 Table of Content:
- Focus
- Items of Interest
- Resources
- In the Literature
|
Focus: Adverse Childhood Experiences in Minnesota (ACES)
An extensive and growing body of research documents that adverse childhood experiences (ACEs)—including abuse, neglect, as well as mental illness, problematic drinking or drug abuse, or incarceration of a household member, and divorce or domestic violence occurring before age 18—are linked to poor physical and mental health, chronic disease, lower educational achievement, lower economic success, and impaired social success in adulthood.
In 2011, the Minnesota Department of Health surveyed over 13,000 Minnesotan adults on their ACEs and current health and well-being. The results from this survey are consistent with the findings from other ACE studies. First, ACEs are common among Minnesotans. Over half (55%) of Minnesotans have experienced at least one ACE. In particular, ACEs are more common among Minnesotans who did not graduate from high school, who were unmarried, who rented rather than owned their own home, who were unemployed, or who worried about paying their mortgage or rent or about buying nutritious food. Second, ACEs frequently occur together. In Minnesota, over half (60%) of Minnesotans with at least one ACE had two or more ACEs. Third, ACEs have a strong and cumulative impact on the health and functioning of adults. For example, Minnesotans with more ACEs, as adults, were more likely to rate their health as fair or poor, more likely to have been diagnosed with depression or anxiety, more likely to report smoking and chronic drinking, more likely to have been diagnosed with asthma, and more likely to be obese.
Stress: ACEs have an effect on the developing brain
Stress in reasonable doses promotes growth and brain development throughout childhood. Stress is a normal part of daily life and learning how to manage stress and regulate stress responses is critical to a child’s development. However, acute or prolonged stress can become toxic to the developing brain and body. ACEs can cause toxic stress.
Children’s stress response systems are immature at birth and therefore vulnerable to maltreatment and neglect. If the adults in a child’s life are not able to buffer the stress or are themselves the source of the stress, the child may begin to experience the world as dangerous and uncertain. In the face of danger, the body reacts by producing excess surges in stress hormones, such as cortisol.
In childhood, persistent and intense stress stemming from ACEs actually influences how the brain develops. Toxic stress strengthens connections in the parts of the brain that are associated with fear, arousal, and emotional regulation. Additionally, toxic stress negatively impacts parts of the brain associated with learning and memory. Continuous activation of the stress response system can also produce disruptions of the immune and metabolic systems. This can result in a lifetime of greater susceptibility to physical illness as well as mental health problems.
Resilience: some children thrive despite ACEs
Adversity is only one part of the equation. Children may also have their own characteristics and experiences that protect them and help them develop resilience despite exposure to ACEs. In the face of adversity, neither resilience nor disease is a certain outcome.
Resilience is the result of a dynamic set of interactions between a person’s adverse experiences and his or her protective factors. This interaction is what determines the developmental path towards health and well–being or towards illness and dysfunction. No child is magically resilient or invulnerable to ACEs, just as no individual child is automatically doomed in the face of ACEs. These protective factors can include a person’s own biological and developmental characteristics. But protective factors can also include characteristics of the family, community, and systems that mitigate the negative impacts of ACEs. Protective factors help explain how some people who have sustained a great deal of adversity as children have fared relatively well in adulthood.
The presence of protective factors, particularly safe, stable, and nurturing relationships, can often mitigate the consequences of ACEs. Individuals, families, and communities can all influence the development of many protective factors throughout a child’s life that can impact his or her development.
How does resilience develop? There are multiple pathways to resilience. Resilience researchers continue to refine understanding about the ingredients and processes involved in supporting resilience. However, there is agreement about a variety of important individual, family and community conditions that support resilience. Here is a list of protective factors:
- Close relationships with competent caregivers or other caring adults
- Parent resilience
- Caregiver knowledge and application of positive parenting skills
- Identifying and cultivating a sense of purpose (faith, culture, identity)
- Individual developmental competencies (problem solving skills, self–regulation, agency)
- Children’s social and emotional health
- Social connections
- Socioeconomic advantages and concrete support for parents and families
- Communities and social systems that support health and development, and nurture human capital
Protective factors help a child feel safe more quickly after experiencing the toxic stress of ACEs and help to neutralize the physical changes that naturally occur during and after trauma. If the child’s protective networks are in good working order, development is strong even in the face of severe adversity.
