In my previous post, I shared my personal journey that led to my discovery of the science of childhood adversities and their potential implication for making a difference in global health. In the process of doing so, my team started mapping who is doing ACEs-related work at our large, multidisciplinary university.
Knowing that our UCSF community has been at the forefront of the most challenging public health problems of our time, such as HV, cardiovascular diseases, and cancer, I was not surprised to discover that we are also home to numerous individuals, centers, and programs engaged in groundbreaking ACEs-related activities in a wide range of subject areas, such as finding innovative treatment and preventive methods, providing quality services to children and families exposed to ACEs, and examining the root causes of ACEs. Many of those centers are nationally or internationally recognized for their leadership.
Therapeutic interventions are key to helping children who have already experienced traumatic events.
Child Trauma Research Program (CTRP) is perhaps one of the most internationally recognized UCSF programs that is conducting research to expand existing therapeutic options while they provide high-quality services to children and families exposed to trauma. Under the leadership of Dr. Alicia Lieberman of the Department of Psychiatry, the Center is developing family-centered effective interventions for children and parents who experience traumatic events, including child-parent psychotherapy (CPP), perinatal CPP, and co-parenting CPP services. The Center for Child Protection, as one of Northern California’s leaders in child protective services, located at UCSF Benioff Children’s Hospital Oakland and co-directed by Dr. James Crawford-Jakubiak and Shelley Hamilton, offers an interdisciplinary approach for early detection and prevention of child abuse and violence. They offer crisis intervention services that could involve law enforcement, continued counseling support, prevention services in schools and community centers, and domestic violence education and screening.
The Family Information and Navigation Desk (FIND) is an interdisciplinary program under the leadership of Dr. Dayna Long, Medical Director of the Department of Community Health and Engagement at UCSF Benioff Children’s Hospital Oakland. In addition to medical care, FIND helps connect families to community resources that provide for basic needs such as counseling, food-stamp programs, and housing supports. Dr. Long and other UCSF faculty are collaborating with the Center for Youth Wellness on the first randomized controlled trial that screens children for toxic stress through parent surveys conducted during regular primary care visits.
There are UCSF programs that have taken their interventions outside of the hospital walls.
Healthy Environments and Response to Trauma in Schools (HEARTS), under the leadership of Dr. Joyce Dorado at the Department of Psychiatry, focuses on building trauma-informed schools in which personnel are empowered to understand, recognize, and effectively address the impacts of traumatic stress on their school communities (students and adults alike) through shifts in their practices, procedures, and policies.The Fuerte Program, directed by Dr. William Martinez, is also a school-based secondary prevention program targeting newcomer Latinx immigrant youth in the San Francisco Unified School District at risk for behavioral health concerns. Fuerte is funded through a CA Mental Health Services Act Innovation Fund with ongoing program evaluation. Across the Bay, under the directorship of Dr. Nooshin Razani, Center for Nature and Health (CNH) at UCSF Benioff Children’s Hospital Oakland has taken a less conventional approach and developed the first nature-based behavioral interventions for psychologically traumatized children.
There are other groups whose mission contributes to breaking the negative cycle of inter-generational trauma by addressing mental health issues in pregnant mothers and underserved adults.
Notably, the Solid Start Initiative, directed by Dr. Melanie Thomas at the Department of Psychiatry, UCSF, is a multi-disciplinary collaboration that promotes health and health equity through innovative models of integrated care that support pregnant women and families with children ages 0-3 at Zuckerberg San Francisco General Hospital. Families who experience chronic exposure to poverty and trauma receive a whole-person model of care to optimize health outcomes and patient experience. Another example is the Program of Research on Mental Health Integration among Underserved and Minority Populations (PReMIUM), directed by Dr. Christina Mangurian at the Department of Psychiatry, focuses on improving mental health integration and general health care of marginalized communities and vulnerable populations. The Trauma Recovery Center (TRC) provides evidence-based trauma-focused care for adult survivors of interpersonal violence. The TRC provides clinical case management, group and individual therapy, and forensic medical care (for acute sexual assault). The center is directed by Dr. Sarah Metz at the Department of Psychiatry. The TRC has a technical assistance manual available on their website.
Several groups at UCSF are examining the root causes of ACEs (i.e., social and economic context that contributes to health disparities) across the age spectrum.
Center for Health and Community (CHC), under Dr. Nancy Adler’s leadership, facilitates cross-disciplinary research and education to enable a comprehensive understanding of social, behavioral, and policy aspects of health and health equity across the lifespan. The Social Interventions Research and Evaluation Network (SIREN) focuses on improving health and health equity by advancing high quality research on health care sector strategies toimprove social conditions. The Network is directed by Dr. Laura Gottlieb, Dr. Nancy Adler, and Dr. Caroline Fichtenberg. The Center for Health Equity (CHE), Co-directed by Dr. Paula Braveman, Kristen Marchi, and Dr. Rita Hamadat the Department of Family and Community Medicine, utilizes innovative approaches to study and monitor social disparities in health and health care such as the Maternal and Infant Health Assessment project. The Center for Vulnerable Populations (CVP) is known nationally and internationally for its innovative research in health communication and health policy pursuant to reduced health disparities. CVP,under the direction of Dr. Margot Kushel of the Department of Medicine, seeks to develop effective strategies to prevent and treat chronic diseases in disadvantaged communities, with a recent focus on addressing homelessness.
The Division of Developmental Medicine of the Department of Pediatrics is another UCSF institution that was created by Dr. Thomas Boyce (Professor Emeritus) to address specific needs of families and children with complex developmental and behavioral issues. Currently led by Dr. Nicki Bush, the division is leading the field, among many other works, by examining children’s biological responses to adversities and investigating the health impacts of mothers’ exposure to toxic stress on their children.
Finally, there are training programs such as Program in Medical Education for the Urban Underserved (PRIME-US), at the UCSF School of Medicine and the UCB-UCSF Joint Medical Program, directed by Dr. Leigh Kimberg at the Department of Medicine. PRIME-US is designed to support and equip medical students to provide healthcare to urban underserved communities and promote health equity.
The UCSF GRACE Initiative came to life to build partnerships and collaboration across our campus with the goal of addressing childhood adversities in resource-limited settings. We will build on the work of these individual research initiatives and create a community of faculty, students, staff, affiliates, and partners who share a passion for addressing childhood adversities among vulnerable populations in global health settings. It will serve as a liaison to domestic and global health, ACEs research and programs across our campus. GRACE is an initiative designed to disrupt academic silos and help other ACEs-naive professionals connect to cutting-edge UCSF projects. It will also seek innovative, affordable, scalable solutions that can directly help address childhood adversities across geographies. Finally, it will contribute by making the existing science of ACEs and solutions widely accessible for health policies and decision making.
In this article, we highlighted only a small slice of work being done by a handful of “easy-to-find” programs and individuals at UCSF. We found a few other relevant programs for which we were either unable to verify their most recent status or whose mission is under revision.
Of course, it is impossible to rightfully reflect the depth and breadth of the work any of these teams do in a few sentences. Further, it is not hard to imagine that there are other individual researchers and groups whose work has not been mentioned here.
As we learn more about work of our colleagues in coming days, we will continue presenting the work of those groups listed here more comprehensively and write about other groups whose work has not been acknowledged above.
I welcome comments and suggestions on how to grow this community together.
By Mohsen Malekinejad, MD, DrPH
Research contributor: Sonia Ghandi, MA
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