All posts by CHOC Children's

CHOC awarded ACEs Aware grant funding to provide trauma-informed care training

CHOC Children’s has received $180,000 in grant funds from the Office of the California Surgeon General and the Department of Health Care Services to participate in the state’s ACEs Aware initiative.

The initiative seeks to change and save lives by helping Medi-Cal providers understand the importance of screening for Adverse Childhood Experiences (ACEs) and training them to respond with trauma-informed care.

CHOC will use its grant funds to conduct supplemental training to promote the ACEs Aware initiative among the Medi-Cal provider community in Orange County. Through this training, providers will learn the importance of incorporating ACE screenings into their clinical practice, as well as how to administer screenings, use clinical protocols to determine evidence-based treatment plans, and provide trauma-informed care. Trainings will also include mental health providers and school professionals to encourage communication and coordination between important systems in children’s lives.

“At CHOC, trauma-informed care is embedded into our treatment and interactions with our patients and families,” said Dr. Heather Huszti, CHOC’s chief psychologist. “The COVID-19 emergency underscores the critical need of using trauma-informed care to treat the whole child. We are so grateful to have received this funding to help teach providers throughout Orange County about the importance and practice of trauma-informed care.”s

CHOC was among 100 organizations throughout the state to receive a total of $14.3 million to extend the reach and impact of the ACEs Aware initiative. These grants will provide funding to organizations to design and implement training, provider engagement, and education activities for providers and organizations that serve Medi-Cal beneficiaries.

“We are looking forward to working in partnership with this amazing group of community leaders to further our efforts to help health care providers become ACEs Aware,” said California Surgeon General Dr. Nadine Burke Harris. “This work is critical, now more than ever, given the stress so many Californians are experiencing as a result of COVID-19 and the role of racial injustice as a risk factor for toxic stress. A trauma-informed health care workforce is vital for helping our state heal.”

The grant funding will provide critical support to community organizations serving Medi-Cal providers and beneficiaries, which have been experiencing increased stress during the COVID-19 emergency. Grant activities will augment California’s efforts, underway since the summer of 2019, to develop provider training and engage providers, including the promotion of payments to Medi-Cal providers for screening their patients for ACEs.

Added Dr. Karen Mark, DHCS medical director: “DHCS is committed to preserving and improving the overall health and well-being of all Californians. The ACEs Aware initiative is a vital part of the Medi-Cal program’s response to the COVID-19 emergency. These grants will help us reach Medi-Cal providers who serve diverse and often at-risk populations throughout the state, and will help to ensure that Medi-Cal members receive the high-quality, integrated care that every Californian deserves.”

Funding for the ACEs Aware grants was previously authorized in the 2019-20 budget using Proposition 56 funds for provider training on how to conduct ACE screening in the Medi-Cal population. In light of the COVID-19 emergency, the grant funding will provide critical support to the community organizations serving Medi-Cal providers and beneficiaries.

View the full list of ACEs Aware grantees.

Fertility future with testicular cryopreservation

Fertility preservation is now a reality for male pediatric and adolescent/young adult (AYA) patients with cancer or blood disorders.

The Hyundai Cancer Institute at CHOC Children’s is a center of excellence and the only program on the West Coast offering testicular preservation for prepubertal patients unable to bank sperm. Testicular tissue is biopsied and preserved in liquid nitrogen.

“Recent research indicates these biopsies contain stem cells, leading to the possibility of generating sperm in the future,” said Dr. Carol Lin, a pediatric oncologist at the CHOC Hyundai Cancer Institute.

Evidence-based research

CHOC participated in an eight-year study alongside U.S. and Israeli institutions to establish a standardized protocol and centralized process to freeze and collect biopsies.

A CHOC Children's pediatric urologist speaks with an adolescent male patient in an exam room

“In total, 189 patients provided samples. A quarter of each sample was used for research and the rest stored for future use. These patients ranged from ages 5 months to 34, with an average age of about 8,” said Lin.

