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Funded Projects

Grant Status: Active

Grant Title: Trauma Screening and Treatment at Roseland Pediatrics

Project Director(s):

Meredith Kieschnick, MD
Santa Rosa Community Health Centers
Santa Rosa, CA
Phone: (707) 578-2005
Email: meredithk@srhealthcenters.org

Problem:

Research shows that 57% of children in California have experienced adverse or traumatic events that are directly linked to poor health outcomes later in life, with low-income, poorly educated and immigrant families disproportionately affected. Addressing trauma is a priority for these families.

Goals and Objectives:

Goal 1: To ensure all staff at Roseland Pediatrics understand the toxic effects of trauma/violence and the principles of trauma-informed care. Objective 1: Train all staff at Roseland Pediatrics in the relationship between traumatic childhood experiences and health outcomes by April 2016 Objective 2: All staff will indicate an understanding of ACEs and the principles of trauma-informed care, as measured by a self-assessment conducted by 9 months into the project. Goal 2: To introduce evidence-based trauma/violence screening at Roseland Pediatrics to a large population of disadvantaged, low-income children age 0-19 to identify youth and families affected by trauma Objective 1: Train staff to use the Adverse Childhood Experiences (ACE) Score Calculator by March 2016 Objective 2: Modify workflows to use ACE screening tool in 90% of all new patient visits starting March 2016. 80% of Roseland patients will have a documented annual ACEs screening in their electronic health record in years 2-5 of the project. Objective 3: Establish a clear triage system for patient scoring & referral by March 2016. Goal 3: To augment immediately available counseling services available on-site at Roseland Pediatrics for children & families who have experienced trauma and improve their emotional health and well-being. Objective 1: Hire and train a 1.0 FTE pediatric psychologist starting March 2016. Objective 2: Hire and train a .5 FTE Care Coordinator starting May 2016. Objective 3: 50% of children and families affected by trauma will receive treatment by March 2018. Goal 4: To make appropriate treatment options available to all children and families who have experienced trauma/violence. Objective 1: Collaborate with community partners and Advisory Board to map available community treatment options for low-income children and families by September 2016. Objective 2: Develop and implement a clear system of shared referral procedures to connect patients to community treatment programs by December 2016. Objective 3: Develop and implement a shared process for care coordination and management with referral partners by March 2017. Goal 5: Reduce the prevalence of community, family, and domestic violence. Objective 1: Document prevention-informed trauma discussion with families as part of 80% of all patient visits in years 2-5 of the project. Objective 2: Develop a comprehensive toolkit of research-based support materials for patients, families and staff by March 2016. Of particular concern, we will emphasize and test materials for cultural and linguistic competence (MCH Goal 10).

Methodology:

Train all staff at Roseland Pediatrics in the relationship between traumatic childhood experiences and health outcomes. Train staff to use the Adverse Childhood Experiences (ACE) Score Calculator. Modify workflows to use ACE screening tool in 90% of all new patient visits. Establish a clear triage system for patient scoring and referral. Begin screening all new patients on history of adverse childhood experiences by March 2016. Modify SRCHC's Electronic Health Record to ensure all members of the patient's health care team will have access to a patient's trauma screening results to inform future treatment and care plans. Hire and train a 1.0 FTE therapist. Hire and train a .5 FTE Care Coordinator. Set screening goals for outlying years after review of baseline data. Collaborate with community partners and Advisory Board to map available community treatment options for low-income children and families Develop and implement a clear system of shared referral procedures to connect patients to community treatment programs. Recruit and support a patient representative to join the Sonoma County ACEs Connection workgroup. Develop a comprehensive toolkit of research-based support materials for patients, families and staff (MCH Goal 10). Modify SRCHC's electronic health records to allow collection of data needed to report on project activities. Monitor costs and build a sustainable model for screening and treatment of ACES in an FQHC setting.

Coordination:

SRCHC is working with the following organizations: Child Parent Institute (CPI), First 5 Sonoma County, the Roseland School District, the Santa Rosa City School District, the Sonoma County Department of Maternal and Child Health, Community Action Partnership, the Sonoma County Department of Mental Health, and the Community Child Care Council, the California Title V Maternal and Child Health Program, and the California American Academy of Pediatrics.

Evaluation:

SRCHC will modify our eCW templates to enable accurate tracking of ACEs screening results, documentation of trauma prevention discussions, and all other data necessary for accurate reporting on project outcomes.

Experience to Date:

SRCHC's Healthy Tomorrow's Partnership for Children (HRPC) Project is going extremely well! The primary goal of our project is to develop and implement an evidence-based ACEs screening program at our Roseland Pediatrics health center, and to expand the therapeutic treatment and referral options available for affected children and families. We're one year into our HTPC project and we have great energy and commitment from all staff. We started screening patients for ACEs as of August 2015. The project team modified the Adverse Childhood Experiences (ACE) Score Calculator into two different questionnaires appropriate for the literacy and culture of our low-income Latino population: one for teens age 12 and up, and one for kids age 0-11 that includes questions directed at the child and the parent. We modified our electronic health record system to capture screening results for tracking and reporting. From March 2015 -- Feb 2016 staff at Roseland Pediatrics conducted 1,227 ACE screenings (54.8% of well-child and new patient visits) and made 470 referrals to internal and external support and treatment resources. We're working on a data crosswalk to allow for even more accurate reporting and analysis on screening and outcomes for children and families in our HTPC project.

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