Santa Barbara Resiliency Project- Adverse Childhood Experiences (ACES) Screening and Referral to Resiliency Services at Well Child Checkups

What if the silos of medical, social and behavior health services were broken down and holistic care was accessible for families?

Photo of Monica Gross
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Founding Story: Share a story about a key experience or spark that helps the network understand why this project got started or a story about how you became inspired about the potential for this project to succeed.

Supporting families is the best way to give children a healthy start. In 2006 as a pediatrician in Juneau Alaska I worked with a group of health care clinicians, educators, behavioral health providers and social service providers to design a brief family stress assessment that could be given in the doctor's office at Well Child Checks and developed a referral system with holistic services to support families with these challenges. I didn't realize it, but we were basically screening for Adverse Childhood Experiences (ACEs). The term, “ACE”, was coined in 1998 following the publication of the groundbreaking Adverse Childhood Experiences Study. ACEs are defined as stressful or traumatic events that take place before a child is 18 years old. High ACE scores significantly increase the risk for poor health outcomes and negative health behaviors and there is a strong dose-response relationship between ACEs and poor outcomes. As the number of ACEs increases, the risk of negative health outcomes increased as well. Dr. Robert W. Block, of the American Academy of Pediatrics has said that ACEs are the single most important unaddressed public health threat facing our nation today. Fast forward to 2016 and with a MPH under my belt I am working with Santa Barbara Neighborhood Clinics (SBNC) to address ACEs in our medically underserved and low-income families. The SBNC Resiliency Project and our ACEs screening and referral intervention is supporting families and helping children thrive.

Which categories describe you? (the answer will not be public)

  • White (for example: German, Irish, English, Italian, Polish, French, Caucasian)


Location: Where is your organization headquartered? [State]

  • California

Location: Where is your organization headquartered? [City]

Santa Barbara

Location: Where is your project primarily creating impact? [State]

  • California

Location: Where is your project primarily creating impact? [City]

Santa Barbara County

Problem: What problem is this project trying to address?

Health is more than not being sick. Health is resiliency to overcome stress. Pediatricians are uniquely positioned to provide resiliency support. During the first 3 years of a child's life the family visits the doctor 10 times for Well Child Checkups. These check ups provide touch points that have power and potential. A huge amount of evidence points to the first three years of life as a critical period with profound and long-lasting implications for physical, social, emotional and economic well-being. Adverse Childhood Experiences (ACEs) and "toxic stress" during this critical period have been linked to risky health behaviors, chronic health conditions, and early death. This Project is addressing ACEs in families with young children and providing resiliency tools and services to mitigate the effects. This is expected to improve social, emotional and physical health of these children.

Supporting families is the best way to give children a healthy start. The Santa Barbara Resiliency Project is building a sustainable model to screen families with young children ages 0-3 for Adverse Childhood Experiences (ACES) during Well Child Checkups and provide resiliency services to support these families.  Our pilot project is at Santa Barbara Neighborhood Clinics.  

Is your model focused on any of the following traditionally underserved communities?

  • Communities of color
  • Low-income communities

Does your model work within any of the following sectors?

  • Childcare
  • Child and Family Services
  • Community Development and Empowerment
  • Criminal Justice
  • Education
  • Mental Health

Year Founded


Project Stage

  • Idea (poised to launch)

Example: Walk the network through a specific example of what happens when a person or group engages with your solution.

Children ages 0-3 are screened at Well Child Checkups at Santa Barbara Neighborhood Clinics for Adverse Childhood Experiences (ACES). If a child is determined to be high risk in this screen the family is referred to a clinic Wellness Navigator. The Wellness Navigator works with the family to access resiliency services to support the family and child. Resiliency services include social services or behavioral health services. The Neighborhood Clinics are partnering with CALM and other resiliency service organizations to develop this referral and treatment system. Developing these partnerships is an important part of the process- often the language and funding strategies of social service, behavioral health and medical health is different.

Impact: What was the impact of your work last year? Please also describe the projected future impact for the coming years.

The Santa Barbara Resiliency Team contains leaders in philanthropy, education, healthcare, research, behavioral health services, child development, and resiliency. This team has been meeting regularly since fall 2015. We have developed a pilot project to start ACES screening and provide resiliency services at the Santa Barbara Neighborhood Clinics in the winter of 2017. The Resiliency Project will carefully follow child health and other metrics to look at efficacy of services. We are partnering with researchers at University of California to develop a rigorous program evaluation system. We expect this project to spread to all pediatric care in Santa Barbara and provide our community with a resiliency safety net that is strong, multi faceted and empowering. Our ultimate goal is to provide an innovative and powerful model for holistic care of all families with children ages 0-3.

