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

Our global community is facing confusing and uncertain times. As the unprecedented novel coronavirus continues to spread, the health and safety of our nearly 40 million Californians is the number-one priority for our state, the Office of the California Surgeon General, and the Department of Health Care Services (DHCS). This includes the physical, mental, and psychological well-being of all individuals.

As the crisis deepens, we are mindful that the public health policies and interventions necessary to slow the spread of COVID-19 are affecting all facets of society and our daily lives. These daily disruptions, coupled with the fear of not knowing what may come, are resulting in stress and anxiety for many.

We launched the ACEs Aware initiative with the mission to change and save lives by supporting MediCal providers to screen, treat, and heal children and adults at risk for toxic stress with interventions and trauma-informed care practices. Our work is important, now more than ever.

Fear and anxiety caused by COVID-19 – and the extraordinary disruptions and hardships brought on by necessary precautions to slow its spread – can be stressful for everyone, but particularly for our most vulnerable Californians. This includes children, families, and adults who already are impacted by Adverse Childhood Experiences (ACEs) and trauma.

Past incidents of acute stressors on communities, such as those brought on by natural disasters, have shown that people already experiencing stress in their lives are likely to be more significantly affected by additional stressors. A compounding factor in our current situation is the abrupt displacement of buffering support systems of family and friends, coworkers, community, schools, and providers due to social distancing. In addition, with the abundance of available information, we must be cautious of misinformation that can lead to greater fear and uncertainty.

As a trusted messenger of health and safety information to your community, here are some actions you can take to support the health and well-being of your patients, your staff, and yourself:

• Learn and share the facts about COVID-19 with your staff and patients to explain why the current precautions are necessary to stem the crisis. A great resource is the CDC COVID-19 FAQs for Healthcare Professionals.
• Identify and respond to patients’ increased risk of stress-related health conditions such as cardiovascular disease, hypertension, diabetes, auto-immune disease and asthma, as well as mental and behavioral health disorders including anxiety, depression, substance use and dependence with closer monitoring of high-risk patients and supplementing usual care with strategies to buffer the stress response.
• Understand and apply the principles of trauma-informed care, as they can help providers and staff maintain good care of patients and themselves in the face of the acute stress created by COVID-19. You can learn more at ACEs Aware Principles of Trauma-Informed Care.
• Direct your patients to tools and resources to help people deal with fear, anxiety, and stress brought on by the COVID-19 pandemic, such as these ACEs Aware Self-Care tools and the CDC coronavirus stress management online resource.
• Reach out and check in with your patients in whatever way is possible for you and your practice. Also, encourage them to stay in contact with friends and loved ones. Though we must stay physically apart, we can still maintain our social ties as a community.
• Keep informed about all California COVID-19 activities at the new consumer-friendly website www.Covid19.CA.Gov and the DHCS COVID-19 response webpage.

In the coming days, weeks, and months, ACEs Aware will share information and resources with providers to support them in delivering trauma-informed care to children, families, and adults. We are also aware of the physical and emotional toll that many providers are already or will be experiencing as a result of being on the front lines of this global health issue. Supporting providers’ well-being is a key priority for us, and we will be sharing selfcare and resilience resources with you and the ACEs Aware community.

We want to make sure ACEs Aware continues to be a source of vital support and information for providers in helping them identify, mitigate, and heal the impacts of anxiety and stress resulting from the coronavirus pandemic.

On behalf of all Californians, thank you for the professionalism, service, fortitude, and compassion you continue to demonstrate in helping keep our community members healthy and safe. Even in these challenging times, your commitment to service to others fills us with hope, inspiration, and gratitude.

With deepest thanks,

Dr. Nadine Burke Harris, California Surgeon General

Dr. Karen Mark, Medical Director, California Department of Health Care Services