COVID-19 & Stress

ACEs Aware supports those on the front lines as California addresses stress and anxiety related to COVID-19

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These resources for managing stress related to COVID-19 and mitigating the impact of stress on physical and mental health are for health care clinicians, their teams, and their patients.

Check out California’s one-stop shop of resources for managing stress for health, which includes hotlines if you or your patients need to talk to someone.

Watch the ACEs Aware webinars on providing trauma-informed care, including via telehealth, during COVID-19.

Download the full ACEs Aware Stress Management Resource List.

Read perspective from Orange Country pediatrician Dr. Eric Ball on how ACEs Aware training can benefit your practice during the COVID-19 pandemic on the ACEs Aware blog. 

For the latest information in California, visit COVID19.CA.gov.

For the latest clinical information on COVID-19, contact your local Department of Public Health website or visit California Department of Public Health COVID-19.

For additional information, including interim guidance and resources on caring with patients with COVID-19, visit the Centers for Disease Control and Prevention COVID-19 Information for Healthcare Professionals site.

A Message to California Health Care Providers About COVID-19 and Toxic Stress

From Dr. Nadine Burke-Harris and Dr. Karen Mark.

California Department of Health Care Services released an All Plan Letter (APL).

These documents provide recommendations for Medi-Cal providers to mitigate the secondary negative health outcomes of the COVID-19 emergency:

Question/answer on billing Medi-Cal for ACE screenings conducted via telehealth

California Surgeon General Interview with Trauma Informed Parent

Interview (20 minutes) with Dr. Nadine Burke Harris on why children and adults who have experienced adversity may be particularly sensitive to COVID-19 anxiety and frustration, and offers practical tools to help our children, ourselves, and others cope with stress and anxiety.

ACEs Aware Outreach Strategies and Sample Message

This document provides outreach strategies that health care providers and practices can use proactively to seek and maintain connections with patients, as well as a sample message for communicating with patients to encourage telehealth during the COVID-19 emergency.

Watch the ACEs Aware webinars on providing trauma-informed care, including via telehealth, during COVID-19.

COVID-19 Telehealth: Relationship-Centered Communication Skills

Academy of Communication in Healthcare sample script on how to communicate with patients about COVID-19 using telehealth.

CDC Recommendations for COVID-19 in Racial and Ethnic Minority Groups

Describes why people in racial and ethnic minority groups are more likely to become seriously ill or die due to COVID-19, and what health care systems and providers, public health professionals, community organizations, and others can do to help.

CDC Recommendations for COVID-19 for People Experiencing Homelessness

Describes why people experiencing homelessness are more vulnerable during the COVID-19 pandemic. Includes handouts that providers can give to patient experiencing homelessness.

Combating Bias and Stigma Related to COVID-19

American Psychological Association article on how to stop the spread of biases and stereotypes that are happening due to the coronavirus.

Caring for Children with Complex Medical Conditions During COVID-19

American Academy of Pediatrics webinar (18 minutes) helping clinicians understand special considerations for children with complex needs, how to prepare clinics/practices, and how to partner with and support families.

Managing Mental Health During COVID-19

American Medical Association fact sheet with strategies and resources to manage physicians’ and other frontline health care workers’ mental health while caring for patients during the pandemic.

Center for the Study of Traumatic Stress Website – Coronavirus and Emerging Infectious Disease Outbreak Response

Uniformed Services University. Includes the following resources:

COVID-19 Considerations for a Trauma Informed Response for Work Settings

Trauma-informed considerations for work settings where services are provided, in light of COVID-19. Trauma Informed Oregon, Portland State University, Oregon Health Authority.

Building Organizational Resilience in the Face of a Ubiquitous Challenge

How organizational leaders can use trauma-informed care approaches to support their workforce in addressing the COVID-19 pandemic. Karen Johnson, Trauma-Informed Lens Consulting.

COVID-19 Emotional Health and Well-Being Resources

California COVID-19 website with hotlines for people who need to talk to someone, including for: parents; youth and teens; veterans; first responders and law enforcement; older Californians; deaf and hard of hearing individuals; and LGBTQ+ individuals. Includes hotlines for crisis, suicide, domestic violence, child abuse and neglect, and for food assistance and other social service resources.

California Surgeon General’s Playbook: Stress Relief during COVID-19

A simple guide with things you can do every day, at home, to help support your mental and physical health.

ACEs Aware Self-Care Tool for Adults

An ACEs Aware-developed tool for adult patients to use in developing a self-care plan to enhance well-being and decrease stress — for adults.

UCLA Mindful App

Learn to practice mindfulness meditation anywhere with the UCLA Mindful Awareness Research Center’s app.

Mental Health Support for COVID-19 from the National Alliance on Mental Illness

Information from the National Alliance on Mental Illness (NAMI) and extensive on-line resources for individuals experiencing anxiety related to COVID-19, as well as specific information for individuals living with a mental illness.

