Last year, we launched The Resilience Effect, our philanthropic commitment to taking on childhood adversity. This effort came as the result of startling research: kids who suffer significant trauma, such as neglect, abuse, or the stresses associated with poverty, are at a higher risk of developing serious diseases when they’re older. Advances in science have uncovered why: the over-activation of the stress response – pumping adrenaline and cortisol into our systems to keep them on high alert – becomes toxic over time, damaging developing bodies and brains. Emerging evidence suggests that this trajectory can be altered, that prevention, early detection and intervention can address the harmful effects of childhood trauma. But we still don’t know the best ways to intervene - and how to get those solutions to children and families in effective, scalable ways.
We’ve started by focusing on the pediatric healthcare system. Health practitioners are often the first point of contact for families who need support, since young children and their caregivers average at least fourteen well-child visits from birth to age six. Among pediatric providers, we honed in on the clinics that often see the most vulnerable children with the fewest resources: “safety net” clinics that serve mainly low-income patients. We entrenched ourselves in the research and debate on addressing childhood adversity in pediatric settings, learning alongside our partners about what was working, what wasn’t. By listening to others, we began to understand how difficult the challenge is, where providers and patients needed help, and where we might make begin to direct our efforts to make a difference.
Jaclyn Czaja, MD, Associate Medical Director for Pediatrics at Ravenswood Family Health Center told us about the families she sees in East Palo Alto. She serves a diverse population, including many immigrant families who face significant trauma in their lives. “We know our patients have been through trauma, just by hearing their stories. But we don’t often know exactly what to do to help them. There’s always a struggle to prioritize the most important thing to focus on in a patient visit. And there are bigger challenges - like mental health access. We need to figure out on a systems level how to support families, with the resources we do have.” Other providers shared that while they did understand the science behind trauma, they needed help convincing their leadership to make it a priority, resources to train staff, and technical assistance to integrate trauma-informed care into their everyday work.
These insights served as the basis for our newest investment as part of The Resilience Effect - the Resilient Beginnings Collaborative (RBC). RBC is a learning collaborative, launched in partnership with the Center for Care Innovations (CCI), designed to uncover how to best support children and families experiencing adversity, within a pediatric setting.
After a competitive call for applications to safety net clinics across the Bay Area, seven sites were selected to participate in the program. Each clinic will receive a suite of tools to address trauma and promote resilience—including training and coaching for all staff, $80,000 in grants, support in adopting clinical improvement strategies, and opportunities to meet with people from other organizations who are facing the same challenges through monthly webinars and in-person meetings. Through RBC, we have the potential to reach more than 50,000 low-income children under the age of five across the Bay Area – almost one-third of all young children eligible for Medi-Cal across the nine Bay Area counties.1 The clinics participating in RBC serve culturally diverse patients with special challenges, including immigrants, refugees, the homeless, and people who struggle to meet their basic needs of food and housing. Our focus on safety net pediatric providers is grounded in a simple belief: programs designed to benefit vulnerable groups often benefit all of society. If we can work with these clinics, which face the most difficult challenges to overcome in dealing with childhood trauma, we have the opportunity to learn how to best impact the health of our next generation of children.
At each clinic, expert consultants will train clinic staff about the latest science of childhood trauma and the social foundations that contribute to adversity, such as racism and poverty. Practitioners have told us that oftentimes their own cultures, policies, and practices get in the way of their ability to support their patients who are experiencing adversity. We’ll give them tools to examine their own organizations, and manage their own stress, so they can support each other in creating a safe, nurturing care environment for their patients.
The clinics that make up RBC are innovators in dealing with childhood trauma, leading the way in understanding how to best help kids now to prevent health problems later on. But one of the challenges they face–given the pressures of time, many patients, and limited resources–is documenting which approaches work so they can share them across the field. RBC will help by providing technical assistance to track their efforts, conducting baseline assessments, and measuring progress along the way. Our mission is to develop insights that are valuable to the field as a whole, informing models for pediatric providers in the Bay Area and beyond.
Dayna Long, Division Chief for the Department of Community Health at the UCSF Benioff Children's Hospital in Oakland, told us, “This collaborative is an opportunity for us to create streamlined systems so that from the bottom up and the top down, we are all working towards the same goal. If we’re successful, it means that every single family gets screened, referred, and followed up for trauma, adversity, and resilience. We’d see staff flourishing—feeling appreciated, respected, and working together as a team. Senior leadership would believe in this mission, and create sustainable funding so all of this can happen. For us, success is multilayered.”
Clinics around our region are stepping up to address childhood trauma in meaningful and sustainable ways - and we’re honored to be part of that journey. We know that journey will be long, and will come with setbacks along the way. But with our partners, we have a chance to begin to understand the best ways to help our most vulnerable children, and even to shift the way we practice medicine. With RBC, we may be taking initial steps toward unlocking the insights we need to address childhood adversity. However, by working together, and applying what we know about science, they will be steps in the right direction toward making a lasting, positive impact on the lives of Bay Area children.
1 United States Census Bureau, 2017 Estimates