Becoming ACEs Aware in California - P2

Training Requirements

To complete the training and receive education credit, learners will need to:

  1. Watch the 11-minute video with California Surgeon General, Nadine Burke Harris, MD, MPH in Section 1; 
  2. Complete either case 1 (featuring a child patient) or case 2 (adult patient) in Section 2; 
  3. Complete four of nine cases, based on clinical interests and patient population, from among cases 3-11 in Section 3; and 
  4. Submit the course evaluation in Section 4.

You may complete more cases, but no additional credit will be provided.

 

Target Audience

Medi-Cal providers in California, and any other providers with an interest in the content.

 

Learning Objectives

After completing this activity, the participant should be better able to:

  • Define Adverse Childhood Experiences (ACEs), toxic stress, and their impacts on health, including underlying biological mechanisms.
  • Identify how to introduce and integrate ACE screening into clinical care. 
  • Apply a clinical algorithm for ACE screening, identification of ACE-Associated Health Condition(s), and risk assessment for toxic stress in creating a tailored treatment and follow-up plan.
  • Identify the Medi-Cal billing codes for administering ACE screening.

 

Method of Participation and Request for Credit

There are no fees for participating and receiving CME/CE and MOC credit for this activity. During the period from November 27, 2019 through November 14, 2021, participants must read the learning objectives, faculty disclosures, and complete the educational activity to receive credit.  

 

Training Details

  • Training Curriculum: Becoming ACEs Aware in California
  • Release date: November 27, 2019
  • Expiration date: November 14, 2021
  • Estimated time to complete activity: 2 hours
  • For questions regarding the certification of this activity, please visit www.pimed.com
  • Jointly provided by Postgraduate Institute for Medicine, The Office of the California Surgeon General, and The California Department of Health Care Services

 

Required Hardware/Software

Media

Internet

Computer System Requirements

This website supports the two most recent stable releases of the following browsers for all public pages: Microsoft Edge, Firefox, and Google Chrome on PCs running Windows and Safari, Firefox, and Google Chrome on Apple computers running OSX.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management.  Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient's conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer's product information, and comparison with recommendations of other authorities.