If these major systems are impaired, either before or after the ACE, then the risk for developmental problems is much greater. This is particularly true if the environmental hazards are prolonged. In sum, even the negative consequences of toxic stress from ACEs can be buffered with the support of caring, competent adults and appropriate intervention and support.
Currently, trained community resilience coaches are presenting the ACE data to community groups throughout the state and a multi-state agency and community effort to reduce ACEs and build community resiliency is being planned. Please contact Autumn Baum, ACE Coordinator at the Minnesota Department of Health, for more information. Autumn.Baum@state.mn.us
***** See the reference in the "In the Literature" Section of this Newsletter for the reference to the Minnesota ACEs Report .
Focus: Turtles and other reptiles are risky pets
Turtles are colorful and cute and are often kept as pets. However, many people don’t know that turtles and other reptiles like snakes and lizards can carry harmful germs that can make people (students) very sick. For this reason, turtles and other reptiles might not be the best pets for the school classroom, particularly if there are young children, 5 years-old and younger or people with weakened immune systems in your school.
Turtles, and other reptiles, often carry a germ called Salmonella, but appear perfectly healthy and clean. People think Salmonella infections are caused only by contaminated food, but these germs can also be caught by touching animals, including reptiles or amphibians, such as frogs. Salmonella infections can also result from having contact with an animal’s habitat, including the water from containers or tanks where they live.
Salmonella germs can make people sick with diarrhea, vomiting, fever, and sometimes abdominal cramps. This illness is called “salmonellosis.” Some people can become so sick that they need to go to the hospital. In severe illnesses, the Salmonella bacteria may spread to the bloodstream and can lead to death unless the person is treated promptly with antibiotics.
Young children are at increased risk for Salmonella illness because their immune systems are still developing. They also are more likely to put their fingers or other items that have come into contact with germs into their mouths. Turtles should not be allowed in schools or child care facilities with young children.
Since 1975, it has been illegal in the United States to sell or distribute small turtles with shells that measure less than 4 inches in length. This size was chosen because young children are more likely to treat smaller turtles as toys and put them in their mouths. This ban, enforced by the U.S. Food and Drug Administration, likely remains the most effective public health action to prevent Salmonella infections associated with turtles.
Tips to reduce the risk of illness from turtles and other reptiles:
1. Don’t buy small turtles from street vendors, websites, pet stores, or other sources.
2. Wash your hands thoroughly with soap and warm water immediately after touching a reptile or anything in the area where they live and roam. Use hand sanitizer if soap and water are not readily available. Adults should always supervise hand washing for students.
3. Don’t let young children handle or touch reptiles or anything in the area where they live and roam, including water from containers or tanks.
4. Keep reptiles out of schools / homes with young children or people with weakened immune systems.
5. Reptiles should not be kept in child care centers, nursery schools, or other facilities with young children.
6. Don’t touch your mouth after handling reptiles and do not eat or drink around these animals.
7. Use disposable gloves when cleaning and do not dispose of water in sinks used for food preparation or for obtaining drinking water. ◦
8. Don't bathe animals or clean their habitats in your kitchen sink, bathroom sink, or bathtub. To prevent cross-contamination, animals should be bathed in a small plastic tub or bin that is dedicated for animal use only.
9. Don’t let reptiles roam freely throughout the areas where food or drink is prepared, served, or stored.
For more information on protecting yourself and your students/families and school from illness and to learn more about safely cleaning reptile habitats, please visit http://www.cdc.gov/Features/SalmonellaFrogTurtle/
Resources
Toolkit Provides Guidance on Puberty in Children with Disabilities
Healthy Bodies: A Parent's Guide on Puberty for Boys with Disabilities and Healthy Bodies: A Parent's Guide on Puberty for Girls with Disabilities provides resources and tips to help parents talk to their children about topics related to puberty. The publications were produced by the Vanderbilt Kennedy Center for Excellence in Disabilities with support from the Health Resources and Services Administration's Maternal and Child Health Bureau. Topics include encouraging good hygiene and appropriate behavior and how to deal with physiological manifestations of puberty. The publications may be individualized to include an organization's name and its most frequent referrals. Appendices with social stories and visual supports are also available. The publications and appendices are available at http://kc.vanderbilt.edu/healthybodies
State Child Welfare Policy Database
State Child Welfare Policy Database, a resource from Casey Family Programs, provides state-by-state policy information on a range of child welfare topics. Individuals can access up-to-date information on individual state policies and can compare their own state's policies to those of other states. New topics will be included in the database regularly. http://www.childwelfarepolicy.org/
The National Child Traumatic Stress Network
The National Child Traumatic Stress Network has recently shared some helpful resources on child maltreatment and caregiver incarceration. Please find links to these resources below. Also included on the list is a link to the Juvenile Justice Bulletin on detained youth from the Child Welfare League of America.
