The Road to Resilience: A Public Health Approach to Adverse Childhood Experiences (ACEs)

The Road to Resilience:  A Public Health Approach to Adverse Childhood Experiences (ACEs)

Physicians and public health nurses representing all 58 counties and 3 cities in California came together for three days to discuss The Road to Resilience: A Public Health Approach to Adverse Childhood Experiences.  Program Brochure

Presentations included (partial list):

• Health Departments’ Evolving Perspective: Addressing ACEs, Childhood Trauma and Toxic Stress
• The Lived Experience of ACEs and Trauma-informed Care
• Neurobiology of Trauma and Resilience
• A Pediatrician’s Public Health Perspective: Childhood Toxic Stress and ACEs
• Collaborations to Support Local Health Efforts to Address ACEs
• Local Health Department Alignment to Prevent Toxic Stress and ACEs
• Statewide Collective Impacts to Foster Resilience
• Mental Health System Infrastructure and Training to Address Specific ACEs
• Annual Indicators of Maternal and Childhood Toxic Stress for Local Health Departments
• Influencing Public Policy to Prevent ACEs
• Building Trauma-informed Collaborations at the State and Local Levels

 The conference hosted by the California Conference of Local Health Officers (CCLHO), the Health Officers Association of California (HOAC), the California Department of Public Health (CDPH) in partner with the Maternal, Child and Adolescent Health (MCAH) Directors and MCAH Action provided a robust continuing medical education program on Adverse Childhood Experiences (ACEs).  

California Conference of Local Health Officers (CCLHO) are physician Health Officers from all 58 counties and 3 cities. These legally appointed physicians provide a state/local forum for the discussion of significant health issues and recommend health policy, including legislative and regulatory review.
 Health Officers Association of California (HOAC) conduct special projects to advance the practice public health in California and to provide technical expertise to the state legislature on matters related to public health.
California Department of Public Health (CDPH) is dedicated to optimizing the health and well-being of the people in California, and health-care clinicians and providers play a vital role. 
Maternal, Child & Adolescent Health (MCAH) Directors work to improve the health and well-being of women, infants, children and adolescents throughout the state. Many programs and initiatives serve California’s diverse populations and regions, providing resources, information and data for physical, emotional, mental and social health.

During open discussions, participants shared thoughts and ideas such as:  
How to bring more caring adults into the lives of at-risk children, suggestions included making bgcp.org Boys and Gils Clubs more accessible, embedding the 41 Developmental Assets pdf document into efforts, and Federal funding for CA after school programs  

There was some concern about "waiting so long" to identify at-risk children.  It was then noted that the American Academy of Pediatrics AAP link recommends screening for mental health for children age 12 and up. 

Asking for trauma and resilience building strategies, one Emergency Room physician discussed how providers are often overwhelmed and can experience a sense of helplessness resulting their own trauma, a situation ripe for “massive burnout”. 

A reference to the Family First Prevention Services Act  was signed into law February 9, 2018. This act reforms the federal child welfare financing streams, Title IV-E and Title IV-B of the Social Security Act Social Security Act, to provide services to families who are at risk of entering the child welfare system. The bill aims to prevent children from entering foster care by allowing federal reimbursement for mental health services, substance use treatment, and in-home parenting skill training. It also seeks to improve the well-being of children already in foster by incentivizing states to reduce placement of children in congregate care.

Many conference participants expressed a desire to empower physicians to be advocates, Address ACEs and to consider environmental adversity as well. 

With an eye towards aligning efforts - Collective Impact - there was discussion about the role of Medi-Cal Managed Care and whether the metrics they are using address ACEs core issues. On March 28, 2018 the State of California—Health and Human Services Agency Department of Health Care Services: published a MEDI-CAL MANAGED CARE QUALITY STRATEGY REPORT  Outcomes pdf metrics associated with ACEs.  

One group representing the smaller counties expressed frustration, stating, "working without county level data – is like working without a stethoscope!".