Asthma Network Forum 2014

Morning Speakers: Toxic Stress Overview

Dayna Long, MD, FAAP, Staff Pediatrician and Co-Director, Family Information and Navigation Desk (FIND), Medical Director, ATTACK Asthma Clinic, UCSF Benioff Children's Hospital, Oakland 

Learning objectives:

  1. What are social determinants of health and their relationship to health inequities?
  2. How do we define “chronic stress” and “toxic stress”?
  3. What is the Adverse Childhood Experiences (ACE) Study?
  4. What recent clinical trials have been done related to toxic stress?
  5. How can the health provider and team offer anticipatory guidance and screen patients for toxic stress?

Sam S. Oh, PhD, MPH, Research Epidemiologist, UCSF

Learning objectives:

  1. What are the multiple pathways by which chronic stress imparts it effect on health?
  2. How do genes get methylated (epigenetics)?

  3. What are the clinical pathways for inflammation?

  1. What biomarkers exist as indicators of response to stress?
  2. What biomarkers are used for inflammation?

  3. Is cotinine a feasible biomarker for toxic stress?

  1. How might toxic stress impact the prevention and control of asthma?

Skills and tools for health providers 

Leanna W. Lewis, LCSW, Clinical Social Worker, Center for the Vulnerable Child, UCSF Benioff Children’s Hospital, Oakland

Learning objectives:

  1. How do we define and recognize micro-aggressions?
  2. Cultural responsiveness:  How do we engage patients around these issues, while acknowledging the power and privilege we have as providers?
  3. What opportunities do we providers have to be allies, and how can I communicate this to my patients?

Nooshin Razani, MD, MPH, Attending Physician, Ambulatory Department, UCSF Benioff Children's Hospital, Oakland

Learning objectives:

  1. What are three physical and mental health benefits from being in nature, and how can exposure to nature can serve as a buffer to toxic stress?
  2. What might be the barriers your patients have to participating in nature? What are some strategies for overcoming those barriers?
  3. What are three San Francisco resources for assisting your patients to participate in nature?

Afternoon Panel:  Resources and interventions 

Learning objectives:

  1. Name resources and interventions to benefit the health of patients with asthma:
  2. What resources exist to help families affected by domestic and community violence?

  3. What psychotherapy resources exist in SF to help children who have experienced emotional trauma?

  4. How are larger clinics using patient navigation assistance to help families find food resources and other resources that address social determinants of health?

  5. How can clinical settings help families have greater housing security and enforcement of housing rights?

  1. Identify ways the local clinical community can continue to collaborate on these efforts.


Blia Moua, MSW, SafeStart Program Manager, San Francisco Child Abuse Prevention Center, Helping families affected by violence in San Francisco

  • SafeStart case management services offered to families

  • SafeStart training offered to providers

  • Collaborative work of CAPC with other agencies and how to participate

Laura Gottlieb, MD, MPH, Assistant Professor of Family and Community Medicine, University of California, San Francisco

  • Effectiveness of patient navigation programs to address social determinants of health in clinical settings: FIND, CCLIP & the Bay Area Regional Help Desk Consortium

  • Challenges to implementation and dissemination of social determinants of health interventions 

  • Tracking social determinants of health in the EHR

Melissa Hagan, PhD, MPH, Postdoctoral Scholar, UCSF Department of Psychiatry, Child Trauma Research Program (CTRP)

  • CTRP psychotherapy services offered to families of children 0-5 years old

  • CTRP services offered in the community & collaboration with community agencies 

  • CTRP research on effectiveness of psychotherapy trauma interventions

Karen Cohn, MS, CIH, San Francisco Department of Public Health, Population Health Division, Environmental Health Branch

  • Children’s Environmental Health Promotion Program home investigation findings while serving low-income families in San Francisco

  • Local resources and strategies for improving housing conditions