Monthly Update
February 2015

CCC Board of Directors Meetings:

All CCC Board of Directors meetings are held at 1111 E. Cesar Chavez St., Austin, TX 78702.

  • Next Meeting: Tuesday, April 7, 2015 from 2:00-4:00 PM.

The CCC Board will also meet on the following dates at 2:00 p.m.  These dates are subject to change pending Board approval:

  • August 11, 2015
  • September 22, 2015



CCC IT Update - Facilitating Access to Patient Data


Starting last month, CommUnityCare's Patient Navigation Center (PNC) began receiving daily reports of all CommUnityCare patients who were discharged from an area hospital (Emergency Department or inpatient stay) within the previous 5 days.  This report is the first step in the process of pushing data from hospitals to the PNC to assist with closer care coordination between hospital-based and primary care services.


The CCC IT team worked closely with Alan Goodwin (PNC Director), Dayna Fondell (DSRIP Program Manager), and Mark Steiger (Director of Operations, PCMH) to determine the work flow and IT requirements needed to provide this data in the most efficient manner.  At this time, the report retrieves hospital discharge information from Central Texas area hospitals that submit data to the Integrated Care Collaboration (ICC), the area's regional Health Information Exchange. The report provides detailed information on patient demographics, medical home and PCP, hospital admission and discharge dates and times, hospital provider, primary and secondary diagnoses related to the hospital visit, and date of the last CommUnityCare clinic visit.  The information is provided to the PNC staff in a spreadsheet file that can be easily sorted and filtered by discharge date and type of visit.


Because of the criticality in getting data to the PNC as soon as possible for patient continuity of care and meeting the DSRIP goal of contacting patients within 72 hours of hospital discharge, the CCC IT team will continue to work with the ICC and area hospitals to identify faster ways to get discharge data to the ICC. 


For more information on this or other reports, please feel free to contact the CCC-IT team at



:: 512-978-8164

Contact: Mark Hernandez
A Note from the CCC Associate Chief Medical Officer
Dr. Ted Held
CCC Associate CMO

Parents have always known that one of the great debates in science and philosophy is poorly framed.  When it comes to raising kids, it's not "nature or nurture" -- it's both.  Children are born with innate, individual personalities, giving rise to some behaviors which are only slightly modifiable by parenting -- my daughter's table manners come to mind.  Involved parents also know that being an attentive and present caregiver, and a positive role model, is crucial to the development of the child's character, emotional development, and success as an adult. 


Recent advances in genomics, epigenetics and behavioral psychology are providing insights into the complex interplay between behavioral and genetic effects, which not only predicts many health outcomes but other life events as well.  One fascinating study has explosive implications.  The study, published in 2013 in the journal "Nature Neuroscience," demonstrated that mice, when simultaneously exposed to the smell of cherries and given a shock, learned to fear the smell of cherries- not surprisingly.  The study also showed, however, that both the children and grandchildren of such mice were also born fearing the smell of cherries -- despite not having received shocks!  Presumably, the subject mouse underwent changes in its epigenetic structure, or changes to factors influencing gene expression, and these changes were passed on to its offspring.


These intergenerational effects on behavior and outcomes are one interesting component of a body of literature broadly classified as "the lifecourse approach" to health -- an approach which emphasizes the importance of prenatal and early life experiences on later adult health outcomes.  Below, we highlight some local initiatives that address early childhood effects on adult health outcomes, with a special focus on adverse childhood experiences (ACES).




Social Determinants of Health -- ACES


As the CCC transforms our local safety net system to focus more on health, rather than just healthcare, it will also consider the social determinants of health that impact the target population.  Social determinants of health, as defined by the Office of Disease Prevention and Health Promotion on their website are --


conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.


Adverse childhood experiences (ACES) is a social determinant of health that has received attention nationally and locally.  Adverse childhood experiences include childhood traumatic experiences of household dysfunction, abuse, or neglect that have been found to be associated with serious medical, mental health, and social issues as an adult. 


Based on initial findings by Dr. Vincent Felitti working with patients at his obesity clinic in the 1980's, the Centers for Disease Control (CDC) conducted a study beginning in 1995 to assess the relationship between ACES and adult health status.  The study asked individuals to indicate if they had experienced any of the following as a child:


Household Dysfunction



Substance Abuse



Parental Separation/ Divorce



Mental Illness



Battered Mother



Criminal Behavior





The findings were surprising and provided new insight into the root causes of many adult medical, mental, and social issues.  

  • The survey found a direct link between childhood trauma and adult onset of chronic disease, mental illness, doing time in prison, and work issues, such as absenteeism.
  • About 2/3 of the adults in the study had experienced one or more types of ACES.  Of those, 87 % had experienced 2 or more types.  Substance abuse was the most prevalent of the childhood exposure categories.
  • More adverse childhood experiences resulted in a higher risk of medical, mental and social problems as an adult - with an ACE score of 4 or higher significantly increasing an adult's likelihood of having diseases such as hepatitis, COPD, or sexually-transmitted diseases.
  • One in 6 people had an ACE score of 4 or more, and one in 9 had an ACE score of 5 or more.

