UCSF’s Center to Advance Trauma Informed Healthcare is leading an effort to address the effects of trauma on health with a focus on “whole family wellness.” The program is 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.”
The intervention will be developed and tested at Bay Area clinics that are part of the California ACEs Learning and Quality Improvement Collaborative (CALQIC), which was created with $10.6 million from the Office of the California Surgeon General and the California Department of Health Care Services to train providers and develop clinical protocols for ACEs screening.
“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.”
More about Whole Family Wellness
Whole-Family Wellness for Early Childhood: A New Model for Medi-Cal Delivery and Financing outlines a new approach for California to conceptualize, deliver, and fund a system of care for Medi-Cal eligible infants and toddlers that is grounded in family wellness. At present, California is not adequately addressing the needs of young children on Medi-Cal, allowing millions to miss out on important preventive care each year because Medi-Cal health plans do not meet the whole family’s needs.
“Persistent stress and trauma can have lasting effects on children’s health, but early intervention can strengthen the resilience of children and families –preventing and even reversing negative health outcomes. We’re hopeful this research will develop new models that treat the whole family, promote health equity and create healthier futures for kids.”
Kristin Campbell ReedExecutive Director, Corporate and Employee Giving at Genentech
The need for family- and community-centered care is particularly critical in pregnancy and the first five years of life, when the architecture of the brain is established and neural connections grow at the fastest rate of a person’s lifetime. During this period, the brain shapes key abilities for long-term wellness, such as forming trusting relationships, being open to learning, and regulating emotions. Healthy, loving caregivers promote healthy development in young children; thus, the whole-family context is vital.
Currently in California, the Medi-Cal system focuses on delivering individual services for children, outside the context of their families and communities. For example, healthcare providers and systems must determine a young child’s “psychopathology” before they offer mental health care or are reimbursed for it. Yet many clinicians do not receive training in early childhood mental health, and the diagnostic criteria are based on adult symptoms, calling accurate diagnosis into question. At the same time, young children in genuine distress due to family conflict, community violence, economic hardship, and parental mental illness may not fall under a diagnosis, but still need support.
The proposed new model of care, the Whole-Family Wellness Hub-and-Spoke Model, recognizes the importance of early prevention, identification, and support to mitigate adversity, and to bolster protective factors and family resilience. Providers would include community-based organizations, county-operated clinics, Federally Qualified Health Centers, and primary care practices, working together to provide peer support and age- appropriate models for attachment and bonding (Hubs), as well as resources to address broader social needs (Spokes). This family-centered model of care and parenting support is preventive, need-based, and therapeutic; it focuses on supporting children and families in community settings that build social connections and directly address the social determinants of health. The model would be financed by accessing and leveraging multiple sources of funding (e.g., Early and Periodic Screening, Diagnostic and Treatment [EPSDT], Realignment, Mental Health Services Act [MHSA] dollars).