Becoming Aces Aware in California: Chapter 1 Informs and Inspires Local Pediatricians

Background: In 2019, California’s Surgeon General, Nadine Burke Harris MD FAAP, launched ACEs Aware, a statewide campaign to educate primary care providers about Adverse Childhood Experiences (ACEs) and encourage them to begin screening for ACEs in their practices. Universal screening and early detection of ACEs is part of California’s evidence-based strategy to address the role of toxic stress as a potential contributor to many chronic diseases, including developmental and mental health issues for children and adults exposed to childhood stressors.

Methods: AAP California Chapter 1 pediatricians have a great interest in strategies to identify and reduce the impact of toxic stress for children and families. In 2019, our Chapter received an ACEs Aware Communications grant to educate Northern and Central California pediatricians about ACEs screening, potential health effects of the toxic stress response, and trauma-informed care. Chapter leaders recruited an "ACEs Aware Think Tank" of six pediatricians with expertise in ACEs, mental health, child abuse and developmental and behavioral health to create a comprehensive communications and educational strategy intended to engage and inform pediatricians about trauma-informed practices and ACEs screening.

Results: ACEs Aware Think Tank members and staff met throughout the pandemic to develop educational tools and messages supporting pediatricians in understanding, identifying and reducing the harmful effects of toxic stress. Using a motivational interviewing framework, our pediatricians outlined barriers and facilitators to adopting changes in practice. They subsequently developed eight core messages intended to motivate providers to see families and children from a trauma-informed perspective, such as "Asking and Listening is an Effective Way to Address ACEs". We integrated the messages into our twice a month communications which we sent electronically to over 4600 board-certified pediatricians in 48 counties. We also established a social media presence, added a dedicated webpage to our Chapter website, and held 4 evening peer to peer learning sessions on ACEs. Evaluation metrics of our engagement showed 93.6% (4331) of the pediatricians opened at least one email, and 11% (507) of the pediatricians engaged in the communications regularly. Communications with increased interest included such topics as "Using Telehealth in Trauma-informed Pediatric Practice", "Associated Health Conditions and Pediatric Toxic Stress". Peer to peer learning Zoom chapter chats were also well received, with over 200 pediatricians attending and providing positive evaluations. 789(17%) of the pediatricians in our target population attested to completion of the California ACEs training by June 2021. All communications and social media messages have been posted on our website (https://aapca1.org/aces-aware/).

Conclusion: A communications portfolio built by experienced pediatricians can support implementation of ACEs screening and trauma-informed practices in pediatric primary care. Innovative pediatric messages and tools developed in this cutting-edge campaign improved our State’s capacity to address ACEs and toxic stress.