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Christina Bethell, PhD, MBA, MPH

Home Institution: Johns Hopkins University

Fields: Public health, systems transformation

Current Positions:

  • Professor, Johns Hopkins University School of Public Health & School of Medicine
  • Director, Child and Adolescent Health Measurement Initiative

My Driving Question

How can we set in place sustainable partnerships, policies, and practices that intentionally promote whole child and family well-being with a focus on promoting early relational health and positive childhood experiences in the home, school, and community?

Scholar Project 

Staying the Course to Build Flourishing Futures for Children, Youth and Families

Ensuring that every child is healthy, ready to learn, and on their optimal trajectory to a positively engaged adulthood is imperative for our nation and the planet. This imperative arises from the inherent value of children and their future health as adults, parents, and decision makers impacting societal, intergenerational, and planetary health. Many advances in science, technology, and human consciousness and awareness can be leveraged to meet this moment of transformation in society. Applying these advances to promote flourishing and relational health for all children and families must be prioritized and will require ongoing attention to the steps in the process, maintaining hope and enthusiasm in the field and building the right data and incentives to make it happen

Building on her contributions to advance a positive, whole child, family, and community approach to public health and health care for children, youth, and families, Dr. Bethell’s work as a Nova Scholar will focus on measurement, new research, and scaling evidence-based models and innovations. She will build on her leadership in national initiatives such as the 2024 National Academies of Sciences, Engineering, and Medicine’s Launching Lifelong Health report, the Engagement in Action Framework (EnAct!) for statewide integrated early childhood health systems, the Prioritizing Possibilities national agenda, and the Cycle of Engagement Well Visit Planner (COE/WVP) model and information technology tools for frontline prevention. She will collaborate with other Nova Scholars and stakeholders to accelerate impact during this time of national attention to child and family flourishing and possibilities for progress. She will hold the vision for whole health, flourishing, relational health, and engagement in life that this work is based on.

A Vision for the Next Decade

A decade from now, the United States will have built on traditional knowledge and the evidence regarding early life experiences, human development, and disease prevention to provide comprehensive, family-engaged, community-integrated, and equitable care focused on optimizing the healthy development and lifelong well-being of all children, youth, and their families. Cross-sectoral efforts will equitably promote flourishing, build on community strength, and address family and community needs to create the safe, stable, and nurturing relationships and environments that all children need to thrive. The major causes of child and adolescent morbidity and mortality and the lived knowledge and expressed needs of children, youth, and families will guide the priorities for how systems allocate resources to achieve this vision.

Biography 

Christina Bethell is a professor at Johns Hopkins University in the Bloomberg School of Public Health and School of Medicine where she advances a new science of thriving to promote the early and lifelong health of children and families. Her research focuses on building and translating the science of healthy development and the development and application of family centered data and tools to inform and drive positive systems improvements. 

Dr. Bethell is the founding director of the Child and Adolescent Health Measurement Initiative which, since 1996, has developed and advanced to national, state, and local use an array of standardized child and family health and system performance measures, including measures on family centered care, care coordination, developmental screening, adverse childhood experiences, positive childhood experiences, family resilience and connection, child flourishing, and an integrated Whole Child Risk Index. Her research has shaped policy including the national Prioritizing Possibilities agenda to prevent and address adverse childhood experiences and promote child health equity. She has been featured on National Public Radio, provided testimony to the U.S. Congress, published dozens of peer reviewed studies focused on informing policy, practice, and culture change, and has contributed to national efforts that promote relational health as the cornerstone of well-being for children, families, and communities. 

Dr. Bethell earned an MBA and an MPH from the University of California, Berkeley and a PhD in public policy and health services research from the University of Chicago. She dances, writes poetry and believes the authentic connection with ourselves, others, and life is the source of our creativity and joy.

Education and Training
  • Irving B. Harris Public Policy Fellowship, University of Chicago
  • David A. Winston Health Policy Fellowship, Washington, D.C.
  • Coro Foundation Public Affairs Fellowship, Los Angeles, CA
  • PhD, Public Policy and and Health Services Research, University of Chicago
  • MPH, University of California, Berkeley
  • MBA, University of California, Berkeley
  • BA, double major in psychobiology and business administration, University of California, Los Angeles
Selected Honors

  • Johns Hopkins Bloomberg School of Public Health Dean’s Award for Excellence in US Public Health Practice, 2023

  • Richard D. Krugman Award, National Foundation to End Child Abuse and Neglect (EndCAN), 2022

  • John MacQueen Award, Association of Maternal and Child Health Programs, 2017

  • MCH National Outstanding Leadership Award, 2012

  • National Health 2.0 REACH Award; Finalist for Health IT to Improve Population Health for the Well Visit Planner Innovation. Awarded by the Office of the National Coordinator for Health IT and Academy Health, 2012

  • Family Voices National Angel Award, 2001

  • Stull Award, University of California, Berkeley, 1991

  • Annual Leadership Award, Women Health Care Executives of Northern California, 1990

  • Vision Award, Los Angeles Area Chamber of Commerce, Yearly Award to Recognize Youth Leaders, 1981

Selected Publications

Healing is facilitated through safety, persistence, and trust.