CME/MOC Credits Available
Course opens: 
11/27/2019
Course expires: 
11/14/2021
Faculty on the California Surgeon General’s Clinical Advisory Subcommittee:
  • Devika Bhushan, MD, Pediatrician and Chief Health Officer, Office of the California Surgeon General 
  • Ken Epstein, PhD, MSW; Principal at PREP For Change Consulting; Trauma Informed Systems Specialist, East Bay Agency For Children; Clinical Professor (WOS) at the University of California, San Francisco
  • Nancy Goler, MD, Obstetrician/Gynecologist and Associate Executive Director for The Permanente Medical Group
  • Leigh Kimberg, MD, Internist, Professor of Medicine at University of California, San Francisco (UCSF); Program Director of the Program in Medical Education for the Urban Underserved (PRIME-US) in the UCSF School of Medicine; Interpersonal Violence Prevention Coordinator for the San Francisco Department of Public Health (SFDPH)
  • Alicia Lieberman, PhD, Irving B. Harris Endowed Chair in Infant Mental Health; Professor and Vice Chair for Faculty Development at the University of California, San Francisco, Department of Psychiatry; Director of the Child Trauma Research Program at San Francisco General Hospital
  • Dayna Long, MD, Director, Center for Child and Community Health, UCSF Benioff Children's Hospital Oakland
  • Edward Machtinger, MD, Internist; Professor of Medicine; Director of the Women’s HIV Program (WHP) and the Center to Advance Trauma-Informed Health Care (CTHC) at the University of California, San Francisco
  • Brigid McCaw, MD, MPH, MS, Internist, The Permanente Medical Group (retired); former Medical Director of the Kaiser Permanente Family Violence Prevention Program
  • Connie Mitchell, MD, MPH, Deputy Director of the Center for Family Health at the California Department of Public Health
  • Sheela Raja, PhD, Project Co-Director, Office of Women’s Health Trauma-Informed Care Curriculum; Licensed Clinical Psychologist; Associate Professor; Director of Clinical Behavioral Sciences, Colleges of Dentistry and Medicine at the University of Illinois at Chicago
  • Leena Singh, DrPH, MPH, Program Director for the National Pediatric Practice Community on ACEs at the Center for Youth Wellness
  • Shannon Thyne, MD, Chief of Pediatrics at the Olive View-UCLA Medical Center; Professor of Pediatrics at the David Geffen School of Medicine at UCLA; Director of Pediatrics at the LA County Department of Health Services
  • Shairi Turner, MD, MPH, Project Co-Director, Office of Women's Health Trauma-Informed Care Curriculum;  Florida Department of Health
  • Karen Mark, MD, PhD, Medical Director, California Department of Health Care Services
  • Nadine Burke Harris, MD, MPH, Pediatrician and California Surgeon General
Faculty on the U.S. Health and Human Services Office on Women’s Health Trauma-Informed Care Training: 
  • Alexander Chessman, MD, Project Co-Director, Office of Women's Health Trauma-Informed Care Curriculum; Family Physician and Professor at the College of Medicine at the Medical University of South Carolina
  • Michelle Hoersch, MS, Project Co-Director, Office of Women's Health Trauma-Informed Care Curriculum; Public Health Advisor for the Office of the Assistant Secretary for Health in the U.S. Department of Health and Human Services in Region V 
  • Sheela Raja, PhD, Project Co-Director, Office of Women’s Health Trauma-Informed Care Curriculum; Licensed Clinical Psychologist; Associate Professor; Director of Clinical Behavioral Sciences, Colleges of Dentistry and Medicine at the University of Illinois at Chicago
  • Shairi Turner, MD, MPH, Project Co-Director, Office of Women's Health Trauma-Informed Care Curriculum;  Florida Department of Health
  • Erin Barnett, PhD, Assistant Professor in Psychiatry and the Dartmouth Institute at the Dartmouth Geisel School of Medicine
  • Kimberly S. G. Chang, MD, MPH, Family Physician, Human Trafficking and Healthcare Policy Fellow at Asian Health Services 
  • Kathy Franchek-Roa, MD, Pediatrician at Primary Children’s Medical Center and Assistant Professor in Pediatrics at the University of Utah School of Medicine
  • Christine Holland, PhD, BCB, Program Lead of Primary Care Mental Health Integration at Los Angeles VA Ambulatory Care Center
  • Whitney Lopez, PsyD, Clinical Psychologist at Joint Base Myer-Henderson Hall, US Army
  • Candice Norcott, PhD, Assistant Professor of Psychiatry and Behavioral Neuroscience at the University of Chicago School of Medicine
  • Anita Ravi, MD, MPH, MSHP, Family Physician and Co-Founder of the PurpLE Health Foundation
  • Patricia Rush, MD, MBA, Internist and Co-Founder of THEN, the Center for Collaborative Study of Trauma, Health Equity and Neurobiology
  • Marilyn Sanders, MD, Pediatrician at the Connecticut Children’s Specialty Group and Professor of Pediatrics at the University of Connecticut School of Medicine
  • Sarah Steinmetz, PhD, Student, University of Wisconsin
  • Amina White, MD, Ob/Gyn, Associate Professor and Director of Medical Professional Development at the University of North Carolina School of Medicine
  • Therese Zink, MD, MPH, Family Physician and Professor at Brown University Department of Family Medicine and School of Public Health
Office of Women’s Health Trauma-Informed Care Curriculum Content Experts and Course Development Leadership Team:
  • Alexander Chessman, MD, Project Co-Director, Office of Women's Health Trauma-Informed Care Curriculum; Family Physician and Professor at the College of Medicine at the Medical University of South Carolina
  • Michelle Hoersch, MS, Project Co-Director, Office of Women's Health Trauma-Informed Care Curriculum; Public Health Advisor for the Office of the Assistant Secretary for Health in the U.S. Department of Health and Human Services in Region V 
  • Emily Jacobs, Project Manager, Office of Women's Health Trauma-Informed Care Curriculum
  • Sheela Raja, PhD, Project Co-Director, Office of Women’s Health Trauma-Informed Care Curriculum; Licensed Clinical Psychologist; Associate Professor; Director of Clinical Behavioral Sciences, Colleges of Dentistry and Medicine at the University of Illinois at Chicago
  • Nancy Tobi, MS, Senior Learning/Instructional Designer, Office of Women's Health Trauma-Informed Care Curriculum; eLearning Systems Designer at Aquifer
  • Shairi Turner, MD, MPH, Project Co-Director, Office of Women's Health Trauma-Informed Care Curriculum; Florida Department of Health

