CTHC at UCSF
In September 2022, CTHC’s Health, Empowerment, and Recovery Services (HERS) program, a clinical and research program nested in our Women’s HIV Clinic received a second $2.5 million five-year grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) to refine our outpatient model of trauma-informed substance use treatment.
For more information please see Trauma-informed Substance Use Treatment
Funding provided by the California Department of Health Care Services, in partnership with the Office of the California Surgeon General
Two of the University of California’s nationally ranked medical centers, UCLA and UCSF, have partnered with the California Department of Health Care Services (DHCS) and Office of the California Surgeon General (CA-OSG) to lead a multi-campus initiative addressing the impact of Adverse Childhood Experiences (ACEs) and other causes of toxic stress on health.
Launched in October 2021, the UCLA/UCSF ACEs Aware Family Resilience Network (UCAAN) brings its expertise and resources to the state’s ACEs Aware initiative, which trains clinicians on how to screen children and adults for ACEs to treat the toxic stress response.
“We now have the opportunity to fully realize the power of addressing ACEs and toxic stress,” said Shannon Thyne, MD, Co-Principal Investigator, UCAAN, and Professor of Pediatrics at the David Geffen School of Medicine at UCLA. “Embedding ACEs Aware into the UC system enables us to tap into a wealth of scientists, clinicians, and educators to create the structure and capacity needed to sustain, grow, and ultimately realize the bold commitment of California’s Surgeon General to reduce toxic stress among our state’s children and families by half in one generation.”
Led and administered through the Department of Pediatrics at the David Geffen School of Medicine at UCLA and the UCSF Center to Advance Trauma-Informed Health Care (CTHC), UCAAN leverages the rich and diverse expertise and resources of both UCs across disciplines to develop, promote, and sustain evidence-based methods to screen, treat, and heal from the impacts of childhood adversity.
Together with a substantial network of community partners and a team that includes frontline primary care providers in the state’s Medi-Cal network delivery system, UCAAN will expand ACE screening throughout the state, and will develop evidence-based, culturally competent responses to prevent and manage the consequences of toxic stress.
“By giving providers the tools and resources they need to screen for ACEs and treat toxic stress with evidence-based interventions, ACEs Aware has served as an integral part of California’s response to the COVID-19 public health emergency,” said California Surgeon General Dr. Nadine Burke Harris. “Our new partnership with UCAAN will further strengthen the scientific foundation to support routine ACE screening and trauma-informed clinical care.”
“As a frontline primary care physician, I am able to better connect with my patients and develop more effective treatment plans by understanding their past traumatic experiences, as well as their sources of strength and resilience,” said Edward Machtinger, MD, Co-Principal Investigator, UCAAN, UCSF Professor of Medicine, and Director of UCSF CTHC. “UCAAN has the opportunity to develop and disseminate the evidence, practice, and policies to address trauma, promote resilience, and achieve better health outcomes and health equity for the many physical and mental health conditions driven by early childhood trauma and other causes of toxic stress.”
Research shows that ACEs, such as abuse, neglect, or having a parent who is incarcerated or struggling with addiction or mental illness, can stimulate the toxic stress response and significantly increase the risk for chronic health conditions, including heart disease, diabetes, depression, and asthma.
“It’s critical that we continue to integrate ACEs screening and treatment for toxic stress into clinical practices throughout the state,” said Dr. Thyne. “UCAAN will enable us to build on the momentum we’ve gained over the last two years, as we worked with the state to integrate ACEs screening and treatment for toxic stress into busy clinical practices.”
For more information, please visit https://ucaan.ucla.edu
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The three-year effort is directed by the Center to Advance Trauma Informed Health Care (CTHC) and made possible with funding by Genentech.
As California’s new program to screen Medi-Cal patients for adverse childhood experiences (which are termed “ACEs”) gets underway, experts at UC San Francisco are trying to ensure that the adults and children who report trauma get the help they need.
