Toxic Stress! Childhood Roots of Health Inequities:Trauma-Informed Approach to Chronic Disease Prevention

Tomas J. Aragon, MD, DrPH

Health Officer, City and County of San FranciscoDirector, Population Health Division (PHD)San Francisco Department of Public Health

Adjunct Faculty, UC Berkeley School of Public Health

Tomas J. Aragon, MD, DrPH (SFDPH) Childhood Roots of Health Inequities 1 / 10

Overview (March 26, 2015)

Foundational themes

1 Childhood roots of health inequities

2 Trauma-informed systems approach

Trauma-Informed Approaches in San Francisco

1 Trauma-Informed Community Building (TICB)

2 Healthy Hearts San Francisco (CDC REACH grant)

3 Black/African American Health Initiative (BAAHI)

Trauma-Informed Public Health Approach for Adults and Children

1 Prevent (toxic stress)

2 Protect (from toxic stress)

3 Prepare (by building resiliency skills)

4 Promote (healthy/enrichment opportunities)

Tomas J. Aragon, MD, DrPH (SFDPH) Childhood Roots of Health Inequities 2 / 10

Causes of Premature Deaths in Men & WomenSan Francisco, 2003–2004

Male (left), Female (right); © Black, 4 Latino, × Asian/PI, + WhiteSource: Aragon TJ. PubMed ID: 18402698

Tomas J. Aragon, MD, DrPH (SFDPH) Childhood Roots of Health Inequities 3 / 10

Toxic Stress! Childhood Roots of Adult Health InequitiesReconceptualizing Early Childhood Policies and Programs to Strengthen Lifelong Health

Source: Center for the Developing Child at http://developingchild.harvard.edu/

Tomas J. Aragon, MD, DrPH (SFDPH) Childhood Roots of Health Inequities 4 / 10

Trauma-Informed Community Building (San Francisco)

Emily Weinstein, MCP, MSRED,Director, Potrero Community andHousing Development, BRIDGEHousing Corporation

Jessica Wolin, MPH, MCRP,Associate Director for CommunityPractice, Health Equity Institute,Clinical Faculty, Department ofHealth Education, San FranciscoState University

Sharon Rose, MPH, WritingConsultant

TRAUMA INFORMED COMMUNITY BUILDINGA Model for Strengthening Community in Trauma Affected Neighborhoods

Weinstein, Wolin, Rose

Tomas J. Aragon, MD, DrPH (SFDPH) Childhood Roots of Health Inequities 5 / 10

Trauma-Informed Community Building (San Francisco)

Challenges to traditionalcommunity building

Lack of trust and socialcohesion

Lack of stability, reliability,and consistency

Inability to vision the future

Disempowerment and lackof sense of communityownership

High level of personalneeds

Depth and breadth ofcommunity needs

Tomas J. Aragon, MD, DrPH (SFDPH) Childhood Roots of Health Inequities 6 / 10

Trauma-Informed Community Building (San Francisco)

TICB

De-escalates chaos and stress

Fosters resiliency

Strengthens social connections

Recognizes trauma

Increases readiness

Foundation and support foreffective delivery of programs andservices

Creates conditions for longtermcommunity and individual change

Tomas J. Aragon, MD, DrPH (SFDPH) Childhood Roots of Health Inequities 7 / 10

CDC REACH Grant—Healthy Hearts San FranciscoA network systems approach to identifying, improving, and linking Community PreventionResources (CPRs) to primary care medical homes (PCMHs) to improve patients’ health

Healthy Hearts SF

San Francisco Health Network

Community A(PCMH 2, 3)

Community B(PCMH 1, 2, 3)

Community C(PCMH 2, 3, 4)

PCMH 1(Com B)

PCMH 2(Com A, B, C, D)

PCMH 3(Com A, B, C)

Community D(PCMH 2, 4)

PCMH 4(Com C, D)

I.Identifying and improving

the QUALITY and ACCESS ofCommunity Prevention Resources

for SFHN PCMH patients

III.Improving QUALITY of PCMH

processes to REFER patients toCommunity Prevention Resources

II.Improving the FLOW of patients between CPRs

and SFHN PCMHs

Future vision

SutterHealth

VAMC

Kaiser

DignityHealth

UCSF

S.F.Health

Network

PHD(public health)

+CPRs

Tomas J. Aragon, MD, DrPH (SFDPH) Childhood Roots of Health Inequities 8 / 10

Black/African American Health Initiative, April, 2014San Francisco Health Network (SFHN)

BAAHI components

1 Collective impact

2 Workforce development

3 Cultural humility* training

Collective impact

1 Heart health — Healthy Hearts SF

2 Behavioral health (focus: alcohol)

3 Women’s Health (focus: breast cancer)

4 Sexual Health (focus: Chlamydia)

*Cultural humility is (a) Committing to lifelong learning and critical self-reflection; (b) Realizingour own power, privilege and prejudices; (c) Redressing imbalances for respectful partnerships;(d) Transforming institutions by promoting accountability

Tomas J. Aragon, MD, DrPH (SFDPH) Childhood Roots of Health Inequities 9 / 10

Review

Foundational themes

1 Childhood roots of health inequities

2 Trauma-informed systems approach

Trauma-Informed Approaches in San Francisco

1 Trauma-Informed Community Building (TICB)

2 Healthy Hearts San Francisco (CDC REACH grant)

3 Black/African American Health Initiative (BAAHI)

Trauma-Informed Public Health Approach for Adults and Children

1 Prevent (toxic stress)

2 Protect (from toxic stress)

3 Prepare (by building resiliency skills)

4 Promote (healthy/enrichment opportunities)

Tomas J. Aragon, MD, DrPH (SFDPH) Childhood Roots of Health Inequities 10 / 10