Nearly 2,500 members of Health Share of Oregon participated in the LIFE Experiences Study, a research effort funded by the Robert Wood Johnson Foundation. 

This study explored associations between life experiences and adult health outcomes in a Medicaid population, with the intent to build knowledge of the social pathways that lead to poor outcomes and understand how interventions might mitigate the health impacts of these experiences. CORE provided preliminary analysis to OHA to support CCO 2.0 deliberations and to Health Share of Oregon to support the creation of their Ready & Resilient healthcare transformation strategy. 

Understanding these connections can support policymakers and other organizations in creating and/or making changes to programs that improve people’s quality of life.

What We Did

From 2015 to 2016, CORE sent out surveys to a group of people enrolled in Medicaid. About 2,500 people completed the survey. In addition to the surveys, our team sat down with 34 people for in-depth interviews about their life experiences, health, and how they got through tough times.

Who Participated?

Below is a snapshot of the demographics of the community members who participated in the survey:

• Age: About 40% of participants were between 18 and 45; about 60% were between 46 and 65.
• Sex: 57.1% identified as female; 42.9% identified as male.
• Race: 67.9% identified as white; 42.9% as black; 10.7% as American Indian or Alaskan Native; 3.5% as Asian; 0.9% as Native Hawaiian or Pacific Islander; and 7.6% identified as “Other”.
• Income: 77.8% had a family income of less than $20,000.

What We Found

Survey Results

In the survey, we asked respondents to think about their childhood (ages 0–18). A high percentage of people remembered supportive relationships, community involvement, and generally happy childhoods. People also experienced a lot of hardship—from unstable housing to abuse.

We also asked folks about their experiences in adulthood (age 19 and older). A high percentage of people experienced unstable housing later in life, as well as trouble finding and keeping steady work. At the same time, many people continued to be or became involved in their community.

Here are a few of the statistics on support (orange) and adversity (gray): 

We also examined the relationship between costly and complex medical challenges in adulthood and negative experiences in childhood.

We narrowed in on a set of negative experiences that are commonly referred to as adverse childhood experiences (ACEs). There are ten ACEs, and they include experiences of abuse, neglect, and household dysfunction. 

In addition to ACEs, we looked at some other difficult experiences in childhood. Those with complex medical challenges as adults were…

• 30% more likely to have used substances before age 18;
• 30% more likely to have remembered discrimination in childhood (0-18); and
• 30% more likely to have witnessed neighborhood violence in childhood (0-18).

The results of the LIFE Experiences Study survey are “weighted.” Weighting is a technique used to make results from a small group reflect a larger population. Our weighted survey results reflect the people in Portland who are enrolled in Medicaid.

Bottom Line

While people shared that they experienced trauma and hardship, we also found that many folks had someone in their life to support them. Our findings tell us that medical complexity in adulthood might be partially explained by negative experiences in childhood. No two people share the exact same life experience, so providing care that takes into account the unique experience of each patient is important to improving health and quality of life.

How these results are being used

The LIFE Experiences Study inspired continued research with foster care alumni, the results of which have informed the way Health Share of Oregon coordinates care for members. This research was featured on Oregon Public Broadcasting in November 2017 and has been presented at a number of conferences.

The study shows support for policies around affordable housing by linking stable housing with better health.

CORE is writing several journal articles on the findings of the LIFE Experiences Study.