Abstract
Background Adverse Childhood Experiences (ACEs) are traumatic events that occur before age 18 years. ACEs, associated with negative health behaviors and chronic health disorders, disproportionately impact people from poor and marginalized communities. Toxic stress from ACEs can be prevented and treated with trauma-informed care. Inadequate training prevents the maternal and child workforce from providing evidence-based trauma-informed care. Cross-sector collaboration between pediatric care sectors is crucial to providing systems-wide trauma-informed care, but significant barriers impede cross sector communication. Training and formal cross-sector communication networks are needed to create strong systems of trauma-informed care in communities.
The Stanford ACEs Aware ECHO (Extension for Community Healthcare Outcomes) program was created with 3 workforce development goals: 1) introduce the California Office of Surgeon General-led ACEs Aware Initiative to the maternal and child health workforce in 3 California counties, 2) disseminate trauma-informed evidence-based best practices, 3) bridge community silos to increase collaboration between care sectors to promote trauma-informed care systems.
Methods Participants were recruited from Federally Qualified Health Centers, county public health departments, community behavioral health organizations, educational institutions, and agencies that serve low-income children and families. 100 unique participants representing 3 counties and 54 agencies joined sessions. Twelve virtual educational sessions were convened over 6 months using the Project ECHO® model via Zoom technology. Sessions consisted of didactic lectures and whole-group case-based discussions.
Results After completing the educational series, participants expressed commitment to increased cross-sector collaboration, and reported increased knowledge and confidence in using trauma-informed skills. After participation, a significant number of participants had also completed another recommended California ACEs Aware Initiative online training.
Conclusion An ECHO series of virtual workforce development sessions on trauma-informed best practices promoted cross-sector communication and was associated with strong participant engagement and satisfaction. The educational series increased knowledge and confidence in use of evidence-based trauma-informed best practices.
Key Messages
Adverse Childhood Experiences (ACEs) are stressful or traumatic events that occur before the age of 18 years and are associated with high human and economic costs to society.
Evidence-based trauma-informed Care (TIC) has been shown to prevent and treat toxic stress caused by ACEs, but training programs for the maternal and child workforce have historically provided inadequate training in TIC best practices.
Cross-sector collaboration to provide systems-level trauma-informed care is known to improve population health and promote health equity, but funding and staffing barriers to optimized collaboration exist.
The Project ECHO® (Extension for Community Healthcare Outcomes) model uses distance learning teleconferencing to create learning communities across geographic distance and care sector, educate and mentor participants, and elevate quality of care in community settings.
The Stanford ACEs Aware ECHO effectively delivered a curriculum about TIC to a tri-county community of maternal and child workforce participants that promoted cross-sector collaboration. Participation was associated with high levels of engagement and satisfaction. Participants reported increased confidence and knowledge to provide systemic evidence-based TIC.
Competing Interest Statement
The authors have declared no competing interest.
Funding Statement
This project was supported by funding by the California Office of the Surgeon General and Department of Health Care Services ACEs Aware Initiative Provider Engagement (Network of Care) grant.
Author Declarations
I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.
Yes
The details of the IRB/oversight body that provided approval or exemption for the research described are given below:
Stanford University Institutional Review Board
All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.
Yes
I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).
Yes
I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.
Yes
Footnotes
Declarations:
Data Availability: Data will be made available by request to corresponding author.
Funding: This work was supported by a Provider Engagement (Network of Care) grant from the California ACEs Aware Initiative.
Conflicts of Interest: The authors declare that they have no conflicts of interest.
Ethics approval: Project deemed not human subject research because it was an educational project.
Consent to participate: Not required because not human subjects research
Consent for publication: The authors consent to publication of the data and manuscript.
Code availability: Data were analyzed using IBM® SPSS® Version 26 software platform.
Data Availability
Data will be made available by request to corresponding author.