BCR Glossary

A

Accountable Care Community (ACC)

The Accountable Care Community is a model of delivering health care that is focused on improving the health of the community and incentivizing the health system to reward improved health while delivering cost-effective care. Success is measured by factors such as the improved health of the whole community, cost-effectiveness and cost savings in the health care system, improved patient experience for those using the health care system, job creation, and more. (Akron Accountable Care Community)

Accountable Care Organization (ACO)

A network of health care providers that band together to provide the full continuum of health care services for patients. The network receives a payment for all care provided to a patient and is held accountable for the quality and cost of care. Pilot programs in Medicare and Medicaid provide financial incentives for these organizations to improve quality and reduce costs by allowing them to share in any savings achieved as a result of these efforts. (kff.org)

Adverse Childhood Experiences (ACEs)

Childhood events, varying in severity and often chronic, occurring in a child’s family or social environment that cause harm or distress, thereby disrupting the child’s physical or psychological health and development. Within the family, ACEs can include physical, sexual and emotional abuse; physical or emotional neglect; physical punishment; witnessing domestic violence; household substance misuse, illness, incarceration; parental separation/divorce or child separation from the family. Social context ACEs can include poverty/socioeconomic stratification; racial segregation; political conflict; hospitalization; community violence; school violence/bullying; maltreatment by a teacher; and natural disaster. (Kalmakis, et al 2013)

Adverse Community Environments

Childhood adversity does not occur in a vacuum. Many traumas may be linked to the lack of resources or increased threats (mental, physical, economic) at the family and community levels. The effects of adverse childhood experiences are compounded when they occur in the context of adverse community environments. For example, in areas of concentrated poverty where public policy, business and economic investment decisions influence systemic inequities in communities (Pinderhughes, 2016), there also exist disproportionate concentrations of chronic conditions such as heart disease and obesity – outcomes associated with adverse childhood experiences. Community inequities include limited economic mobility and access to social services, poor housing conditions, systemic racism and other community-based stressors, such as violence and substance abuse. These environments often lack positive buffers that promote resilience, such as safe neighborhoods and parks, social supports, affordable and stable housing, thriving and diverse retail and opportunities for employment and creative expression.

Adverse Community Experiences

The cumulative and synergistic impact of regular incidents of interpersonal violence, historical and intergenerational violence, and continual exposure to structural violence. (Pinderhughes, 2013)

Accountable Health Communities

Accountable Health Communities is a model of delivering health care based on emerging evidence that addressing health related social needs through enhanced clinical-community linkages can improve health outcomes and reduce costs. Unmet health-related social needs, such as food insecurity and inadequate or unstable housing, may increase the risk of developing chronic conditions, reduce an individual’s ability to manage these conditions, increase health care costs, and lead to avoidable health care utilization. (Centers for Medicare & Medicaid Services. (2016). Accountable Health Communities Model.)

B

C

Community Engagement

The process of working collaboratively with groups of people who are affiliated by geographic proximity, special interests or similar situations with respect to issues affecting their wellbeing. (CDC, Principles of Community Engagement, 2011). In the context of the BCR initiative, community engagement refers to direct interaction with community residents to involve them in prioritizing, developing, implementing and/or evaluating strategies to improve population health in their community.

Community Partners

Health care and other organizations within a community that join the BCR initiative to identify, develop, and refine innovative strategies for promoting population health.

Community Resilience

The capability of a community to anticipate risk, limit impact, and bounce back rapidly through survival, adaptability, evolution, and growth in the face of turbulent change and stress. The capability to endure and thrive despite adversity. (Norris, et al 2008)

D · E · F · G

H

Health

A state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity. (World Health Organization) Children’s Health is dependent on the extent to which children or groups of children are able to a) develop and realize their potential, b) satisfy their needs, and c) develop the capacities that allow them to interact successfully with their biological, physical, and social environments. (Institute of Medicine, 2004) Health care Services offered by the medical and allied health professions to prevent, treat, and manage illness and to preserve mental and physical wellbeing.