Organization Type

  • nonprofit/NGO/citizen sector

Annual Budget

  • $100k - $250k

Financial Sustainability Plan: What is your solution’s plan to ensure financial sustainability?

The SBNC Resiliency Project will develop sustainability through partnerships with philanthropy, Cen Cal (Central Coast Medicaid), Cottage Hospital, and other government or nongovernment organizations. An important component to sustainability is proving efficacy. The SBNC Resiliency Project is building a strong evaluation component into its operation from the outset to demonstrate the strength of outcomes due to the Project's interventions.

Unique Value Proposition: How else is this problem being addressed? Are there other organizations working in the same field, and how does your project differ from these other approaches?

Breaking down the silos of Behavioral Health, Social Services and Medical Care is not intuitive. Everyone wants his/her piece of the pie. The Santa Barbara Resiliency Team is bravely moving beyond the world of turf to provide services that make sense for the families that need them. As we work between disciplines to create this Team we have become aware of the different language, funding strategies and evaluation tools used by the fields of medicine, social services and behavioral health. As our health care system demands integration of these services our program will provide a unique model.

Reflect on the Field and its Future: Stepping outside of your project, what do you see as the most important or promising shifts that can advance children’s wellbeing?

The Patient Centered Medical Home (PCMH) model of health care is the most important recent shift to advance children's wellbeing. In the PCMH model medical providers provide comprehensive care for the family- social, emotional and medical health and well being. Pediatricians have been doing this for a while. What PCMH does is institutionalize healthcare payment systems and infrastructure to operate in the way. This new concept of healthcare is changing the face of medicine. Healthcare in the future will work to optimize complete well being, including social, emotional and medical needs.

Source: How did you hear about the Children’s Wellbeing Challenge? (the answer will not be public)

  • Word of mouth

Program Design Clarity

The SBNC Resiliency Project will screen children ages 0-3 at Well Child Checkups for ACEs. There are approximately 1600 SBNC patients in this age group and we expect about 400 to have 2 or more ACEs. Wellness Navigators are at the heart of the Project and are community health workers who are trained to interact and respond to families using an ACEs informed lens. The Project will partner with families to strengthen protective factors, collaborate with other organizations for a multidisciplinary family focused approach, and develop sustainability by proving outcome efficacy.

Community Leadership

Resilience has been defined as the maintenance of healthy and successful functioning or adaptation within the context of adverse experiences. SBNC Resiliency Project will partner with families to strengthen protective factors, build parental resilience, provide social support, make connections for concrete support and increase parent's parenting skills and knowledge of child development. Family partnership & leadership is integral to the Project.

Age of Children Impacted

  • 0-1.5
  • 1.5 -3

Spread Strategies

The SBNC Resiliency Project strengthens the local community and will provide a model for best practices. Identification of ACEs provides information about health trends among pediatric populations, and links health indicators and community interventions. Sharing this data gives insight into identifying strategies to coordinate action, and provides a sustainable model of care for families with young children that is holistic and collaborative.

Reflect on how your work helps children to thrive. How are you cultivating children’s sense of self, belonging, and purpose through your model?

The SBNC Resiliency Project is a community-based initiative that addresses an urgent health issue: early adversity harms the developing brains and bodies of children. For those children determined to be at risk SBNC will partner with families to build protective factors and access community resources that support resiliency. This Project will help children thrive by supporting families to alleviate toxic stress.

Leadership Story

Monica Gross MD MPH is board certified in Pediatrics and is a Fellow of the American Academy Pediatrics. She has 20 years of experience as a pediatrician in Juneau, Alaska. Most recently she has worked with SBNC on Medical Home transformation. The Resiliency Project has come out of this work. She is a health advocate on multiple levels, starting with the family. When a baby is born there is an incredible teachable moment when parents are empowered. Dr. Gross believes that we can build systems that support this teachable moment and her passion lies in improving health care for all children.

Organization’s Facebook Page (URL)

Leader's LinkedIn Profile (URL)

Evaluation results

3 evaluations so far

1. Relevance: Does this project seem to help children (ages 0 to 12 years) develop a strong sense of self, belonging, and purpose?