The study discovered that a centralized process and testicular biopsies from multiple sites was a viable option and could accelerate recruitment. Click here to learn more about the study.

Sharing expertise

CHOC is a member of the Oncofertility Consortium, a group of scientists and providers who are committed to fertility preservation in cancer patients. The consortium studies the science of cryopreservation methods, storage of tissue, in vitro follicle growth and communication between patients and doctors, as well as ethical and legal concerns.

Our care and commitment to children has been recognized

CHOC Children’s Hospital was named one of the nation’s best children’s hospitals by U.S. News & World Report in its 2020-21 Best Children’s Hospitals rankings and ranked in the cancer specialty.

Best Children's Hospitals, U.S. News & World Report, Cancer, 2020-21

Learn how CHOC’s pediatric oncology treatments, expertise and support programs preserve childhood for children in Orange County, Calif., and beyond.

CHOC recognized as one of nation’s best children’s hospitals

CHOC Children’s is one of a select group of pediatric facilities nationwide to have been ranked today as a best children’s hospital by U.S. News & World Report.

The following CHOC specialties are honored in the 2020-21 Best Children’s Hospitals rankings: neonatology; cancer; diabetes and endocrinology; neurology and neurosurgery; orthopaedics; pulmonology; and urology. Both orthopaedics and diabetes and endocrinology earned a “Top 20” spot.

“At CHOC, we are committed to the highest standards of care, safety and service – and this honor reflects that unwavering dedication,” said Dr. James Cappon, CHOC’s vice president, chief quality and patient safety officer and interim chief medical officer. “Not only does this recognition of our excellence in these subspecialties, including two on the top 20 lists, validate our efforts, but it also offers our patients and families additional assurance of our commitment to their health and safety.”

The Best Children’s Hospitals rankings were introduced by U.S. News in 2007 to help families of children with rare or life-threatening diseases find the best medical care available. Only the nation’s top 50 pediatric facilities are distinguished in 10 pediatric specialties, based on survival rates, nurse staffing, procedure and patient volumes, reputation and additional outcomes data. The availability of clinical resources, infection rates and compliance with best practices are also factored into the rankings.

The U.S. News Best Children’s Hospitals rankings rely on clinical data and on an annual survey of pediatric specialists. The rankings methodology factors in patient outcomes, such as mortality and infection rates, as well as available clinical resources and compliance with best practices.

Learn more about Best Children’s Hospitals rankings.

CHOC study shows reduced risk of emergency department COVID-19 infection

A new CHOC Children’s study that could help calm public fears about contracting COVID-19 shows that asymptomatic healthcare professionals who work in a community with a low prevalence of the disease and who undergo daily health screenings are unlikely to be carriers of the coronavirus that causes the disease.

Findings of the study, one of the first of its kind and conducted during California’s projected peak of coronavirus-related use of hospital resources, shine an encouraging light on a topic where there are currently limited data available.

CHOC’s study tested patient-facing staff at its Julia and George Argyros Emergency Department during a two-week period in April 2020, using a Polymerase chain reaction (PCR) test for COVID-19 viral RNA. Subjects were asymptomatic and had no fever, as all employees undergo daily pre-shift health and temperature screenings prior to entering the hospital. Testing found just one of 145 subjects was positive for COVID-19, and contact tracing showed that this person was not responsible for any further transmission of infection.

With these findings indicating that strict screening measures in a hospital serving a community with a lower prevalence of COVID-19 are effective in preventing the spread of the disease, the study could also offer some comfort to people who may have been reluctant to seek medical care for themselves or their children because they fear contracting COVID-19 in a healthcare setting. 

“We are encouraged by the results of the study and trust that our community will be reassured to know that the chances of acquiring COVID-19 during a visit to a pediatric emergency department can be lower than during routine activities,” said study co-investigator Dr. Terence Sanger, CHOC’s vice president of research and chief scientific officer. “We continue to urge them to seek prompt expert care for themselves and their children when the need arises.”

