Kansas City’s Resilient KC initiative, a partnership of Healthy KC and Trauma Matters KC, supports the emerging “upstreamist” movement in health care. The concept is to address health problems before they emerge as individual or community-centered health issues. Resilient KC targets community-based trauma.
Long-term and often invisible damage can be caused by childhood abuse and neglect, a troubled home or toxic stress. These factors can influence an individual’s physical and behavioral health throughout life — and even result in early death. Research suggests that this damage is compounded by multiple adverse childhood experiences (ACEs).
No Missouri or Kansas community is immune from these factors. Sadly, some are at high risk for all.
Resilient KC’s website allows members of the community to develop a personal ACE score. Unfortunately, a personal ACE score is a “downstream” score. The Kansas Hospital Association and Missouri Hospital Association wondered whether a community-level score could be developed to help stakeholders identify the home- and community-based risks for ACEs to help steer assets toward these high-risk targets. This would focus resources more effectively on ACE prevention.
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In first of its kind research, the Kansas Hospital Association and Missouri Hospital Association were able to deliver a community ACE score at the ZIP-code level for communities in both states. The risk analysis, developed by the Hospital Industry Data Institute, aggregated three years of hospital inpatient, outpatient and emergency department data at the ZIP-code level for Kansas and Missouri. The review included hospital codes for 25 measures attributed to abuse, neglect, household challenges and toxic stress factors.
The data are alarming. High-risk ZIP codes can be found throughout each state, including rural and urban communities.
In the Kansas City metro area, high-risk areas were apparent in Kansas City’s core ZIP codes and stretched across Jackson County and into much of Wyandotte County. The majority of ZIP codes in northern and western Jackson County also were identified as high risk.
There’s more. Communities with high gun violence were found to be highly correlated with negative childhood experiences. Between 2006 and 2015, Kansas and Missouri rates of gun-related hospitalization and pediatric stress diagnosis in the top 20 ZIP codes were significantly higher than statewide rates. In Kansas, the top 20 ZIP codes for gun violence had a 233 percent higher rate than statewide. In Missouri, the top 20 had a 845 percent difference. The rate of childhood stress diagnoses in the top 20 ZIP codes for gun violence in Kansas and Missouri was 55 percent and 75 percent higher, respectively.
Treating the cumulative effects of ACEs long after the fact is costly to the health care system and the individual. And evidence suggests the downstream costs of Kansas City-area childhood trauma are high.
A profile of work being done at Truman Medical Center-Behavioral Health in Kansas City found that many of the center’s clients suffer from significant physical and behavioral health problems resulting from traumatic childhood events. Many of these clients come from the ZIP codes with the highest ACE scores in the greater Kansas City area.
Although the risk-based modeling in the research is preliminary, a ZIP-code-level tool holds promise for hospitals and their partners’ collaborative population health improvement efforts. Nonetheless, better identification of communities with high risk for ACE can improve stakeholders’ targeting of limited resources.
Situated at the confluence of the Kansas and Missouri rivers, Kansas Citians know that what happens upstream matters.
Adverse childhood experiences have high downstream costs — poorer health, lower quality of life and reduced longevity. Better health starts upstream from the health care system.
Tom Bell, of Topeka, is the president and CEO of the Kansas Hospital Association. Herb B. Kuhn, of Jefferson City, is the president and CEO of the Missouri Hospital Association.