The American Psychological Association calls trauma “an emotional response to a terrible event.”1 It can stem from collective experiences (e.g., a natural disaster or a global pandemic), or it can come from personal experiences such as family violence or poverty. These personal experiences are often referred to as the Social Determinants of Health (SDoH), the parts of life that affect its quality. Many SDoH also catalyze or exacerbate trauma, which can have both a direct and indirect impact on oral and ocular health.
About 11 million American children live in poverty—91.7 percent of them non-white. The financial insecurities these families experience affect housing, education, nutrition, and healthcare—just about every aspect of their lives. Even a short-term experience with poverty can affect health, resulting in an increase in chronic disease, malnutrition, and trauma. About 70 percent are covered by Medicaid or other government healthcare program, and out-of-pocket healthcare costs are likely to affect whether families seek oral and ocular care.2
Before the 2020 coronavirus pandemic, more than 10 percent of all U.S. households had experienced food insecurity. By the end of 2020, food insecurity had touched nearly a quarter of American families and their five million children. Black and Hispanic families are disproportionately affected.3 According to the National Institutes of Health (NIH), food insecurity “hinders access to health care” and contributes to an inability to fill prescriptions or seek medical treatment or prevention services.4
Each year in the U.S., just shy of 700,000 unique abuse incidents are reported, with youngest children being the most vulnerable. Neglect is the most common (61%) form of abuse.5
Poverty—and other social determinants of health—puts children at greater risk for abuse and have a higher chance of dying because of it.6 But because poor housing and food insecurity result from poverty, it can often be mistaken for neglect.7 Poverty can also contribute to intimate partner violence and substance abuse.
Among ethnic groups, child abuse affects Native Americans and Alaskan natives most (15.2 cases per 1,000), followed by African Americans (13.8). Hispanic children suffered abuse at a rate of 8.1 per 1,000. Asian Americans saw the lowest abuse rate (1.7).8
In addition, about 20 percent of children aged 12 through 18 experience bullying in school. Wealth inequality is a major contributor to bullying.9
Five million cases of elder abuse are reported each year, with nearly one in ten people over 60 claiming to have experienced abuse.10
In this country, about 6.5 million women are victims of IPV each year. About 45 percent of them have their first experience before age 25. Studies show that as social class decreases, the rate of domestic abuse increases and that IPV affects nearly half of all women of color. It is also more likely in women who receive Medicaid. 11
Oral and eye health care providers have a unique opportunity to identify potential abuse simply because of their focus on the face. In abused children, between 50 and 70 percent incur injuries to the face, neck, and head.13Injuries to the eye account for about 45 percent of intimate partner violence injuries.14
Training providers who participate with your plan to become familiar with the signs of child, elder, or intimate partner abuse is not only the right thing to do. It helps protect the providers in your network, and it enhances your plan’s reputation for doing that right thing. We’re here to help.
Understanding the wide reach of trauma and its relationship to SDoH is valuable for enrollees, practitioners, and health plans, as it can affect patient compliance, health outcomes, and care costs.
Vendors who deliver trauma-informed care may be in high demand as health plans acknowledge its urgency. Avēsis delivers consistent high-quality staff and provider training, and we help provide the care coordination our clients and their enrollees need.
Mandated reporters are those whose professions concern vulnerable populations such as children and the elderly. Law enforcement, childcare providers, healthcare workers, teachers—these are just a few examples of those who must report suspected abuse.
The role of a mandated reporter is to notify, only. In most states, anonymous reports are allowed, and as long as the reporting is made in good faith, reporters suffer no repercussions. A mandated reporter is not an investigator.
All 50 states require healthcare workers to report child abuse to state authorities. Elder abuse reporting to state or local law enforcement is required in 47 states. Only a few mandate reporting for IPV. To see the requirements of your state and look for training opportunities, click here. Avēsis keeps track of state requirements and helps make sure our network providers understand their obligations under the law.12
Addressing the SDoH facing your enrollees can often help improve their overall health by reducing stress associated with food insecurity, job stability, home safety, literacy and language support, internet and telephone access, and more.
As your ancillary benefits manager, we can introduce our SDoH program to your service model. This value-add initiative identifies enrollees who may be negatively impacted by SDoH through behavioral interviewing conducted during standard interactions with our team. We then pass the information gleaned from these interviews regarding enrollees’ needs along to the health plan, so that you can match the enrollee with the appropriate resource. With this program, we treat every interaction with an enrollee as an opportunity to address SDoH barriers and improve their overall health.
Learn more about how our SDoH Program can help you improve health and efficiency.