Hospitals nationwide have reported a significant drop in emergency department visits for major acute conditions. Patients may seek medical attention too late for adequate treatment, which could have serious, even fatal, consequences.

Preliminary data from California suggest that while healthcare workers represent 10% of all known COVID-19 cases in the state, only 18% of those cases were known to be acquired in a healthcare setting. This indicates the workers likely contacted the disease outside of the healthcare setting.

The low rate of infection in CHOC’s emergency department could be attributed to many factors, including the lower percentage of infection in the surrounding community, as well as people in the community following safety guidelines including social distancing and wearing masks.

Additionally, healthcare workers in a pediatric setting might be expected to have a lower risk of infection than those in an adult healthcare setting due to a lower rate of high-risk aerosolization procedures such as intubation in younger patients.

“We take every precaution we can to prevent the spread of COVID-19 in CHOC care settings,” said Dr. Theodore Heyming, medical director of CHOC’s emergency department and study co-investigator. “While the effects of the coronavirus continue to be devastating, this report offers a ray of hope that brave healthcare workers can continue to administer care to their patients without the added burden of putting themselves or the people they care for at further unnecessary risk.”

Also contributing to the study were Aprille Tongol, a CHOC research administrator; Jennifer MacLean, a CHOC nurse practitioner; and multiple staff from the CHOC Children’s Research Institute.

Learn more about the CHOC Children’s Research Institute.

How QR codes could improve cast care for pediatric patients

Scrawled get-well messages, doodles and friends’ autographs might be common sights on children’s casts following a bone fracture, but what about QR codes?

It turns out that quick response (QR) codes – those ubiquitous boxes with pixelated lines that lead smart phones to web pages – could be an effective way to communicate at-home cast care instructions to patients and families, according to a new study co-authored by a CHOC Children’s orthopaedic surgeon.

A QR code that leads to a website spelling out care instructions can be accessed on-demand and supplement details provided by the physician in the clinic, said study co-author Dr. John Schlechter. Use of this technology could help enhance the retention of care instructions, possibly leading to improved outcomes and reducing emergency department visits.

A QR code leading to the CHOC Children’s Orthopaedic Institute’s website

“At CHOC, we know how stressful and scary a child’s injury can be,” Dr. Schlechter said. “In these cases, it can be difficult for parents to retain information and instructions. For parents who are faced with a child who has a broken or fractured bone, simple technology like a QR code can help bring added confidence and peace of mind that they can provide quality follow-up care at home.”

Released as part of the American Academy of Orthopaedic Surgeons’ (AAOS) recent Virtual Education Experience, QR Codes – Alternative Methods for Cast Care Instructions in Children tracked 88 children with fractures who didn’t require surgery and had a family member with a smart phone. A waterproof QR code was secured to the child’s cast, allowing a family member to scan the code with their phone.

Dr. John Schlechter. orthopaedic surgeon, CHOC Children’s Orthopaedic Institute

Among other factors, researchers monitored cast complications, the number of times the QR code was scanned, treatment satisfaction, and whether the code helped prevent a call to the physician.

Finding that 60 families used the code, researchers also noted:

  • The QR code was scanned an average of 1.6 times, though participants believed they scanned it an average of 2.4 times.
  • Seventy-four percent of patients were very satisfied with the convenience.
  • Ninety percent of the patients found the QR code convenient and useful.
  • Thirty-seven participants reported that the information on the website the QR code led them to kept them from needing to contact a physician to ask a question.
  • Some reported problems with the QR code, including it not scanning, falling off, being unable to find the code on the cast, and the code not working after the first scan.
  • Eleven cast complications – including eight wet casts – were reported among participants.

“Our data shows that the use of a QR code for a non-surgical pediatric fracture has a high level of patient and family success and satisfaction and can reduce the number of phone calls to an attending physician,” Dr. Schlechter said.

Learn more about the CHOC Children’s Orthopaedic Institute.