Child Maltreatment 2011 - Child Maltreatment Fact Sheet - Data from NCANDS, 2011:
https://www.childwelfare.gov/pubs/factsheets/canstats.cfm
Preventing Child Maltreatment and Promoting Well-Being: A Network for Action 2013 Resource Guide:
https://www.childwelfare.gov/preventing/preventionmonth/guide2013/index.cfm
OJJDP Juvenile Justice Bulletin: PTSD, Trauma, and Comorbid Psychiatric Disorders in Detained Youth:
http://www.ojjdp.gov/pubs/239603.pdf
Sesame Street Online Toolkit: Little Children, Big Challenges: Incarceration:
http://www.sesamestreet.org/parents/topicsandactivities/toolkits/incarceration
Be Alert to the Signs of Indoor Air Quality (IAQ) Problems in Your School
Poor IAQ Can Affect Health: Can You Recognize the Symptoms?
Poor indoor air quality (IAQ) in schools can lead to a wide variety of health problems for students and staff, which may lead to a loss in productivity, reduced academic performance, http://www.epa.gov/iaq/schools/student_performance/evidence.html and an increase in absenteeism. Being aware of common health symptoms caused by poor IAQ can help you identify, resolve and prevent the issues from becoming more serious IAQ problems.
Identifying short-term effects of IAQ can be a challenge, as they can be similar to those produced by a cold, allergies or the flu. These include common symptoms like: http://www.epa.gov/iaq/schools/symptoms.html
• Cough
• Fatigue, drowsiness, dizziness or lethargy
• Fever
• Headache
• Nausea
• Sinus congestion
• Skin irritation
• Sneezing
How to Determine if You Have an IAQ Problem in Your School
Familiarize yourself with the typical sources of indoor air pollutants. http://www.epa.gov/iaq/schools/tfs/guide2.html#Typical%20Sources%20of%20Indoor%20Air%20Pollutants
Although it is not easy to determine if health symptoms relate to IAQ problems, the following clues may suggest that IAQ is the source.
• Symptoms are widespread within a classroom or area of the school.
• Symptoms disappear when students and staff leave the school building.
• Onset of symptoms is sudden after a change made at the school, such as building renovation, pesticide application, painting, or changes in cleaning practices.
• People with allergies, asthma or chemical sensitivities have reactions indoors but not outdoors.
Resources to Help You Resolve and Prevent Indoor Air Quality (IAQ) Problems
Environmental Protection Agency's (EPA’s) IAQ Tools for Schools Framework for Effective School IAQ Management helps schools identify, resolve and prevent IAQ problems through simple, low-cost measures. http://www.epa.gov/iaq/schools/excellence.html
• The Problem Solving Tool helps school health leaders identify the connection between health complaints and common IAQ solutions in school buildings. http://www.epa.gov/iaq/schools/problem_solving_tool.html
• The Walkthrough Inspection Checklist can be used when conducting school walkthrough assessments. http://www.epa.gov/iaq/schools/pdfs/kit/checklists/walkthruchklst.pdf
• Managing Asthma in the School Environment http://www.epa.gov/iaq/schools/pdfs/publications/managing_asthma.pdf focuses on steps that schools can take to help children breathe easier. Because 10.5 million school days are missed each year due to asthma, it is important that schools take action to create healthy indoor learning environments for those students and staff with asthma. http://www.epa.gov/iaq/schools/asthma.html
• The Action Kit http://www.epa.gov/iaq/schools/actionkit.html provides best practices, industry guidelines, sample policies and a sample IAQ management plan to improve school indoor air at little or no cost. Schools can save time and money by taking preventative steps to create healthy indoor learning environments.
Access EPA's IAQ Tools for Schools resources to help identify, correct and prevent IAQ problems and protect the health of your students and staff.
http://www.epa.gov/iaq/schools/index.html
New Geographic Preference Resources
One of the best tools for schools looking to buy local food is the geographic preference option, which allows purchasers to include language in solicitations so that vendors who can supply local products have an edge. Schools get to decide for themselves how to define local, how much preference to give to local items, and how exactly to structure their solicitations. Now, two new resources are available to help schools incorporate geographic preference correctly and successfully!
