Salus Health Care Forum July 2, 2025

Bill B

Craig, in one of our earlier sessions, one of the things that was brought up is some of the research that’s been done, closely related to what you’re talking about. A lot of things we’ve talked about in this series are closely related to your comments, but one was about the role that a single mentor can play. Some studies that were done about some children who are facing all the conditions you’re talking about that lead to high ACE scores. Sometimes all it takes is one strong mentor, someone in their neighborhood. They’re in a horrible, low socioeconomic neighborhood, but there’s a mentor for boys that may be a coach or now even for girls a coach. It could be a minister. It’s someone who seems to make a huge difference in their life. They can mediate some of the stress in the child’s life and address some of the challenges that you’re talking about. Does that make any sense? Is this related at all to any of the findings you are aware of?

Craig

Absolutely. That’s why I mentioned the absence in the original study of positive childhood experiences and the idea that toxic stress is defined as occurring in the absence of positive adult supports. So that when you have positive, strong adult supports, people may face adversity, but not experience toxic stress and allostatic load.

Bill G

Many states have taken to heart the social determinants of health and have gotten waivers under Medicare to provide wraparound services addressing the social determinants of health. Have any of those experiments been studied carefully and proved effective in terms of improving, actually improving health, independent of just having access to care?

Craig

Bill G, I plead absolute ignorance. I don’t know of those interventions or studies of them. And some of the challenge in doing that research may be that the effects appear over many years if they are to appear, so you need a serious longitudinal study, and in the aggregate, to tease out the effects. So, if you have interventions, you may certainly see adult health change 20 years later. Childhood health may change more rapidly, but these have to be longitudinal studies to gauge the change, and I don’t know if they exist or not. I’d love to hear some of the states that have used that wraparound approach.