June 15, 2022

For more than seven years, California-based provider TrueCare has made screening patients for Adverse Childhood Experiences (ACEs) a priority. In September 2020, OCHIN began integrating a new suite of tools that would allow providers, including TrueCare, to screen patients for ACEs and toxic stress directly from their OCHIN Epic electronic health record (EHR) platform. Since joining the OCHIN network and participating in the program, TrueCare has screened more than 3,600 patients and imported 70,000 past ACEs/Pediatric ACEs and Related Life-events Screeners (PEARLS) into Epic. They consider this work to be a critical part of offering comprehensive, connected care for their community.

“The better we can collect data, the more we can understand how prevalent these experiences are in our population,” said Leon Altamirano, Ph.D., Director of Integrated Behavioral Health and a licensed psychologist at TrueCare, “and the better we can integrate primary and behavioral health to provide whole-person health care.”

Understanding the impact of toxic stress on health disparities

ACEs are potentially traumatic events that occur during childhood, such as physical and emotional abuse, neglect, caregiver mental illness, and household violence. When multiple ACEs occur without supportive adults, there can be an excessive activation of the stress-response system, also known as toxic stress — leading to long-lasting wear and tear on the body and brain. The more ACEs a child has, the more likely they are to suffer from chronic physical, mental, and behavioral health problems later in life. According to the Centers for Disease Control and Prevention (CDC), about 61 percent of adults reported experiencing at least one type of ACE before age 18, leading to a variety of long-term effects. For example, the CDC estimates that up to 1.9 million heart disease cases and 21 million depression cases could have been potentially avoided through timely intervention. These negative health outcomes disproportionately impact underserved communities.

TrueCare’s 11 health centers are dedicated to serving a wide range of patients, including many from marginalized communities who are at a greater risk for ACEs and toxic stress, according to research published in the National Library of Medicine. With the COVID-19 pandemic putting more physical, mental, and economic stress on families, health centers are committed to meeting the growing need for ACEs screening and intervention in a primary care setting.

Enhancing care quality and efficiency

Early detection and intervention is key to helping patients achieve their full health potential and avoid long-term health challenges caused by ACEs, but efficiency is critical to this effort. By enabling providers to screen patients for ACEs and toxic stress directly from their OCHIN Epic EHR platform, OCHIN helps TrueCare and other community care organizations in its growing national network better identify patients who may need intervention and seamlessly connect them with additional clinical or community resources for support.

These tools, which were among the first ACEs screenings to be integrated directly into an EHR nationally, are available from OCHIN in partnership with the Community Health Center Network (CHCN), with support from Blue Shield of California. In addition to being more efficient than the paper surveys previously used, they are also highly effective in helping providers find toxic stress early and break cycles of generational poverty, abuse, and neglect by coordinating proper counseling, behavioral health services, or community-based resources for needs like food or housing assistance.

Connecting and transforming care 

Conducting ACEs screenings has been a part of TrueCare’s operations for several years, but having a more formalized and integrated process with support from OCHIN has helped TrueCare connect care teams and offer patients access to a more complete circle of care within their community.

“This isn’t just a provider initiative; it’s a whole team initiative,” Altamirano said. “OCHIN has shown dedication to helping us improve the care that we’re giving, and everyone involved in our practice— from our nurses, physicians, mental health providers, administrative staff and everyone in between—enthusiastically participated in trainings and knowledge sessions,” Altamirano said. “Placing value on ACE screenings and whole-person care has truly become ingrained in our culture.”

While this culture shift didn’t occur overnight, the robust tools, training, and technical support available to TrueCare and other pilot participants throughout their partnership with OCHIN has enhanced clinical capacity and transformed wrap-around care delivery.

“In the beginning, it was difficult for some providers to ask questions that may feel invasive because they were unsure of exactly what action to take if the question revealed something unrelated to the physical care they were providing,” said Matthew Kosel, Vice President of Clinical Informatics and Enterprise Analytics and a physician assistant at TrueCare. “They wanted to help but didn’t necessarily know what to do in certain instances. By having this process formalized and having training and resources available, our providers know exactly how to connect patients to services they need to experience their full health potential. It’s changed the way we’re able to help people.”