The USDA farm to school team recently developed a fact sheet titled Geographic Preference: What it is and how to use it, http://www.fns.usda.gov/cnd/F2S/pdf/F2S_geo_pref.pdf which gives a quick overview of the law and associated regulations and then walks through three ways to use the geographic preference option. In addition, School Food FOCUS has just released Geographic Preference: http://www.schoolfoodfocus.org/wp-content/uploads/2013/07/FOCUS_GP_Primer_July-2013.pdf A primer on purchasing fresh local food for schools, which provides step-by-step guidance on how to implement a geographic preference policy, starting with articulating the legal authority and rationale for buying local foods. For more helpful procurement links, check out the resources page. http://www.fns.usda.gov/cnd/F2S/f2s-resources_2013.htm#lfp
New Help Me Grow website (Minnesota's early intervention system for children 0-5 years of age)
There is a new Help Me Grow website that helps families/providers learn about typical developmental milestones and access the on-line Help Me Grow referral form when there are concerns about a child’s development (0-5 years of age): http://www.helpmegrowmn.org/. Please feel free to share with your partners.
|
|
 |
Items of Interest
HOW SAFE ARE OUR SCHOOLS. Indicators of School Crime and Safety, 2012.
A new report issued jointly by National Center for Education Statistics (NCES) and the Bureau of Justice Statistics, examines crimes occurring in school, as well as on the way to and from school, and presents data on safety at school from the perspectives of students, teachers, and principals. It covers topics such as victimization, bullying, school conditions, fights, weapons, and the availability and student use of drugs and alcohol. http://nces.ed.gov/pubsearch/pubsinfo.asp?pubid=2013036
Report: State child care laws fail to protect children. http://www.naccrra.org/node/3025
Most states do little to protect the health and safety of children in child care, according to a new report from Child Care Aware® of America. We Can Do Better: 2013 Update scores and ranks state laws governing child care centers in the 50 states, the District of Columbia and the Department of Defense (DoD) on 11 program requirements and four oversight benchmarks. State rankings show modest improvements since 2011. The average score was 92 out of 150 points – the equivalent of 61 percent, a "D" in most classrooms in America. There were no "A's" and only DoD scored a "B." The remaining top 10 states (New York, Washington, North Dakota, Oklahoma, Texas, Wisconsin, Delaware, Illinois, Minnesota and Tennessee) earned a "C." Twenty-one states earned a "D" and the remaining 20 states earned a score of 60 or less, a failing grade.
The National Prevention, Health Promotion, and Public Health Council (the National Prevention Council) 2013 Annual Status Report is now available. http://www.surgeongeneral.gov/initiatives/prevention/2013-npc-status-report.pdf
The Report shows how each of the departments and agencies that make up the National Prevention Council are making the federal government a leader in prevention. Highlights include the Department of Defense’s Healthy Base Initiative, new work from the VA improving access to healthy food, and a multidepartment collaboration to prevent heart attacks and strokes. Additionally, the Report shows positive trends in some leading health indicators, including decreases in the number of youth ages 3 to 11 exposed to second-hand smoke and decreases in stroke and overall cancer deaths.
The Report also includes several major new announcements, including:
•A new Uniform and Appearance policy from the USPHS Commissioned Corps, making it the first Uniformed Service to prohibit tobacco use while in uniform
•The addition of three new departments to the National Prevention Council, creating new opportunities for prevention
•The availability of new toolkits developed by the Association of State and Territorial Health Officials and the National Association of City and County Health Officials to support state and local implementation of the National Prevention Strategy.
Kids Count Data Center
Kids Count Data Center, from the Annie E. Casey Foundation, includes regular updates surrounding hundreds of measures of child well-being. Users can view data by state or across states, and can sort the information by topic, rankings, or view raw data. Also available are interactive tools, a section of popular topics, state data, and regularly updated spotlights and new reports. http://datacenter.kidscount.org/
Bike Helmet Safety
Bicycling is a fun activity and a healthy mode of transportation. One of the most important safety measures while riding is wearing a bike helmet. Wearing a properly fitted bike helmet also provides protection against upper and mid-face cuts and fractures. A helmet should be worn by bicycle riders and passengers of all ages, including those being pulled in a pull behind trailer, every time a bicycle is ridden. For more information go to: http://gallery.mailchimp.com/eae7f46a35a34f39a7fce9c7f/files/Bike_Helmet_Safety.pdf
Parental Employment, Education, and Disability are Factors in Food Insecurity among Children.
