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SAN FRANCISCO ASTHMA NETWORK FORUM
“How Toxic Stress Takes Our Breath Away”: Why does toxic stress
matter to the prevention and control of asthma?
Friday, October 10, 2014
8:30 am - 3:30 pm
Kaiser Permanente San Francisco Outpatient Medical Center
2238 Geary Blvd, 3rd Floor, Diamond Room
Pay parking entrance is to the east side of the building
Public transit bus routes: 24 & 38
REPLY TO GLORIA.THORNTON@WELLPOINT.COM
Include the following information: your name, job title, work
affiliation, and email. This no-cost event is sponsored by Kaiser
Permanente San Francisco .
“We are living through a revolution in biology” that provides the explanation for
“why and how ZIP code affects health outcomes,” explained Jack Shonkoff, director
of Harvard’s Center on the Developing Child, a Robert Wood Johnson Foundation
grantee. “We are in big trouble if we don’t recognize” the powerful evidence that even
in the womb, the effects of prolonged exposure to stress are “built into our bodies,”
potentially altering everything from immune function to insulin resistance, and
leaving behind the biological signs of inflammation that are linked to multiple
chronic conditions.
AGENDA
8:30 am – Registration & pre-survey on Children’s Health and Nature (15 minutes)
8:45 am – Welcome & Intro to Learning Objectives (15 minutes)
Peg Strub, MD, Chief of Allergy, Asthma and Immunology, Kaiser Permanente San
Francisco and Asthma Task Force Clinical Committee Chair
9:00 am - Morning Speakers: Toxic Stress Overview (90 minutes)
Dayna Long, MD, FAAP, Staff Pediatrician and Co-Director, Family Information and
Navigation Desk (FIND), Medical Director, ATTACK Asthma Clinic, UCSF Benioff
Children's Hospital, Oakland (Lecture 30 minutes; Q&A 15 minutes)
Learning objectives:
1. What are social determinants of health and their relationship to health inequities?
2. How do we define “chronic stress” and “toxic stress”?
3. What is the Adverse Childhood Experiences (ACE) Study?
4. What recent clinical trials have been done related to toxic stress?
5. How can the health provider and team offer anticipatory guidance and screen patients for
toxic stress?
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Sam S. Oh, PhD, MPH, Research Epidemiologist, UCSF (Lecture 30 minutes; Q&A 15
minutes)
Learning objectives:
1. What are the multiple pathways by which chronic stress imparts it effect on health?
o How do genes get methylated (epigenetics)?
o What are the clinical pathways for inflammation?
2. What biomarkers exist as indicators of response to stress?
o What biomarkers are used for inflammation?
o Is cotinine a feasible biomarker for toxic stress?
3. How might toxic stress impact the prevention and control of asthma?
10:30 am - Break with refreshments provided (20 minutes)
10:50 am –Skills and tools for health providers (90 minutes)
Leanna W. Lewis, LCSW, Clinical Social Worker, Center for the Vulnerable Child, UCSF
Benioff Children’s Hospital, Oakland (Lecture 30 minutes; Q&A 15 minutes)
Learning objectives:
1. How do we define and recognize micro-aggressions?
2. Cultural responsiveness: How do we engage patients around these issues, while
acknowledging the power and privilege we have as providers?
3. What opportunities do we providers have to be allies, and how can I communicate this to
my patients?
Nooshin Razani, MD, MPH, Attending Physician, Ambulatory Department, UCSF Benioff
Children's Hospital, Oakland (Lecture 30 minutes; Q&A 15 minutes)
Learning objectives:
1. What are three physical and mental health benefits from being in nature, and how can
exposure to nature can serve as a buffer to toxic stress?
2. What might be the barriers your patients have to participating in nature? What are some
strategies for overcoming those barriers?
3. What are three San Francisco resources for assisting your patients to participate in
nature?
12:20 pm - Break with lunch provided (40 minutes)
1:00 pm - Afternoon Panel: Resources and interventions (90 minutes)
Learning objectives:
1. Name resources and interventions to benefit the health of patients with asthma:
o What resources exist to help families affected by domestic and community violence?
o What psychotherapy resources exist in SF to help children who have experienced
emotional trauma?
o How are larger clinics using patient navigation assistance to help families find food
resources and other resources that address social determinants of health?
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o How can clinical settings help families have greater housing security and enforcement of
housing rights?
2. Identify ways the local clinical community can continue to collaborate on these efforts.
Panelists:
1:00 pm - Blia Moua, MSW, SafeStart Program Manager, San Francisco Child Abuse
Prevention Center, Helping families affected by violence in San Francisco
o SafeStart case management services offered to families
o SafeStart training offered to providers
o Collaborative work of CAPC with other agencies and how to participate
1:20 pm - Laura Gottlieb, MD, MPH, Assistant Professor of Family and Community
Medicine at the University of California, San Francisco
o Effectiveness of patient navigation programs to address social determinants of health
in clinical settings: FIND, CCLIP & the Bay Area Regional Help Desk Consortium
o Challenges to implementation and dissemination of social determinants of health
interventions
o Tracking social determinants of health in the EHR
1:40 pm - Melissa Hagan, PhD, MPH, Postdoctoral Scholar, UCSF Department of
Psychiatry, Child Trauma Research Program (CTRP)
o CTRP psychotherapy services offered to families of children 0-5 years old
o CTRP services offered in the community & collaboration with community agencies
o CTRP research on effectiveness of psychotherapy trauma interventions
2:00 pm - Karen Cohn, MS, CIH, San Francisco Department of Public Health,
Population Health Division, Environmental Health Branch
o Children’s Environmental Health Promotion Program home investigation findings
while serving low-income families in San Francisco
o Local resources and strategies for improving housing conditions
2:20 pm – Panel Q&A (30 minutes)
2:50 pm – Wrap up (30 minutes)
o Next steps for collaboration on this theme
o Post-survey on Children’s Health and Nature
Reminder: Online Kaiser forum evaluation must be completed by announced due date in
order to receive CME.
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