  • Persistence: “People did not simply progress through this sequence and experience healing. The healing journey was a recursive, back and forth process. They found helpers, used the skills/resources that those helpers provided, found other helpers that provided more resources and used those skills and resources. As this process continued, people experienced a gradual amelioration of their suffering. Although many despaired at times, all demonstrated the quality of persistence—they refused to give up.”
  • Safety & Trust: “To connect to helpers, it was essential for people to feel safe in those relationships and able to trust that the person would be a helper and not a barrier to healing. Persons whose wounds included a violation of trust were especially careful about testing the safety of new relationships.”

Resources support us as we heal. They include reframing, responsibility, and positivity. “Making connections enabled participants to acquire and refine resources and skills that were essential in their healing journey. People also brought their own personal strengths to the journey.”

  • Reframing: “A particularly important skill was the ability to reframe—that is to look at suffering through a different lens.” This does NOT mean minimizing trauma or pain, but rather it often means the opposite: understanding what happened was wrong, unfair, or uncontrollable and that we are not to blame for it.
  • Responsibility: While we don’t have control over what happened to us, we are the only ones who can help ourselves heal. “A third essential resource that people acquired or refined was the ability to take an appropriate amount of responsibility for their healing journeys. They participated actively in the process of healing. Once again, some participants already had developed this skill, and some acquired or refined it from their helpers.”
  • Positivity: “Another resource that people acquired or refined during their healing journey was choose to be positive—that is to have some optimism about their situation.” People have varying predispositions to positivity. In the study, positivity was important in helping people heal. This doesn’t mean a toxic positivity, but rather simply finding some good in life and feeling hopeful about our situations.

“Connection to others was an essential part of all the healing journeys.” Humans are social creatures, and even the most introverted of us need close relationships. Friends and family add meaning and value to life and help support us, in good times and bad. 

When we experience relational trauma, relationships can feel scary, but reestablishing safety and trust in relationships is where the healing happens. (To be clear, we do not mean reestablishing safety and trust with abusers, but rather finding other healing relationships.) 

“When safety and trust had been established, people were able to connect with helpers. The nature of the behaviours of helpers that fostered healing ranged from small acts of kindness to unconditional love.”

  • “Moving from being wounded, through suffering to healing, is possible. It is facilitated by developing safe, trusting relationships and by positive reframing that moves through the weight of responsibility to the ability to respond.”
  • “Relationships with health professionals were among these but were not necessarily any more important to the healing journey than other kinds of helpers, which included family members, friends, spirituality and their God, pets, support groups, administrators, case workers and supervisors.”

Healing probably means different things to different people, but one definition that emerged from the study is: “The re-establishment of a sense of integrity and wholeness.” 

Healing was an emergent property that resulted from each individuals’ complex healing journey, a result of bridged connections between resources and relationships. “…they gradually found relief from suffering and began to exhibit emergent characteristics: a sense of hope, self-acceptance, and a desire to help others—the immediate precursors to healing.”

 In varying degrees, “they were able to transcend their suffering and in some sense to flourish.” 

  • Helping Others: We find meaning in helping others. “Understanding that suffering gives the strength and experience to help others in similar situations.”
  • Hope: We begin to have hope that we will not always feel this bad. A Crohn’s patient said, “I think gradually I realized that I was going to feel better. I did have days when I actually didn’t vomit, when I did feel better. And I think gradually I came to believe that maybe I could have a normal life again.”
  • Self-Acceptance: We see our inherent value and understand that we are not to blame for our suffering. A participant living with HIV said, “I’m really proud of myself. I think that now I still want to live. I don’t want to die, and I really love myself a lot. I have a lot of comfort in myself.”

Suffering is the ongoing pain from wounding. 

There is some debate about whether people always experience suffering on the path to healing.

Wounding happens when we experience physical or emotional harm. It can stem from chronic illness or by physical or psychological trauma for which we do not have the tools to cope, or a combination of those factors. 

“The degree and quality of suffering experienced by each individual is framed by contextual factors that include personal characteristics, timing of their initial or ongoing wounding in the developmental life cycle and prior and current relationships.”

Characteristics: How predisposed someone may be to wounding/how many tools and resources someone may have to deal with trauma/illness.

Lifestages: Developmental timing plays an important role in the impact of trauma — young children often do not have the same resources as older adults.

Relationships: Relationships can provide solace and support for those suffering, while lack of healthy relationships can prolong suffering.