The UCSF Fresno Department of Pediatrics is collaborating with community partners and leveraging grant funding to increase awareness of Adverse Childhood Experiences (ACEs), pilot ACEs screening protocols, provide training in trauma-informed care (TIC) and develop a strong network of support for children and adults affected by ACEs.
“All of us, as providers recognize that an awareness of ACEs and screening patients for ACEs are important, but there was no infrastructure in place for provider training,” said John Moua, MD, interim chief of the UCSF Fresno Department of Pediatrics.
Last year, the California Department of Health Care Services (DCHS) began paying Medi-Cal providers for conducting ACEs screening of children and adults, and this year DCHS and the California Surgeon General’s office are providing ACEs Aware initiative grants for training of providers. The UCSF Fresno Department of Pediatrics received $180,000 to train Pediatric, OB/GYN and Family and Community Medicine providers in Fresno County. It is collaborating with two Fresno community-based organizations – Exceptional Parents Unlimited Children’s Center (EPU), and Every Neighborhood Partnership (ENP) – for the project.
“We are excited to be participating in these initiatives that are going to broaden or expand the incorporation of ACEs screening into pediatric practices all over the state,” said Aimee Abu-Shamsieh, MD, a UCSF Fresno pediatrician and UCSF clinical professor. “We are able to pilot practices in our clinic and be a part of the development of best practices for ACEs screening that can be shared with our pediatric colleagues throughout the state.”
Adversities experienced by age 18 from physical abuse, sexual abuse, exposure to violence and/or household dysfunctions are linked to an increased risk for chronic health problems, including heart disease, diabetes, and premature death. Many of the patients seen by UCSF Fresno pediatricians have experienced four or more ACEs, said Christian Faulkenberry-Miranda, MD, UCSF Fresno Department of Pediatrics program director, ambulatory residency clinic director and UCSF associate clinical professor. In its application for the ACEs Aware Supplemental Implementation Grant, the department said the COVID-19 pandemic has placed even more stress on families, increasing the need for partnerships in the training of providers to be able to recognize and respond to a surge of traumatic experiences.
EPU and ENP are helping produce an ACEs video that can be shown in physician offices to increase acceptance of the screening process. The video will explain why physicians screen for ACEs and highlight examples of protective factors for children. The ability to adapt to adverse experiences – resilience — during childhood can be an offset to toxic stress that children experience when they are exposed to traumatic experiences often and/or over long periods of time. EPU and ENP found volunteer families to videotape regular family moments, such as taking a walk or eating dinner together that illustrate how even small activities of daily living can help reduce stress.
“When parents go in to see the provider and the provider has a conversation with them about ACEs, we want to have already planted the seed for the focus to be on positive things, not necessarily over the negative things,” said Dana Riley, PhD, a licensed clinical psychologist, and manager of clinical services at the Assessment Center for Children at EPU. EPU serves children with medical, mental health and developmental needs and provides support to parents.
ENP Executive Director Andrew Feil has seen positive effects of resiliency. ENP connects churches and community groups to serve at elementary schools. “From our youth program that pairs students with mentors, we have seen kids from age five who now are graduating college,” he said. “We really wanted to be a part of the education on ACEs for ourselves to grow and learn, and also for the community.”
The UCSF Fresno Department of Pediatrics also will provide training on the clinical response to ACEs, including clinic workflows and information about local resources for patients in the Central Valley. The ACEs training sessions will be conducted virtually, and will include physicians, nurse practitioners, medical assistants and office staff. “In many cases, medical assistants may be doing the ACEs screening and they may not quite understand why this is important because no one stops to tell them why it is important,” said Dr. Abu-Shamsieh.
With an $80,000 California ACEs Learning and Quality Improvement Collaborative (CALQIC) grant, the UCSF Fresno Department of Pediatrics will help providers implement PEARLS, the new ACEs screening tool developed by the Bay Area Research Consortium on Toxic Stress and Health (BARC), a partnership between the Center for Youth Wellness, UCSF and UCSF Benioff Children’s Hospital Oakland. UCSF Fresno is one of only 15 organizations throughout California to be awarded a CALQIC grant. CALQIC was launched in cooperation with the UCSF Center to Advance Trauma-Informed Healthcare to identify promising practices, tools, resources and partnerships to further inform California’s ACEs Aware initiative.
UCSF Fresno pediatricians adopted PEARLS screening in December at the 1-, 3- and 5-year well-child visits. “We have incorporated trauma-informed care into our curriculum for the past few years,” said Amy Parks, DSW, LCSW, CLEC, and lead for the ACEs Aware grant. Parks is coordinator of Development and Behavioral Pediatrics, Community Pediatrics, Adolescent Medicine & Child Advocacy and director of Pediatric Healthy Steps at the UCSF Fresno Department of Pediatrics. “UCSF Fresno is really amazing in how supportive our faculty are of trauma-informed care practices and the time that has to be invested to make that culture change to provide trauma-informed care,” she said.
The UCSF Fresno Department of Family and Community Medicine, as part of the CALQIC grant, will soon implement PEARLS screening in its clinic for 1-, 3- and 5-year well-child visits, said Ila Naeni, DO, a UCSF Fresno Family and Community Medicine associate program director and UCSF associate clinical professor. Long-term, the screening can be expanded to adults. “The screening is such an important part of making sure our patients in the Valley get the full, comprehensive care that they deserve,” Dr. Naeni said. “We serve a population at risk that could definitely benefit from the resources that go along with screening for ACEs.”
The UCSF Fresno Department of Pediatrics also is a partner in a $2.6 million ACES Aware Implementation Grant that is being administered by Saint Agnes Medical Center. Funding will allow community health workers to be placed in clinics, including those staffed by UCSF Fresno pediatricians and Family and Community Medicine physicians, Dr. Parks said. The workers will help link patients to resources, and inform physicians of resources their patients have accessed, she said.
The ACEs Aware and CALQIC grants are fostering new partnerships between community-based organizations and UCSF Fresno, Parks said. “It’s creating more receptive and effective and efficient linkages. And ultimately, it’s going to create a healthier Fresno – a more resilient Fresno.”
Partnerships are essential to successfully implementing the ACES grants, Dr. Moua said. “One of the strengths of the UCSF Fresno Department of Pediatrics is we are doing community-based medicine. We are mission-driven to take care of the community we serve; and we collaborate with community partners instead of just being in a silo by ourselves.”