The study focused not on individuals who were living in poverty or with other obvious high-risk factors but on average Americans - 80% white (including Latino), 10% black, and 10% Asian.  They were middle-class, middle-aged, and 74% were college-educated. A full picture of the study and its findings can be accessed at


Why does early toxic stress impact later health?  It impacts brain development.  The stress of severe and chronic childhood trauma releases hormones that physically damage a child's developing brain. The "fight or flight" part of the brain is chronically activated while the part of the brain - the prefrontal cortex - that is needed for cognitive functioning becomes stunted as responding to real or perceived emergencies takes precedence over other activities.



Additionally, if no resiliency or other protective social/emotional skills are learned, children/teens continue to respond to the world as a place of constant danger and often seek solace in food, alcohol, tobacco, drugs and other high-risk behaviors.  They don't regard these coping methods as problems. Consciously or unconsciously, they use them as solutions to escape from depression, anxiety, anger, fear and shame.


This is important information in planning effective prevention and intervention strategies to help decrease future chronic health issues.  

Current CCC and Community Efforts around ACEs


The CCC, and the larger community, are already focused on this issue, and have undertaken a number of efforts to expand provider education and provide resiliency and education-based programs to support early childhood development and help prevent childhood trauma.




Dr. Tara Greendyk and Dr. Michelle Gallas are general pediatricians and faculty with the Dell Medical School for the pediatric residency program at CommUnityCare East Austin Clinic.  In their role as faculty for a residency program, Dr. Greendyk and Dr. Gallas received a Community Access to Child Health (CATCH) grant for a visiting professorship through the American Academy of Pediatrics (AAP). 

Through this grant, Dr. Greendyk and Dr. Gallas brought Dr. Andrew Garner to Austin for two days in January to present on the impact of adverse childhood experiences (ACES) on health outcomes.  Dr. Garner, MD, PhD, FAAP, is Associate Clinical Professor of Pediatrics at Case Western Reserve University School of Medicine in Cleveland, Ohio. During his time in Austin, Dr. Garner presented on the link between significant adversity or violence in childhood and poor outcomes to -

  • CommUnityCare's All Provider meeting
  • Dell Medical School Faculty Development meeting for pediatrics
  • United Way's Quarterly Stakeholder Meeting
  • A dinner for Community Pediatricians and other providers
  • Dell Children's Medical Center's Annual Pediatric Conference, as key note speaker, and
  • Medical residents during informal meetings

Based on Dr. Garner's latest presentation that illustrates the association between maternal depression and childhood stress, local providers have decided to increase the screening rates for maternal depression to allow for early intervention. 


In addition to the recent visit by Dr. Garner, the CCC DSRIP "CenteringPregnancy" program taking place at the North Central and East Austin CommUnityCare health centers is a great example of a program that is designed to increase the resiliency and coping skills of pregnant women by decreasing their stress and helping to promote a healthy pregnancy.  "CenteringPregnancy" is a multifaceted model of prenatal care that incorporates three foundational pillars -- health assessment, education, and support -- into a unified program within a group setting.  Eight to twelve women with similar gestational ages meet together, and learn about the importance of self-care and health promotion during pregnancy, as well as caring for their new baby. 


This happens while participating in a facilitated discussion, and developing a support network with other group members that empower them to choose health-promoting behaviors.  


The maternal "graduates" of the "Centering Pregnancy" program then transition into "Centering Parenting," also a group model of care where the focus shifts to the child.  The mother-infant dyads participate in group well child checks over the ensuing two year period for the child's two-month through two-year visits in a series of eight group sessions.  This program promotes positive parenting and works to help prevent and/or mitigate the effects of the adverse childhood events that can arise while raising children in poverty and other difficult circumstances.  


In FY14, the "Centering Pregnancy" program provided 10-class sessions to 18 groups for a total of 95 women.   The East Austin Centering Parenting program is also robust with over 150 dyads that have participated since its inception, plus new groups forming almost every month.

Leader Spotlights    


Michelle Gallas, D.O., is a general pediatrician at the CommUnityCare East Austin Health Center and faculty with the Dell Medical School - University of Texas at Austin Pediatric Residency Program. She attended medical school at Rowan University - School of Osteopathic Medicine (formerly UMDNJ) and completed her residency training at Newark Beth Israel Medical Center where she was also chief resident before moving to Austin in 2006.  She loves working with the residents in the ambulatory setting during these vital and formative years of their career, while also providing evidence based and high quality care to the patients of the East Austin Health Center.  She is the lead pediatrician for the Centering Parenting program which began at CommUnity Care in 2009.  It is the only Centering Parenting program in Texas, and the only one nationally that functions in the setting of a pediatric residency program.  When not working, she enjoys being with her family which includes husband Keith and three wee ones, five years old and under: Kevin, Maria and the most recent addition in November 2014, KJ.     


