California ACEs Learning and Quality Improvement Collaborative (CALQIC)

UCSF’s Center to Advance Trauma Informed Healthcare is leading the California ACEs Learning and Quality Improvement Collaborative (CALQIC), an 18-month statewide learning collaborative to to integrate screening and response for ACEs into healthcare settings.

About CALQIC

In January 2019, California Governor Gavin Newsom appointed Dr. Nadine Burke Harris — a national leader in pediatric medicine, research scientist, and a national voice elevating issues around adverse childhood events (ACEs) and toxic stress — as California’s first-ever Surgeon General.

Surgeon General Harris, in partnership with Governor Newsom, the California Department of Health Care Services (DHCS), and health and community leaders, is leading system reform that recognizes, and responds to, the effects that ACEs have on our biological systems and addresses the lifelong impacts of ACEs.

Key to that roll out is the ACEs Aware initiative. Starting on January 1, 2020, DHCS is providing a payment to Medi-Cal providers for screening their patients for ACEs. The Office of the California Surgeon General and DHCS are committed to providing organizations and providers across California’s healthcare system and communities the training, tools, and resources they need to effectively and equitably incorporate ACEs screening into patient care.

As part of this effort, the UCSF Center to Advance Trauma-informed Healthcare is leading the California ACEs Learning and Quality Improvement Collaborative (CALQIC). The goal of CALQIC is to integrate screening and response for ACEs in healthcare settings in a way that enhances connection between patients and providers, helps connect patients to services that they want and need, and leads to better outcomes, reduced disparities, and more positive experiences of care for all involved.

CALQIC is leading an 18-month statewide learning collaborative of pediatric and adult clinics in seven regions. CALQIC will identify promising practices, tools, resources, and partnerships that will inform future phases of California’s ACEs initiative.

What are ACEs?

ACEs – adverse childhood events –  are stressful or traumatic events experienced by age 18 that relate to adversities across three domains; physical, emotional, or sexual abuse; physical or emotional neglect; and household dysfunction (e.g., a parent with a mental health condition or substance use disorder, absence due to separation or divorce, or intimate partner violence).

Recently, the U.S. Centers for Disease Control and Prevention issued a special report on ACEs and suggested that the prevention of ACEs may lead to a reduction in a large number of health conditions, including heart disease, stroke, cancer, and diabetes, as well as depression, unemployment, and substance dependence.

According to the most recent California Department of Public Health data reporting from the Behavioral Risk Factor Surveillance System, 63.5 percent of Californians have experienced at least one of the ACEs, and 17.6 percent of Californians have experienced four or more. Nationally, the prevalence rate is similar.

Additionally, research shows that individuals who experienced ACEs are at greater risk of numerous ACE-Associated Health Conditions, including nine of the 10 leading causes of death in the United States, and that early detection, early intervention, and trauma-informed care can improve outcomes.

How is CALQIC organized?

The UCSF Center to Advance Trauma-informed Healthcare is leading CALQIC, a public-private partnership including the Center for Care Innovations (CCI), and RAND Corporation that will train California’s Medi-Cal providers to effectively screen and respond to ACEs. This partnership includes the leading content experts with both academic and front-line experience in screening and responding to ACEs (UCSF); the leading California-based nonprofit organization focused on using innovation, performance improvement, and peer-based learning to transform care for low-income communities (CCI); and the preeminent California-based nonprofit focused on healthcare innovations and evaluation (RAND).

UCSF co-directors Anda Kuo, MD, Marguerita Lightfoot, PhD, and Edward Machtinger, MD, are leading the collaborative.

Why does California need CALQIC?

Because screening and response to ACEs is an early-phase healthcare innovation, CALQIC is engaging providers in the context of a learning collaborative, where participants will learn best practices through training, coaching, and peer support. Lessons learned will be methodically collected and analyzed as learning collaborative providers deploy ACEs screening and responses. This iterative process will allow learnings to inform trainings in the learning collaborative, as well as lead to best practices and tools that will support the next phases of the broad statewide training initiative.

Which organizations are participating in the learning collaborative?

The learning collaborative runs from July 1, 2020 to October 31, 2021.

In this collaborative, participating organizations are receiving coaching, and the opportunity to learn from experts and other organizations who are implementing ACEs screening. They are participating in learning sessions with the aim of successfully implementing ACEs screening in clinics sites serving both pediatric and adult populations. 

Clinic support will include coaching (content and process); expert training and peer-to-peer sharing of promising approaches, challenges and solutions; and funding support.