(Thanks to Karen Clemmer for contributing to this blog post.)
In our work towards breaking down silos, ACEs in Maternal Health Community Manager Karen Clemmer and I, the community manager of ACEs in Pediatrics, co-hosted a lively discussion for the April 3 “Better Normal” brainstorming session. The session included looking at workarounds for pediatricians and other health care providers during a time when all of our lives have been upended and rerouted, how we in our communities are being affected, and what resources are available to help us navigate through these unchartered waters.
The meeting drew a wide swath of the ACEs Connection community including parents, grandparents, a mom-to-be, family members, pediatricians, social workers, community advocates, trauma specialists, home visiting social workers, an ACEs health consultant, and a pediatric primary care psychologist from the Center for Youth Wellness. They hailed from California, Virginia, Texas, Massachusetts, and Pennsylvania.
As a starting point, we mentioned the following questions to spark some ideas for discussion:
- What we are we all doing in our ACEs in Maternal Health and ACEs in Pediatrics communities?
- What kinds of resources and information do health care providers need?
- What are examples of workarounds for ensuring that patients receive care during the COVID-19 pandemic, and which of those might become permanent?
- How does a warm handoff work between health care providers and community-based organizations during COVID-19?
I talked about the ACEs in Pediatrics community and some of the ways that ACEs-informed pediatricians were transitioning to telehealth and how they were faring in a sheltering-in-place world, which was captured in this article. And gave examples of how other health care providers were transitioning, based on an ACEs Aware webinar, which I wrote about here.
And then I asked those on the call to talk about what they needed in this transition? “The first question everyone has been asking is ‘How do I keep my patients safe?’ And the second one is ‘How do I keep a roof over my head?’” said Dr. Kate Williamson, the president of the Orange County chapter of the American Academy of Pediatrics, who has been holding weekly chats with their members. The answer to both of those questions, said Williamson, is by using telehealth, which during COVID is both reimbursable and makes for the necessary social distancing to keep everyone safe. Williamson directed attendees to the step-by-step tools on the AAP-OC website to help providers get their practices up and running with telehealth. She also invited anyone to attend their weekly chats.
Pediatrician Mary Beth Steinfeld, whose team at a medical resident-led Federally Qualified Health Center at UC Davis Medical Center was just about to implement ACEs screening, asked other participants “How we can integrate a discussion regarding ACES screening with the importance of a parent's ACE history and the elevated risk of toxic stress in the home?”
“There’s so much going on with families with all the stress that I think just talking to families in general about how they’re affected by the current situation, which we know exacerbates [stress] from adverse childhood experiences is important,” said Dr. Suzanne Frank, supervising pediatrician at the School Health Clinics of Santa Clara County, who retired from Kaiser San Jose where she was an ACEs champion. She also suggested offering mindfulness exercises and advising patients to try and stick to routines to help reduce stress.
While telehealth is a solution for keeping patients and health care providers safe, Frank said one challenge for providers is how to schedule necessary in-person visits such as immunizations for infants and children, noting that many patients are afraid to come to the office.
Williamson said that some providers are staggering patient visits for vaccines. And a few have come up with some out-of-the-box approaches: “I know that some providers are going out to patients’ cars and doing the vaccines in the cars.”
Several participants on the call talked about how stress from sheltering-in-place and the profound changes in daily life have led to increases in domestic violence and sexual violence. One participant, a social worker who identified himself as Reed who works with people who are survivors of domestic violence, wrote in the chat line that in Virginia, where he is based, calls to the domestic violence hotline had jumped 73 percent from March 2019 to March 2020.
One participant asked if it was possible to add someone from outside the pediatric practice to a call to help a patient. Williamson said that via telehealth you need only get verbal consent from the patient.
Karen Clemmer asked about what people are hearing about women having to give birth isolated from their partners and other support, which she noted would be particularly trying for new moms with high ACEs. To lessen the feeling of isolation, Williamson said that some hospitals are releasing new mothers after one day rather than having them stay the typical two days.
Thank you for your participation in our “Better Normal” community discussion! We are grateful for your participation, and we recognize that time is at a premium, especially during a pandemic. We’ll be here with our ears open and we’re looking forward to more sessions with you. Let us know what you need.
Join the conversation!