This report looked at various factors that cause food insecurity among children. Not knowing when your next meal will come is often a concern for young children with unemployed parents. The lack of this nutrition can cause various health problems for children including oral health complications and asthma. In many low-income areas there is still a need for food programs to combat food insecurity among children. It is important to stay engaged as health professionals, educators, and citizens in order to fight hunger in the U.S. http://blogs.usda.gov/2013/07/09/parental-employment-education-and-disability-are-factors-in-food-insecurity-among-children/
http://www.ers.usda.gov/publications/eib-economic-information-bulletin/eib113.aspx
Toxic Free Kids Update: Chemicals of High Concern list revision
The Minnesota Department of Health (MDH) is sending this update to inform you of recent activities relating to Toxic Free Kids Act. An updated 2013 version of the Minnesota Chemicals of High Concern list http://www.health.state.mn.us/divs/eh/hazardous/topics/toxfreekids/highconcern.html
and a report concerning the review and revision of the list have been published to the MDH website for Toxic Free Kids. http://www.health.state.mn.us/divs/eh/hazardous/topics/toxfreekids/index.html
For additional information regarding the Minnesota Chemicals of High Concern list, refer to the MDH Toxic Free Kids home page or contact us at health.risk@state.mn.us.
Author Highlights Importance of “Big Data” for Child-Health Research
Future of Children senior editor and Princeton University professor Janet Currie tackles big questions about child heath with the help of big sets of data. Currie describes the benefits and risks of research using Big Data: "There have lately been many discussions of the potential of Big Data to answer important questions. In medicine, much of this discussion revolves around gene sequencing and the use of bio-samples. But Big Data also exist in the form of birth and death records, hospital records, insurance claims, disease registries, and other administrative records. It is important for researchers (school nurse researchers) to have access to these data while safeguarding patient (student and individual) privacy.” To read the full article click here. http://www.princeton.edu/main/news/archive/S37/06/16E72/index.xml?section=topstories
Indicators of School Crime and Safety: 2012
A joint effort by the Bureau of Justice Statistics and National Center for Education Statistics, this annual report examines crime occurring in school as well as on the way to and from school. It provides the most current detailed statistical information to inform the Nation on the nature of crime in schools. This report presents data on crime at school from the perspectives of students, teachers, principals, and the general population from an array of sources--the National Crime Victimization Survey, the School Crime Supplement to the National Crime Victimization Survey, the Youth Risk Behavior Survey, the School Survey on Crime and Safety and the School and Staffing Survey. Data on crime away from school are also presented to place school crime in the context of crime in the larger society. Publication #: NCES 2013036. Authors: Robers, Simone; Kemp, Jana; Truman, Jennifer. Available at: http://nces.ed.gov/pubs2013/2013036.pdf
In the Literature
Bullying and Suicide: A Public Health Approach. Marci Feldman Hertz, M.S.; Ingrid Donato; James Wright, M.S., L.C.P.C. Journal of Adolescent Health. Volume 53, Issue 1, Supplement , Pages S1-S3, July 2013.
The supplement to the July 2013 issue of the Journal of Adolescent Health explores bullying and suicide among adolescents. The supplement was published by the Society for Adolescent Health and Medicine with support from the Centers for Disease Control and Prevention. Contents include eight articles that generally show a strong association between involvement in bullying behaviors and suicide-related behaviors. Topics include suicidal thinking and behavior among adolescents involved in verbal and social bullying; psychological, physical, and academic correlates of cyberbullying and traditional bullying; inclusive anti-bullying policies and reduced risk of suicide attempts in lesbian and gay adolescents; suicidal ideation and school bullying experiences; potential suicide ideation and its association with observing bullying in school; suicidal adolescents' experiences with bullying perpetration and victimization during high school as risk factors for later depression and suicidality; acutely suicidal adolescents who engage in bullying behavior; and precipitating circumstances of suicide among adolescents (ages 10-17) by sex. The supplement is available at http://www.jahonline.org/supplements. (MCH Alert)
Adverse Childhood Experiences in Minnesota, Findings & Recommendations Based on the 2011 Minnesota Behavioral Risk Factor Surveillance System.
