programs,140,141 home visiting programs,142,143 quality early child care settings69,71) that promote these early positive relational experiences, they are not funded at levels that would make them universally accessible. The concept of childhood toxic stress taps into a rich literature on the biology of adversity and explains the danger in overlooking significant adversity in childhood. Identify and address sources of inequity, isolation, and social discord (poverty and racism). To translate this relational health framework into clinical practice, generative research, and public policy, the entire pediatric community needs to adopt a public health approach that builds relational health by partnering with families and communities. "The . Teach residents how to identify and develop collaborative relationships with the local referral resources and early childhood initiatives in their communities. Dr Garner collaborated in conceptualizing and drafting this document, took the lead in reconciling the numerous edits, comments, and suggestions made by many expert reviewers, and made significant contributions to the manuscript; Dr Yogman collaborated in conceptualizing and drafting this document and made significant contributions to the manuscript; and all authors approved the final manuscript as submitted. In the case of toxic stress responses, universal primary prevention means trying to prevent the precipitants of toxic stress responses (eg, advocating to address the spectrum of adversities discussed above) as well as promote healthy, adaptive responses to adversity through the provision of social supports that nurture the development of foundational resilience skills (such as task persistence, curiosity, and self-regulation).16,19,59,83, A public health approach to prevent childhood toxic stress is a public health approach to promote relational health. The AAP remains committed to respond when empirical evidence and the latest developmental science shine new light on the issues and trends of the day. They have been proven useful and effective in addressing mental health symptoms in pediatrics across the age spectrum (as per the AAP policy statement on mental health competencies in pediatric care). Order: This principle asserts that for an organization to run smoothly, the right person must be in the right job and that, therefore, every material and employee should be given a proper place. This public health approach to relational health needs to be integrated both vertically (by including primary, secondary, and tertiary preventions) and horizontally (by including public service sectors beyond health care). Finally, many of the indicated treatments for children who are symptomatic as a result of toxic stress are programs that focus on repairing strained or compromised relationships (eg, ABC, PCIT, CPP, and TF-CBT). Toxic stress responses are known to alter multiple systems that interact in a reciprocal and dynamic manner: genomic function, brain structure and connectivity, metabolism, neuroendocrine-immune function, the inflammatory cascade, and the microbiome.13,14 Toxic stress-induced alterations also influence the adoption of maladaptive coping behaviors decades later.3740. Toxic stress explains how a wide range of ACEs become biologically embedded and alter life-course trajectories in a negative manner. For example, significant adversity in the last trimester of pregnancy is associated with methylation of the childs glucocorticoid receptor gene.76 In adults, the methylation of this gene is associated with the expression of fewer glucocorticoid receptors in the brain.5 Because cortisol downregulates its own production via negative feedback loops in the brain that use glucocorticoid receptors, children with fewer glucocorticoid receptors would be expected to have higher cortisol levels and be more irritable and harder to console.77 These changes could be considered adaptive and beneficial in the short-term because they might prepare the newborn infant for a stressful world in which the infant may need to be more vocal to have his or her needs met. Relational health explains how the individual, family, and community capacities that support the development and maintenance of SSNRs also buffer adversity and build resilience across the life course. These varied adversities share the potential to trigger toxic stress responses and inhibit the formation of SSNRs. Build the therapeutic alliance; promote positive parenting; encourage developmentally appropriate play. A vertically integrated public health approach acknowledges that universal primary preventions are absolutely necessary yet insufficient to promote relational health. Move beyond singular, panacea programs toward a layering of interventions that are integrated, both vertically and horizontally, into the local public health efforts to promote safe, stable, and nurturing communities, families, and relationships. Applying a public health approach to the promotion of relational health (see Fig 1) reveals that many of the universal primary preventions for toxic stress are also effective means of promoting the development of SSNRs (eg, positive parenting styles, developmentally appropriate play with others,66,73,74,128 and shared reading129,130). Unfortunately, the two theories are very much at odds regarding what is "right." Shareholder theory asserts that shareholders advance capital to a company's managers, who are supposed to spend corporate funds only in ways that have been authorized by the shareholders. Children with known adversity but no overt symptoms,18 children with parents who experienced significant