5 - Yes, this is great! The project lays out a strong, compelling case for how its model nurtures children’s wellbeing. - 66.7%

4 - It seems like a good fit, and the model talks explicitly about children’s wellbeing. - 33.3%

3 - I think so. The project seems related to children’s wellbeing, but the logic is vague. - 0%

2 - Not sure. The project doesn’t have much to do with wellbeing, or it doesn’t give enough information. - 0%

1 - Nope, this project definitely doesn’t fit the challenge brief (e.g., It doesn’t help kids younger than 12, isn’t in the U.S., etc.) - 0%

2. Innovation: Does this project tackle children’s wellbeing from a new angle?

5 - I loved this! The project describes a novel model that addresses important cultural or systemic barriers. - 33.3%

4 - This is pretty cool. The project is addressing an important problem in a new or compelling way. - 33.3%

3 - I feel like there’s something there, but I want more details about what makes it distinctive. - 0%

2 - It’s a good project, but I’ve seen others like it before. - 33.3%

1 - It was confusing or hard to tell what it made it different. - 0%

3. Social Impact: What is this project’s potential for creating positive social impact?

5 - Lots of potential. This project is achieving impressive results, and it’s growing quickly. It could absolutely inspire changes in the ways we approach caring for kids nationally, across sectors (e.g. childcare, healthcare, education). - 33.3%

4 - Pretty good potential. This project demonstrates significant positive impact so far, and it could scale regionally or nationally one day and fundamentally change how a system operates (e.g. childcare, healthcare, education). - 33.3%

3 - Budding potential. This project is creating local impact, but it would take a few adjustments before it could scale. - 33.3%

2 - Some potential. This project demonstrates some initial positive impact, but it would require major changes before it could scale. - 0%

1 - Limited potential. This project has great intentions, but it looks like it does not include key drivers of a shift towards children’s wellbeing. - 0%

4. Overall, how do you feel about this idea?

5 - This idea rocked my world. It’s awesome! - 33.3%

4 - This idea seems really exciting. With a little more polishing, it’d be among my favorites. - 66.7%

3 - I think the idea is great, but it needs some work before it moves onto the next round. - 0%

2 - I liked it fine but preferred others. - 0%

1 - It didn’t make my heart beat faster. Needs significant revisions. - 0%

5. Offer some feedback. Where should this participant spend some time revising?

DEFINING THE PROBLEM. Make sure to articulate the root causes or main barriers of the social issue your project addresses. (Founding Story, Problem, Solution). - 0%

CLARITY OF MODEL. Make sure to mention (a.) the beneficiary, b) the main activities, and c) how those activities drive social impact. Keep it streamlined! - 50%

MARKETPLACE. Make sure to research other players in this space and articulate how this project is different. I didn’t get a complete sense of how this project compares to others. - 100%

IMPACT POTENTIAL. Make sure to use specific numbers to describe what your project has achieved so far! And consider how you might scale the model or its insights, through partnerships, trainings, or franchising. - 50%

WRITING STYLE. Try to stay concise and make it vivid. Avoid jargon. - 0%

Nothing stands out! I thought it was great. - 50%


Join the conversation:

Photo of Melanie Gilbert

Hi there, Monica:

Can I just say that I hope your project is one of the 10 Changemakers Challenge winners?

Doctors screen for weight, height, vision and hearing. They ask whether kids feel safe in the home, wear their seat belt in the car and their helmet while bike riding. They ask about risky personal and family behaviors like domestic violence, guns in the home, smoking, drinking, drugs and sex. They have a routine schedule for vaccinations. Why not also screen for trauma? Why not make ACEs a regular part of the childhood health evaluation?

When I foster-adopted my children in 2008, ACE's screening was just being presented as an idea, not an actionable plan. Just now is that idea being translated into practice - literally, thorough wellness clinics like yours.

We were fortunate to get our kids into a ACEs-type program at Children's Hospital Boston, but I think our experience then - and even now - is more the exception than the rule. My daughter scored a 9; my son an 8. And their trauma was "behind" them, allegedly, although we know CPTSD haunts their lives for a long time. . . . Imagine the powerful impact your model will have on children whose trauma needs require daily remedy and services.

There's one other applicant doing direct-care ACEs work:

I am so happy to know of your work. Best of luck with your project. You're already a champion for children!
- Melanie

PS: I followed you on Twitter ;)

Photo of Monica Gross

Hi Melanie-
Thank you for your thoughtful comments.
Dr. Nadine Harris Burke in San Francisco has certainly been an incredible champion.
Slowly the model of pediatric wellness is shifting!