http://www.health.state.mn.us/divs/chs/brfss/ACE_ExecutiveSummary.pdf
More than half of Minnesotans have had an adverse experience in their childhood that could have a life-long impact on their health and well-being, according to data released by the Minnesota Department of Health. The Minnesota Department of Health surveyed 13,520 Minnesota adults in 2011 and found that 55 percent of them reported having at least one adverse childhood experience (ACE) such as divorce or separation of their parents; an incarcerated household member; a mentally ill parent; domestic violence against a parent; a household member with an alcohol or substance abuse problem, or verbal, physical, or sexual abuse.
"The significance of this study is that it shows that these experiences, which can significantly affect the health and well-being of adult’s decades later, are much more common in Minnesota than one might expect," said Dr. Ed Ehlinger, Minnesota Commissioner of Health. The four most common adverse experiences reported by adults include verbal abuse at 28 percent, a drinking problem in the household at 24 percent, mental illness in the household 17 percent, and physical abuse at 16 percent.
Minnesota is one of 18 states that have surveyed residents in an effort to better understand the impact of adverse childhood experiences on the health and well-being of adults. Minnesota collected ACE data for the first time in 2011, as part of the Behavioral Risk Factor Surveillance System (BRFSS), which is a national telephone survey conducted by states.
Minnesota's report contributes to a growing body of research that shows a strong link between adverse childhood experiences (ACEs), toxic stress, changes in brain chemistry, and life-long outcomes. For two decades, research by the Centers for Disease Control and Prevention (CDC) and other states has demonstrated over and over again the powerful impact of ACEs on health, behavioral, and social problems. An extensive and growing body of research documents that adverse childhood experiences (ACEs)—those causing toxic levels of stress or trauma before age 18—are specifically linked to poor physical and mental health, chronic disease, lower educational achievement, and lower economic success in adulthood.
Minnesota's results are consistent with those found by the initial ACE study and in other states. First, ACEs are common; second, ACEs frequently occur together, and third, higher ACE scores put a person more at risk for poorer health and well-being outcomes as an adult. For example, Minnesotans with more ACEs were more likely to rate their health as fair or poor, to have been diagnosed with depression or anxiety, to report smoking and chronic drinking, to have been diagnosed with asthma, and to be obese. In addition, ACEs are more common among Minnesotans who did not graduate from high school, who were unmarried, who rented rather than owned their own home, who were unemployed, or who worried about paying their mortgage or rent or about buying nutritious food. Second, ACEs frequently occur together. In Minnesota, over half of Minnesotans experiencing ACEs had more than two ACEs; and third, ACEs have a strong and cumulative impact on the health and functioning of adults.
For example, the study found the following associations between ACEs and outcomes. 19 percent of adults with five or more ACEs rated their health as "fair or poor" compared to 9 percent of adults with no ACEs. Minnesotans reporting five or more ACEs were more than twice as likely to have had asthma, than adults reporting no ACEs. Minnesota adults who were frequently worried or stressed about having enough money for shelter and nutritious meals were more than 2.5 times more likely to have experienced five or more ACEs than adults who had these feelings less often.
"Though this research shows that adversity increases risk, it is also clear that adversity is not destiny and many people with high ACE scores overcome challenging childhoods," said MDH Assistant Commissioner Jeanne Ayers. "Part of the value of this research is that we can let people know they are not alone in these experiences and that they can break the cycle and prevent ACEs instead of dealing with their impact later."
As part of Governor Mark Dayton's Children's Cabinet, the Minnesota Department of Health plans to work with other state agencies to find ways to reduce ACEs and improve the lives of adults. Other communities and states, such as Washington, have rallied around the idea of combating the negative effects of ACEs with the concept of resiliency. For example, positive experiences at school or a loving adult involved in a child's life can help a child overcome exposure to ACEs.
"The hopeful part of ACEs research is that it is stimulating communities to take action to protect children early in their lives and find new ways to help children, families, and communities to become more resilient," Commissioner Ehlinger said. "We will use this information to launch similar efforts here in Minnesota. “The executive summary can be found at: http://www.health.state.mn.us/divs/chs/brfss/ACE_ExecutiveSummary.pdf
and
http://www.health.state.mn.us/divs/chs/
| 
