How Trauma-Informed Programming to Treat Social Determinants Unveils Challenges to Systems Alignment.

Cross-sector collaboration and systems alignment to promote a culture of health can address social determinants of health (SDH), improve family well-being, and create a more equitable society. This paper documents our attempt to align Temporary Assistance for Needy Families (TANF) and Medicaid to promote health through a trauma-informed program, The Building Wealth and Health Network (The Network). The Network successfully integrated into traditional TANF and addresses SDH through peer-group programming where caregivers heal from adversity and build financial skills. We identify three challenges to alignment of TANF and Medicaid: 1) TANF's culture of compliance, 2) societal and systems-level forces including racism and discrimination, 3) misaligned partnerships (values, priorities, structure, and capability). For each challenge, we propose solutions including incentives for innovation and partnership, and promotion of racial equity initiatives, including reparations. By highlighting challenges and solutions we seek to strengthen current approaches to achieve health equity through systems alignment.