Staying Safe During COVID-19 for People Experiencing Domestic Violence – English – Spanish Version

Suggestions for staying safe for people who are experiencing domestic violence. National Domestic Violence Hotline.

Alzheimer’s Association Guidance on COVID-19​

Tips for dementia caregivers during COVID-19.

California Surgeon General’s Playbook: Stress Relief for Caregivers and Kids during COVID-19

A stress relief playbook to help you understand what to look out for and what you can do to protect your family’s health.

ACEs Aware Self-Care Tool for Pediatrics

An ACEs Aware-developed tool for patients to use in creating a self-care plan to enhance well-being and decrease stress — for children and families.

Positive Parenting & COVID-19: 10 Tips to Help Keep the Calm at Home – English Version – Spanish Version

American Academy of Pediatrics article with tips for families facing longer periods of time isolated at home, including positive parenting and healthy approaches to discipline.

Young Children at Home during the COVID-19 Outbreak: The Importance of Self-Care

Information from ZERO TO THREE about why self-care is not selfish or indulgent—it’s how we keep ourselves well to ensure we are physically, emotionally, and mentally capable of being there for our young children.

Getting Children Outside While Social Distancing – English Version – Spanish Version

American Academy of Pediatrics article with tips to help parents and children explore outside while practicing good physical distancing.

Teens & COVID-19: Challenges and Opportunities During the Outbreak – English Version – Spanish Version  

American Academy of Pediatrics article highlighting ways for parents to help teenagers cope during COVID-19.

General Patient Handouts on Buffering Toxic Stress from the Center for Youth Wellness and ZERO TO THREE

DHCS All-Plan Letter 20-008: Mitigating Health Impacts of Secondary Stress Due to the COVID-19 Emergency (April 7, 2020)

The purpose of this All Plan Letter is to offer recommendations to Medi-Cal managed care health plans on mitigating negative health outcomes to members due to the Novel Coronavirus Disease (COVID-19) emergency.

Medi-Cal Fee-For-Service Mitigating Health Impacts of Secondary Stress due to the COVID-19 Emergency (April 7, 2020)

The purpose of this guidance is to offer recommendations to Medi-Cal fee-for-service providers on mitigating negative health outcomes to members due to the Novel Coronavirus Disease (COVID-19) emergency.

Medi-Cal Payment for Telehealth and Virtual/Telephonic Communications Relative to COVID-19  (March 24, 2020)

Per new DHCS guidance in response to COVID-19, providers may screen a patient for ACEs via telehealth if the provider believes that the ACE screening can be administered in a clinically appropriate manner via telehealth. Providers must continue to comply with all other billing procedures, Medi-Cal guidelines, and confidentiality laws.

END USER SUBLICENSE AGREEMENT

PLEASE READ CAREFULLY: This End User Sublicense Agreement (the “Agreement” or “Sublicense”) is a legally binding agreement between you (an individual or an entity, hereinafter “You” or “Sublicensee”) and the Department of Health Care Services (“DHCS”) for the use of the Pediatric ACEs and Related Life-events Screener (“PEARLS”) for children and adults up to the age of 21.

BY WAY OF DOWNLOADING, COPYING, ACCESSING, OR OTHERWISE USING THE PEARLS TOOL, YOU ARE AGREEING TO BE LEGALLY BOUND BY THE TERMS OF THIS AGREEMENT. IF YOU DO NOT AGREE TO BE BOUND BY THE TERMS OF THIS AGREEMENT, THEN YOU HAVE NO RIGHTS TO THE PEARLS TOOL AND MAY NOT DOWNLOAD, COPY, ACCESS, OR OTHERWISE THE PEARLS TOOL.

THE PEARLS TOOL IS PROTECTED BY COPYRIGHT LAWS AND IS OTHERWISE PROTECTED INTELLECTUAL PROPERTY. THE PEARLS TOOL IS LICENSED AND IS NOT SOLD.