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers, and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

Faculty

The faculty members listed have nothing to disclose.

Planners and Managers

The Office of the California Surgeon General and The California Department of Health Care Services planners and managers have nothing to disclose. The PIM planners and managers have nothing to disclose.  

Joint Accreditation Statement 
Jointly Accredited Provider

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine, The Office of the California Surgeon General and The California Department of Health Care Services.  Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.


Physician Continuing Medical Education

The Postgraduate Institute for Medicine designates this enduring material for a maximum of 2.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

 

ABIM MOC Continuing Education

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 2.0 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

 

ABP MOC Continuing Education

Successful completion of this CME activity, which includes participation in the activity and individual assessment of and feedback to the learner, enables the learner to earn up to 2.0 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit learner completion information to ACCME for the purpose of granting ABP MOC credit.

 

AAFP Prescribed Credit

This Enduring Material activity, Becoming ACEs Aware in California, has been reviewed and is acceptable for up to 2.00 Prescribed credit(s) by the American Academy of Family Physicians. AAFP certification begins 11/27/2019. Term of approval is for one year from this date. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

 

Continuing Nursing Education

The maximum number of hours awarded for this Continuing Nursing Education activity is 2.0 contact hours. 

 

Continuing Physician Assistant Education

AAPA Category 1 CMEPostgraduate Institute for Medicine has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 2.0 AAPA Category 1 CME credits. Approval is valid until November 14, 2021. PAs should only claim credit commensurate with the extent of their participation.


Continuing Psychologist Education

Continuing Education (CE) credits for psychologists are provided through the co-sponsorship of the American Psychological Association (APA) Office of Continuing Education in Psychology (CEP). The APA CEP Office maintains responsibly for the content of the programs.

 

Continuing Social Worker Education

As a Jointly Accredited Organization, Postgraduate Institute for Medicine is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit.  Postgraduate Institute for Medicine maintains responsibility for this course. Social workers completing this course receive 2.0 clinical continuing education credits.

 

NAADAC

This course has been approved by the Postgraduate Institute for Medicine, as a NAADAC Approved Education Provider, for educational credits. NAADAC Provider #144331, Postgraduate Institute for Medicine is responsible for all aspects of the programming.

 

 
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Method of Participation and Request for Credit 

There are no fees for participating and receiving CME/CE and MOC credit for this activity. During the period from November 27, 2019 through November 14, 2021, participants must read the learning objectives, faculty disclosures, and complete the educational activity to receive credit.  

Click on the 'Enroll' button to be automatically enrolled in all of the cases. To complete the Becoming ACEs Aware Training and receive education credit, learners will need to:

  1. View the 11-minute video with California Surgeon General, Nadine Burke Harris, MD, MPH in Section 1;
  2. Complete either case 1 (featuring child patient) or 2 (adult patient) in Section 2;
  3. Complete four of nine cases, based on clinical interests and patient population, from among cases 3-11 in Section 3; and
  4. Submit the course evaluation in Section 4.

You may complete more cases, but no additional credit will be provided.

