Current Work with Local and California State Government
Julia Adler-Milstein, PhD led several projects for the state of California to improve usage of health information technology (HIT). The Promoting Interoperability Program (PIP) began in 2011 to incentivize hospitals and professionals to adopt, implement or upgrade certified health information technology (HIT) and to use it in a meaningful manner in clinical practice. Since then, the CA Department of Health Care Services (DHCS) has distributed over $1.6 billion in federal incentive payments to over 25,000 professionals and 320 hospitals in California under the program. The goal of this project was to assess the HIT landscape in California at the conclusion of the PIP. This assessment assists DHCS and stakeholders in determining the impact of the HITECH Act programs over the last decade and makes recommendations for improvements in HIT in the future.
Dr. Adler-Milstein also assessed the health invormation technology landscape for California Advancing and Innovating Medi-Cal (CalAIM), which has “a long-term commitment to transform and strengthen Medi-Cal, offering Californians a more equitable, coordinated, and person-centered approach to maximizing their health and life trajectory.” As a part of CalAIM, the state Data Exchange Framework governs and requires the exchange of health information among health care entities and government agencies. The goal of this project was to characterize the availability of health information technology (HIT) systems to support CalAIM in sectors outside of the traditional medical setting (continuum of care, county behavioral health, county child welfare, county in-home supportive services, county jails, Medicaid managed care plans, respite care, school-based health centers, sobering centers, state prisons).
Naomi Bardach, MD served full time with the California Health and Human Services Agency, leading the state Safe Schools for All Team to re-open and support schools during the COVID 19 pandemic. She currently serves as an ad hoc consultant for school and health related discussions with the California Department of Public Health.
Janet Coffman, PhD, MPP, MA has provided guidance to the California State Legislature for many years through the California Health Benefits Review Program (CHBRP). Established in 2002, CHBRP is a collaboration among faculty and staff at seven University of California campuses. The program provides independent analysis of the medical, financial, and public health impacts of proposed health insurance benefit mandates and repeals. She serves as one of the program’s Vice Chairs and supervises a team of IHPS staff who review literature on the effectiveness of the health care services or providers to which a mandate would apply.
Dr. Coffman also shares her expertise in the health care workforce with state government. She has testified before several legislative committees and given presentations to the California Health Workforce Education and Training Council and at multiple conferences held by state level health policy and advocacy organizations. In addition, she has completed research and evaluation projects for several state government agencies. She currently has a contract with the California Emergency Medical Services Authority to evaluate the impact of AB 1544, legislation enacted in 2020 that expands the scope of practice of paramedics to encompass transfer of eligible patients to mental health crisis centers and sobering centers and provision of non-emergency services to people who frequently use the emergency medical services system.
Jayme Congdon, MD, MS is working with pediatric colleagues in Santa Clara County on the implementation and evaluation of a new buprenorphine treatment program for adolescents with opioid use disorder, which was developed in response to a surge in pediatric overdoses and a severe shortage of youth treatment access. Program participants initiate buprenorphine in the inpatient pediatric unit during an approximately 1-2 day hospital stay and are then linked to outpatient or residential treatment upon discharge. After about one year and 50 admissions for youth ages 12-21, about 90% completed buprenorphine induction, and about three-quarters were successfully linked with ongoing treatment after discharge. A manuscript of these findings and the inpatient induction protocol are in press at Hospital Pediatrics. They are continuing to follow patients to assess longitudinal clinical outcomes and are also working with neighboring counties developing similar programs.
One of the barriers that arose in the Santa Clara OUD treatment program was the need for parental consent for minors, per California law. While pediatric providers always make every effort to engage caregivers, a number of the patients <18 who present for treatment do not have an available or supportive caregiver to consent (e.g., unhoused youth). Last Spring, Dr. Congdon reached out to newly sworn in California Assemblymember Matt Haney about this barrier to care, and he immediately responded that he wanted to help. After working with his team and other experts for several months, they now have a draft bill that would allow minors 16 and up to consent to OUD treatment with buprenorphine. Assemblymember Haney plans to introduce the bill in the next legislative session.
Mara Decker, DrPH and her team have been providing evaluation, technical assistance, and training in partnership with the California Department of Public Health’s Maternal, Child and Adolescent Health division to support their Adolescent Health Education Programs since 1997. They currently evaluates the Adolescent Sexual Health Education Programs supporting local agencies to provide comprehensive sexual health and life skills education to young people. The IHPS team surveys over 10,000 youth annually at more than 300 sites and oversees all evaluation activities to document and assess program outcomes.