    1. The PEARLS Tool. The PEARLS tool is a unique tool that assess for both Adverse Childhood Experiences (“ACEs”) such as abuse, neglect, and household challenges, and related events, such as discrimination, food insecurity, and community violence, thought to be risk factors for toxic stress. The PEARLS tool was made in the course of research under the auspices of the Children’s Hospital Research Center at Oakland (“BCHO”) and the University of California, San Francisco. BCHO has licensed the PEARLS tool to DHCS and provided DHCS with the right to sublicense the PEARLS tool.
    2. Sublicensee Attestation. By agreeing to this Agreement, You attest that You are a provider of health care services to Medi-Cal beneficiaries, a Medi-Cal Managed Care Plan, a Medi-Cal beneficiary, a parent or guardian of a Medi-Cal beneficiary, or an Electronic Health Records (“EHR”) vendor.
    3. The Sublicense. Subject to the terms of this agreement, DHCS hereby grants to Sublicensee a non-exclusive, royalty-free, non-assignable, non-transferable sublicense (the “Sublicense”) to the PEARLS tool. Under the Sublicense, Sublicensee may use the PEARLS tool as directed, and may save, download, print, copy, reproduce, or distribute the PEARLS tool to facilitate such use.
    4. Use in a Remote Patient Portal. The PEARLS tool was developed as a screener of risk for toxic stress and has been tested for safe, reliable screening when used during in-person (i.e., synchronous) visits. The questions and responses of the PEARLS tool may be administered using the EHR as structured data fields to facilitate record and follow-up. Because the PEARLS tool was never studied under asynchronous screening formats, DHCS cannot provide recommendations regarding its use in a remote patient portal. This includes information around safety and adequate windows of response. Sublicensee acknowledges that DHCS is not responsible for providing any recommendations regarding the use of the PEARLS tool in a remote patient portal, and that DHCS is not responsible for overseeing implementation and use of the PEARLS tool in a remote patient setting. This includes information around safety and adequate windows of response.
    5. Disclaimer of Warranty. This Sublicense and the associated PEARLS tool are provided WITHOUT WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE OR ANY OTHER WARRANTY, EXPRESS OR IMPLIED. DHCS MAKES NO REPRESENTATION OR WARRANTY THAT THE PEARLS TOOL WILL NOT INFRINGE ANY COPYRIGHT, PATENT, OR OTHER PROPRIETARY RIGHT.
    6. Limitations of Liability.
      1. IN NO EVENT WILL DHCS BE LIABLE FOR ANY INCIDENTAL, SPECIAL OR CONSEQUENTIAL DAMAGES RESULTING FROM EXERCISE OF THIS SUBLICENSE OR THE USE OF THE PEARLS TOOL.
      2. DHCS WILL NOT BE LIABLE FOR ANY LOST PROFITS, COSTS OF PROCURING SUBSTITUTE GOODS OR SERVICES, LOST BUSINESS, ENHANCED DAMAGES FOR INTELLECTUAL PROPERTY INFRINGEMENT OR ANY INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE OR OTHER SPECIAL DAMAGES SUFFERED BY SUBLICENSEE, JOINT VENTURES, AFFILIATES, OR DEVELOPMENT PARTNERS ARISING OUT OF OR RELATED TO THIS AGREEMENT. DHCS WILL NOT LIABLE FOR ANY CAUSES OF ACTION OF ANY KIND (INCLUDING TORT, CONTRACT, NEGLIGENCE, STRICT LIABILITY, AND BREACH OF WARRANTY) EVEN IF DHCS HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES.
    7. Indemnity and Duty to Defend. Sublicensee shall indemnify, defend, and hold harmless DHCS from and against all claims, actions, damages, losses, liabilities (or actions or proceedings with respect to any thereof), whether or not rightful, arising from any and all actions or claims by any third party or expenses related thereto (including, but not limited to, all legal expenses, court costs, and attorney’s fees incurred in investigating, preparing, serving as a witness in, or defending against, any such claim, action, or proceeding, commenced or threatened) to which DHCS and/or any employee, contractor, or agent acting on DHCS’s behalf may be subject, whether or not Sublicensee is a party to any pending or threatened litigation, which arise out of or are related to (i) claims and losses accruing or resulting to any person, firm or corporation who may be injured or damaged by Sublicensee’s use, reproduction, manufacture, sale, offer to sell, distribution, import, export, modification, public and private  performance/display, license, and disposition of the PEARLS tool; (ii) the incorrectness or breach of any of the representations, warranties, covenant or agreements of Sublicensee pertaining the PEARLS tool; or (iii) any intellectual property infringement, or any other type of actual or alleged infringement claim, arising out of Sublicensee’s use, reproduction, manufacture, sale, offer to sell, distribution, import, export, modification, public and private performance/display, license, and disposition of the PEARLS tool. This indemnity obligation shall apply irrespective of whether the infringement claim is based on a patent, trademark or copyright registration that issued after the effective date of this Agreement. DHCS reserves the right to participate in and/or control, at Sublicensee’s expense, any such infringement action brought against DHCS.
    8. Governing Law. This Agreement is to be interpreted and construed in accordance with the laws of the State of California.
    9. Miscellaneous
      1. The relationship between DHCS and Sublicensee established by this Agreement is that of independent contractors. No joint venture or partnership is established by this Agreement. Neither party is the agent, broker, partner, employee, or legal representative of the other for any purpose.
      2. The headings of any sections are inserted for convenience of reference only and are not intended to be part of, or to affect the meaning or interpretation of this Agreement.
      3. This Agreement embodies the entire understanding of DHCS and Sublicensee and supersedes all previous communications, representations or understandings, either oral or written, between them relating to the subject matter of this Agreement.
      4. In the event that any provision of this Agreement is unenforceable or held to be unenforceable, all other provisions of this Agreement have force and effect and will not be affected thereby.
      5. This Agreement may only be amended, modified, or supplemented by an agreement in writing signed by each party hereto.