Participants will complete a total of five cases. 

You may choose one of two introductory cases (case 1 or 2) based on patient population, written by the Office of California Surgeon General with advisement from the California Surgeon General’s Clinical Advisory Subcommittee: 

Case Number and Description

Recommended Provider Types

Case 1: 33-Month-Old Boy with Poor Growth

Defines ACEs, explains how to administer the PEARLS, applies a clinical algorithm to assess risk of toxic stress physiology, and incorporate screening results into clinical care and follow-up plans, and identifies the Medi-Cal billing codes.

Recommended for pediatric and family medicine providers

Case 2: 43-Year-Old Woman with Hypertension and Pre-Diabetes

Defines ACEs, explains how to administer the ACE Questionnaire for Adults, applies a clinical algorithm to assess risk of toxic stress physiology, and incorporate screening results into clinical care and follow-up plans, and identifies the Medi-Cal billing codes.

Recommended for providers who care for adult patients (including internal medicine, family medicine, obstetrics/gynecology)


Participants will then choose four of nine cases, based on specialty, adapted from the U.S. Health and Human Services’ Office on Women’s Health Trauma-Informed Care training: 

Case Number and Description

Recommended Provider Types

Case 3: 28-Year-Old Pregnant Woman with a History of Witnessing Violence

Demonstrates trauma-informed care practices, evidence-based screening, and treatment for a pregnant woman with a toxic stress response and peri-partum depression.

Pediatrics 
OB/Gyn
Family Medicine

Case 4: 8-Year-Old Boy with Asthma

Highlights the biological mechanisms of a toxic stress response underlying asthma flares and trauma-informed, evidence-based care for a parent and child.

Pediatrics
Family Medicine

Case 5: 45-Year-Old Woman with Diabetes Experiencing Stress

Identifies the challenges patients face when disclosing intimate partner violence and other traumas.

Internal Medicine
Family Medicine

Case 6: 50-Year-Old Woman Experiencing Homelessness in Need of Surgery

Explores possible relationships between mental illness, homelessness, trauma history, and health care utilization.

OB/Gyn
Internal Medicine
Family Medicine

Case 7: 58-Year-Old Man with Gastrointestinal Symptoms

Demonstrates motivational interviewing skills and recognizes how trauma history may influence treatment plans and patient adherence.

Internal Medicine
Family Medicine

Case 8: 32-Year-Old Woman with Anxiety

Uses patient-centered care strategies such as motivational interviewing to provide trauma-informed care and increase trust between a patient and a provider.

OB/Gyn
Internal Medicine
Family Medicine

Case 9: Mother Worried about her 3-Year-Old Son

Recognizes potential triggers of traumatic stress reactions in a patient encounter and identifies ways to respond to parental anxiety.

Pediatrics
Family Medicine

Case 10: 24-Year-Old Woman with IBS

Defines ACEs, describes the prevalence of sexual assault in women, discusses human trafficking, and demonstrations concepts of re-traumatization and professional burnout.

OB/Gyn
Internal Medicine
Family Medicine

Case 11: Nurse Experiencing Vicarious Trauma

Describes how a provider’s own trauma history may influence interactions with patients who have experienced trauma and defines vicarious trauma.

Pediatrics
OB/Gyn
Internal Medicine
Family Medicine

If you wish to receive acknowledgment for completing this activity, please complete the post-tests and final evaluation.  Upon registering and successfully completing the post-tests with a score of 75% or better, and the activity evaluation, your certificate will be made available immediately.  

Once you have met the requirements above, you will be able to claim credit by accessing the claim credit tab on this activity.  The claim credit tab will only appear once you have completed all the requirements.

Beginning July 1, 2020, Medi-Cal providers must attest to completing certified ACEs training on the DHCS website to continue receiving payments for screening Medi-Cal patients for ACEs. The attestation page is available here: https://www.medi-cal.ca.gov/TSTA/TSTAattest.aspx.