We invite you all to join these communities on our website
https://www.pacesconnection.com...ternal-mental-health
https://www.pacesconnection.com/g/aces-in-pediatrics
Resources shared or requested
Docs for Tots http://docsfortots.org/docs-fo...-update-on-covid-19/
Sesame Street Elmo Belly Breathing https://www.youtube.com/watch?v=_mZbzDOpylA Journal of Breastfeeding Medicine re BF and COVID https://www.bfmed.org/abm-statement-coronavirus -
Early Education Resources www.tfec.org/early-education-resource-center
ACEs Connection webinar: Trauma-Informed Practices to address Covid 19
Key takeaways - How have providers adapted to meet the needs of their patients while being in quarantine?
Telehealth http://files.medi-cal.ca.gov/p...COVID19_response.asp http://files.medi-cal.ca.gov/p...ewsroom_30339_02.asp
In light of both the federal Health and Human Services Secretary’s January 31, 2020, public health emergency declaration, as well as the President’s March 13, 2020, national emergency declaration relative to COVID-19, the Department of Health Care Services (DHCS) is issuing additional guidance to enrolled Medi-Cal providers, including but not limited to physicians,nurses,mental health practitioners, substances use disorder practitioners, dentists – as well as Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), and Tribal 638 Clinics.
https://www.dhcs.ca.gov/Docume...-COVID-19-031620.pdf
https://www.cms.gov/newsroom/f...-provider-fact-sheet
https://www.nejm.org/doi/full/10.1056/NEJMp2003539
Domestic Violence and IPV calls in Virginia increased by 73% when comparing March 2019 to March 2020. https://www.thehotline.org/help/
HIPAA How to effectively support / coordinate / collaborate around patient care?
https://www.hhs.gov/hipaa/for-...elehealth/index.html From participant — if you have an agreement with other agencies you could do a conference/shared call.
How is shelter-in-place impacting perinatal health?
Childbirth-laboring women have only been allowed to have medical personnel present
https://www.who.int/news-room/...th-and-breastfeeding
Breastfeeding from the Academy of Breastfeeding Medicine. "In a similar situation to COVID-19, the CDC recommends that a mother with flu continue breastfeeding or feeding expressed breast milk to her infant while taking precautions to avoid spreading the virus to her infant. Given low rates of transmission of respiratory viruses through breast milk, the World Health Organization states that mothers with COVID-19 can breastfeed.https://www.bfmed.org/abm-statement-coronavirus -
https://icea.org/breastfeeding-and-covid-19/
https://www.cdc.gov/breastfeed...d-breastfeeding.html Breast milk provides protection against many illnesses and is the best source of nutrition for most infants.
Mental Health
https://www.apaservices.org/pr...h-providers-covid-19
https://www.cdc.gov/coronaviru...-stress-anxiety.html
Wellness Strategies
Providers: https://www.apaservices.org/pr...h-providers-covid-19
Parent/Caregiver: https://www.nctsn.org/sites/de...reak_factsheet_1.pdf
Ways to connect Social support and relationships are important buffers to toxic stress - can we reflect on ways to connect socially - virtually? We invite you all to continue the conversation in our communities on our website: https://www.pacesconnection.com...ternal-mental-health https://www.pacesconnection.com/g/aces-in-pediatrics
Offerings and Suggestions
Jeanne: At TFEC we have created a resource center on our website to share information about COVID 19 to share with families and at-home activities families can do with young children here is the link: www.tfec.org/early-education-resource-center
Carolyn Curtis: I am leading free classes online on overcoming trauma through https://www.dibbleinstitute.org/ https://www.dibbleinstitute.or...tters-online-series/
Elizabeth Prewitt: Resources needed for people caring for individuals who are having unaddressed addiction problems made worse by the isolation caused by COVID-19…approaches to harm reduction since the individual may not want treatment https://www.ama-assn.org/deliv...-pain-harm-reduction
https://www.nhs.uk/live-well/e...home-cardio-workout/
https://www.nhs.uk/live-well/e.../10-minute-workouts/
https://www.exerciseismedicine...virus%20Pandemic.pdf
http://www.chicagomag.com/city...ng-Social-Isolation/
Emma Harmon: I would love to learn more about ACES and how to support families via telehealth/virtual visits when you usually work in the home with high-risk families. https://www.childtrends.org/du...services-to-families
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6597149/
Contact Us:
acebulla@acesconnection.com
kclemmer@acesconnection.com
ludesky@acesconnection.com
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