Experts now believe it’s most effective to treat the whole family when traumas occur. But any successful program would need to overcome fragmented payment systems, which usually dictate separate and poorly coordinated care for children and adults. So, with funding from Genentech, the UCSF researchers plan to develop a “Whole Family Wellness” intervention that integrates resources from Medi-Cal clinics with outside agencies and test it over a three-year period.
Using a hub-and-spoke model, the intervention would employ a family care manager to ensure coordination between Whole Family Wellness Hubs within Medi-Cal clinics, and affiliated “spoke” agencies, such as community-based organizations and adult physical and behavioral health services, as well as housing, legal, and other social supports. The hubs would also offer programs to promote mental and behavioral health for the whole family.
“The growing awareness that trauma is driving health disparities has led California to start the ACEs Aware initiative, which reimburses providers to screen patients in the Medi-Cal system for adverse childhood experiences,” said Edward Machtinger, MD, a professor of medicine who directs the Women’s HIV Program, as well as the Center to Advance Trauma-Informed Healthcare at UCSF. “But we still need to understand how screening for ACEs can support a whole family approach to care within our current systems.”
“As the largest coordinated dissemination of ACEs screening and response, CALQIC offers an ideal infrastructure to test innovative responses to the traumatic origins of health disparities among children and families from low-income communities,” said Machtinger, who co-leads CALQIC with the Center for Care Innovations, the RAND Corporation and Los Angeles County Department of Healthcare Services.
The project’s research and clinical team includes UCSF’s Alicia Lieberman, PhD, professor of psychiatry and director of the Child Trauma Research Program, an expert in early childhood development with a specific focus on Latinx children and families; Kenneth Epstein, PhD, LCSW, professor of psychiatry, an expert in family therapy and in developing trauma-informed systems of care; Jayme Congdon, MD, assistant professor of pediatrics, an implementation scientist with a focus on intergenerational approaches to health; Anda Kuo, MD, professor of pediatrics and an expert in community engagement and medical education; and Marguerita Lightfoot, PhD, professor of medicine, who is chief of the Division of Prevention Science and directs the Center for AIDS Prevention Studies and the UCSF Prevention Research Center, and is an expert on mental health interventions for African-American adolescents. They are joined by Alex Briscoe, MA, principal of the California Children’s Trust.
If the intervention succeeds, it will become a blueprint for a whole-family wellness model of primary care to improve outcomes for low-income children and families.
“The findings will provide critical guidance to statewide and national efforts to address toxic stress and achieve health equity for children and families,” said California Surgeon General Nadine Burke Harris, MD, a pediatrician who has focused much of her work on ACEs and toxic stress. “The disproportionate effect of the pandemic on communities of color makes this the perfect time to develop innovative policies that will truly improve the lives of the most vulnerable Californians.”
Nadine Burke Harris, MD, California’s first surgeon general, has a bold goal: cut adverse childhood experiences and toxic stress in half within one generation.
She spoke about her vision and her groundbreaking work to reduce adverse childhood experiences across the state during a speech at the UC San Francisco Parnassus Heights campus. The lecture at Cole Hall on Feb. 13 was part of Chancellor Sam Hawgood’s health policy series, organized by the Philip R. Lee Institute for Health Policy Studies.
In January, the UCSF Center to Advance Trauma-informed Healthcare (CTHC) signed a $10.7 million contract with the California Office of the Surgeon General and the Department of Health Care Services to lead a learning and quality collaborative to disseminate best practices and tools to help providers treat ACEs.
The UCSF California ACEs Learning and Quality Improvement Collaborative (CALQIC), led by UCSF co-directors Anda Kuo, MD, Marguerita Lightfoot, PhD, and Edward Machtinger, MD, is an 18-month statewide learning collaborative of pediatric and adult clinics in five California regions that will include onsite and virtual coaching (content and process); expert training and peer-to-peer sharing of promising approaches, challenges and solutions; site visits to successful programs; and funding support.
This four-minute video provides a compelling snapshot of the value of trauma-informed care from both provider and patient perspectives. Those featured participated in Advancing Trauma-Informed Care, a national initiative made possible through support from the Robert Wood Johnson Foundation. To learn more, visit the Trauma Informed Care Implementation Resource Center.