Dr. Decker’s team with Kathleen Tebb from UCSF’s Division of Pediatrics also evaluate the Adolescent Family Life Program (AFLP), an evidence-informed program model that provides expectant and parenting adolescents with comprehensive, strengths-based case management services to enhance protective factors and promote resilience. This includes two surveys of approximately 1,200 participants a year to assess youth resilience and program satisfaction, and a mixed methods assessment of program fidelity.
Decker also leads a pilot program to address the rising rate of congenital syphilis in San Joaquin County. This pilot program targets pregnant individuals ages 12-44 with epidemiologic risk factors for syphilis during pregnancy, including unstable housing and/or substance use, accessing care through the Pregnancy Connections program at the San Joaquin County Clinic.
She leads the Rural Education and Development for Youth (READY), which is guided by a systems-thinking approach that recognizes the multiple environments that youth must navigate to achieve optimal health, including their families, schools, policies, and health care systems. The project combines the replication of an evidence-based sexual health education curriculum (Positive Prevention Plus) and the implementation of a new booster sexual health curriculum (READY, Set, Go!) in local school districts with additional leverage points in the community to ensure the greatest impact on adolescent health. This includes repeated points of contact with youth for sexual health education (in 9th and 11th grade), professional learning opportunities for school staff, training on youth-friendliness for local clinics, the development of a referral system for services, and educational workshops for parents and caregivers. This multipronged approach aims to stimulate sustainable and innovative change in rural Fresno County and, if successful, provide a model for other rural communities in need.
Rita Hamad, MD, PhD is currently collaborating on a project with the California state WIC (Special Supplemental Nutrition Program for Women, Infants and Children) agency, to increase take up of the earned income tax credit among their participants statewide.
Megie Okumura, MD, MAS and her team have been working on two evaluation projects involving the California Children’s Services (CCS) program. The first was to evaluate a CMS 1115 waiver project that tested two integrated healthcare delivery models for the CCS program (a new pediatric accountable care organization and an existing managed care organization). The second evaluated the implementation of the Whole Child Model (WCM) program (SB586) which transitioned 21 counties from a MediCal fee-for-service model to a MediCal Managed Care model for child specialty and primary care services. Both evaluations reported the impact on access to care, service use, quality, and coordination of care for pediatric patients and on related health outcomes.
Matt Pantell, MD, MShas been working for the last two years with the California Office of the Surgeon General and Department of Health Care Services to explore adverse childhood experiences (ACEs) screening as measured by Medicaid claims
The California GROWs initiative is the California Department of Aging’s program to develop and support career pathways for the Home and Community-Based Services (HCBS) workforce. The program includes training opportunities, career navigation, and retention incentives, and just announced 78 grantees who will serve every county of California. IHPS staff and faculty will conduct the evaluation of this program, led by Joanne Spetz, PhD, and collaborating with Laura Wagner, PhD, RN, FAAN, Taressa Fraze, PhD, Timothy Bates, Jackie Miller, Susan Chapman, RN, PhD, FAAN, Lauren Hunt, RN, PhD, FNP, and Jarmin Yeh, PhD, MPH, MSSW. The team will visit 12 of the grantees for in-depth evaluation, and also explore the overall success of the program in advancing the direct care workforce that serves people with long-term care needs.
Last year, the California legislature asked the new California State Policy Evidence Consortium (CalSPEC), directed by Tracey Woodruff, PhD, MPH, to write a report on how microplastics in the environment are impacting health and what governments have done to address this problem. UCSF’s Program on Reproductive Health and the Environment (PRHE) led the health impacts section of the report with a rapid systematic review of nearly 2,000 studies on how microplastics affect health. The report, which was released earlier this week, reveals that microplastic exposure appears to harm fertility as well as induce biological changes that are markers for increased cancer risk in the digestive tract. Preliminary evidence was also identified demonstrating that microplastic exposure harms respiratory health. Led by a UC Berkeley team, the report further summarizes microplastic policies both at a national and international level – demonstrating that, although progress has been made in some areas (for example, microbead policies in California), more needs to be done by governments to protect people and the environment from the effects of microplastics exposure. Read the report and related blog here.