adversity as a child,86 and families struggling with the social determinants of health (SDoHs) (eg, poverty leading to food or housing insecurity,87,88 language barriers, or acculturation leading to conflicts within immigrant families89) may benefit from an array of interventions that mitigate specific risk factors. Universal screening for prevalent barriers seen in that practice; facilitate, track, and follow-up on referrals offered. Acronym for Attachment and Biobehavioral Catch-up; ABC is an evidence-based program of interventions to assist foster parents in nurturing children who have experienced disruptions in care. Stability of tenure: This principle says employees must have job security to be efficient. Biological Sensitivity to Context/Adaptive Calibration Model. Advances in fields of inquiry as diverse as neuroscience, molecular biology, genomics, developmental psychology, epidemiology, sociology, and economics are catalyzing an important paradigm shift in our understanding of health and disease across the lifespan. By continuing to use our website, you are agreeing to, COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH, SECTION ON DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS, COUNCIL ON EARLY CHILDHOOD, The Ecobiodevelopmental Model of Disease and Wellness, Components of a Public Health Approach to Toxic Stress, The Emerging Science of Relational Health, Links Between Relational Health and Resilience, A Public Health Approach to Build Relational Health, Vertical Integration to Match Levels of Need With Specific Interventions, Horizontal Integration Across Sectors at the Community Level, The Centrality of Relationships in Pediatric Care, Acknowledging the Role and Toll of Social Isolation, A Renewed Commitment to Science-Based Policy Formation, Application of Science-Based Principles to Strengthen Pediatric Practice, Reduce External Sources of Stress on Families, Glossary of Terms, Concepts, and Abbreviations, Committee on Psychosocial Aspects of Child and Family Health, 20202021, Section on Developmental and Behavioral Pediatrics, 20202021, Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician: Translating Developmental Science Into Lifelong Health, http://acestoohigh.com/got-your-ace-score, https://psych.utah.edu/research/labs/biological-sensitivity.php, https://developingchild.harvard.edu/resources/wp1/, https://developingchild.harvard.edu/resources/supportive-relationships-and-active-skill-building-strengthen-the-foundations-of-resilience/, https://developingchild.harvard.edu/resources/wp3/, https://developingchild.harvard.edu/resources/building-the-brains-air-traffic-control-system-how-early-experiences-shape-the-development-of-executive-function/, https://developingchild.harvard.edu/resources/the-timing-and-quality-of-early-experiences-combine-to-shape-brain-architecture/, https://helpmegrownational.org/hmg-system-model/, https://developingchild.harvard.edu/resources/three-early-childhood-development-principles-improve-child-family-outcomes/. Emphasizing that the vertical integration of this public health approach or the layering of primary, secondary, and tertiary preventions and/or interventions is necessary because the heterogeneity of responses to adversity seen at the population level will need to be addressed through a menu of programs that are layered and matched to specific levels of individual need (universal preventions, plus targeted interventions for those at risk, plus indicated therapies for those with symptoms or diagnoses). See the Appendix for full descriptions of the abbreviations. An important consideration across many harmed and exploited communities (such as American Indian or Alaska Native populations) is the accumulation of toxic stress responses across generations, sometimes referred to as historical trauma.60 Although higher levels of historical trauma are associated with poorer health outcomes, the science underlying these associations is only now being studied rigorously.61 A detailed discussion of historical trauma and the special needs of these communities is beyond the scope of this policy statement, but the layered, integrated public health approaches presented here to prevent childhood toxic stress and promote relational health might inform efforts to address historical trauma as well. To minimize the burden of toxic stress responses at the population level, the entire pediatric community needs to identify and address not only the acute threats to child wellness such as abuse and physical violence but also the ongoing, chronic life conditions such as racism, poverty, and isolation that are rooted in deep-seated social constructs, societal inequities (including those within the health care system), and public policies that inhibit social cohesion, equity, and relational health. Build the therapeutic alliance; employ a common-factors approach; explain behavioral responses to stress; endorse referral resources. Emerging data supporting a biological sensitivity to context (see the Appendix for a glossary of terms, concepts, and abbreviations) begin to explain heterogeneous responses to both adversity and interventions at the population level.92,131136 Consequently, there is an urgent need for a battery of biological, behavioral, and contextual markers that might better stratify both the risks and predicted responsiveness to interventions at the individual level.37 FCPMHs (see the Appendix for a detailed description) are well placed to begin matching levels of need with specific types of interventions, a process known as vertical integration.82.

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