Health Equity

Attainment of the highest level of health for all people. Health equity means efforts to ensure that all people have full and equal access to opportunities that enable them to lead healthy lives. (Healthy People 2020)

Health Inequity

Differences in health between groups of people or individuals that are avoidable, unfair and unjust. Health inequities are affected by social, economic, and environmental conditions. (Healthy People 2020)

Health System

A health system is the sum total of all the organizations, institutions and resources whose primary purpose is to improve health. This includes efforts to influence determinants of health as well as more direct activities in a clinical setting, for example. (WHO)

I · J · K

L

Life Course Orientation

A view of health that focuses on equity and the impact of social determinants and includes an understanding of how biology and environment interact, and thereby offering a richer definition of health and of how it develops over a lifetime and across generations. (Maternal and Child Health Bureau)

M · N · O

P

Pair of ACEs

In every state across the country, more than 30 million American children are exposed to a range of adverse childhood experiences – including abuse, neglect, domestic violence or parental depression. Adverse community environments, such as lack of opportunity, limited economic mobility, community violence and the associated effects of poverty and joblessness, contribute to – and compound – the adversities experienced within households by children and families. Together, adverse childhood experiences and adverse community environments are the “Pair of ACEs.”

Population Health

1. The health outcomes of a group of individuals, or population. It can include the distribution of such outcomes within the group. This includes health outcomes, patterns of health determinants, and policies and interventions that link the two. (From What is Population Health? Kindig and Stoddart, 2003.)
2. A community-centered, upstream-oriented system of care and patient management that includes an emphasis on prevention and responsiveness to wider social and environmental issues that affect the health and wellbeing of a population. (Adapted from Achieving Healthy Communities through Community-Centered Health Systems, David Fukuzawa 2013)

Q · R

S

Social Determinants of Health

The conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems. (WHO)

Sustainability

Effective community change and financial support are “sustainable” when they remain in place and continue to evolve to promote progress towards long-term health and equity goals. In addition, the relationships between people and organizations created or reinforced by initiatives continue to drive social action to improve health. (Adapted from Community Health Initiatives Sustainability Framework, Kaiser Permanente 2009)

System of Care

A service delivery approach for health care and other services that builds partnerships to create a broad, integrated process for meeting families’ multiple needs. This approach is based on the principles of collaboration across sectors; individualized, strengths-based care practices; cultural competence; community-based services; accountability; and full participation of families and communities at all levels of the system. (Adapted from HHS Child Welfare Information Gateway)

System Integration

Systems can be vertically, horizontally and/or longitudinally integrated. The ACO model is a model of vertical integration, whereby all levels of health care (e.g., primary, ancillary, tertiary, etc.) are integrated to provide a continuum of health care to beneficiaries. Horizontally integrated systems integrate health promoting service provided by non-medical organizations with the services of the health sector. Longitudinally integration requires the integration of developmentally appropriate services over time across the life course.

T

Toxic Stress

Persistent exposure to adversity without adequate family and other social supports. A toxic stress response can occur when an individual experiences strong, frequent, and/or prolonged adversity—such as physical or emotional abuse, chronic neglect, caregiver substance abuse or mental illness, exposure to violence, and/or the accumulated burdens of family economic hardship. This kind of prolonged activation of the stress response systems in children can disrupt the development of brain architecture and other organ systems, and increase the risk for stress-related disease and cognitive impairment, well into the adult years. (Harvard University, Center on the Developing Child)

Trauma-Informed Care

A program, organization, or system that is trauma-informed: 1) Realizes the widespread impact of trauma and understands potential paths for recovery; 2) Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; 3) Responds by fully integrating knowledge about trauma into policies, procedures, and practices; and 4) Seeks to actively resist re-traumatization. (SAMHSA)

U · V

W

Wellbeing

Indicators rooted in childhood that influence whether a person will have the likelihood of being well-educated, economically secure, productive and healthy adult. These indicators include family and social environment, economic circumstances, health care, physical environment and safety, behavior, education and health. (From Forum on Child and Family Statistics report: America’s Children: Key National Indicators of Well-Being 2013.)

X · Y · Z