Tara Greendyk, M.D., is a general pediatrician at the CommUnityCare East Austin Health Center and faculty with the Dell Medical School - University of Texas at Austin Pediatric Residency Program. She attended medical school at Rutgers University - New Jersey Medical School (formerly UMDNJ) and completed her residency training at New York Presbyterian - Weill Cornell Medical College Pediatric Residency Program. Tara subsequently joined the pediatric faculty at Weill Cornell and worked as a general pediatrician in an FQHC in Long Island City, Queens, NY.  In 2009, she and her family relocated to Austin. Tara's passion has always been twofold: to work with underserved, vulnerable populations and to educate pediatricians in training.  Tara has been a recipient of the residency program's "Community Pediatrician of the Year" award.  In her free time, she enjoys spending time with her family - husband Jesse, and three children, Jacob, Abigail and Lily.

People's Community Clinic


People's Community Clinic (PCC) has received a grant from the Meadows Mental Health Policy Institute to provide the Circle of Security (COS) Program to enhance the attachment security between parents and children.  This program helps increase caregiver awareness of children's needs and whether their own responses meet those needs which can help protect children from the effects of toxic stress.


As part of their grant, PCC plans to implement 3 levels of services:

  • Universal messaging to all families who come for well-child check-ups around the importance of parent/child attachment to early brain development.  This messaging will be provided through handouts and video exerts.
  • Screening/assessment will be conducted at the 6 month well-child check-up.  The screening instrument combines several measures to assess for parental stress, child-parent attachment issues, and toxic stress risk factors.
  • COS education/intervention will be provided to families that test positive on the screening to increase the parent's ability to provide and support healthy child development.  This will be an 8 week group program, led by social workers trained in the COS curriculum.  The groups will be kept at about 8-10 individuals, and PCC hopes to serve about 60 families during the grant's 2-year service period.

St. David's Foundation provided seed money for the program.  PCC is gathering baseline data now and hopes to begin screening in a few months.  PCC will be working with researcher Dr. Toni Watt at Texas State University to assess program outcomes.  

Leader Spotlights    


Louis Appel, MD, MPH

serves as Chief Medical Officer and Director of Pediatrics at People's Community Clinic in Austin, Texas. Dr. Appel provides primary pediatric care at the Clinic in addition to overseeing the clinical programs.  He is the Community Access to Child Health (CATCH) Program Facilitator for District VII of the American Academy of Pediatrics and serves on the Executive Legislative Committee of the Texas Pediatric Society.  In the past he has co-chaired the Texas Pediatric Society's Community Health Advocacy Committee and served on the Texas Pediatric Society's Task Force on Childhood Obesity as well as on the Travis County Early Impact Team, advising on the coordination of Early Childhood Intervention services in the county.  A graduate of Princeton University, Dr. Appel received his medical degree from Harvard Medical School and obtained his Masters of Public Health at the Harvard School of Public Health, with a concentration in public management and community health. He completed his pediatric residency at the University of Washington in Seattle.


St. David's Foundation 


The staff at St. David's Foundation is using the ACEs research, as well as related research around toxic stress, as a framework for thinking about the root causes (i.e. prevention) and effective interventions for many mental health and physical health issues.  Within the last 24 months, the Foundation made preliminary investments intended to help reduce the gap between the findings of ACEs research and the local practice of health care. 

In 2014, the Foundation invested approximately $6 million in mental health programs for low income individuals in Central Texas.  Within those investments, were programs specifically targeting trauma/toxic stress/ ACEs including: 

  • Developing local capacity to understand and treat trauma through a grant to Austin Child Guidance Center to create a trauma-informed consortium.  The first stage of this work is culminating in the Cross-Discipline Trauma conference ( to be held in Austin on March 30-31, 2015, that will feature lead experts on trauma, including Dr. Vince Felitti and Dr. Bruce Perry.
  • Increasing mental health provider training specific to trauma through a grant to Center for Child Protection to train staff on the Neurosequential Model of Therapeutics (NMT), a developmentally sensitive, evidence-based approach that integrates core principles of neurodevelopment and traumatology to inform work with children, families and the communities in which they live.
  • Addressing the intergenerational impact of trauma and ACES via prevention and early intervention techniques, such as People's Community Clinic's project called Circle of Security, a relationship-based early intervention program designed to enhance attachment security between parents and children, and the relief nursery model being replicated by Austin Children's Services within the agency's Strong Start program. 
  • Researching model community interventions and evaluating Travis County's efforts to incorporate ACE research into our health and social services interventions via a grant SDF has made to the Meadows Mental Health Policy Institute.

System Facility Updates

Central Health Downtown Campus Redevelopment


We want to hear from you!  Central Health is hosting a Brackenridge Campus Community Forum on March 6,2015, at the Thompson Conference Center at The University of Texas from 11:00 - 3:00.  This forum will be moderated by State Senator Kirk Watson and will include an update on where Central Health is in the planning process and input received from the community to date.  It will also include panel discussions on transforming care through our integrated delivery model and building a model healthy community through innovation.  Panelists include Dell Medical School Dean Clay Johnston and Mini Kahlon, George Miller of CommUnityCare, and our own Dr. Mark Hernandez of the Community Care Collaborative.  Please rsvp for this event at  

University of Texas Dell Medical School



The future of medical education is taking shape at 15th and Red RiverAll eight cranes are now in operation at the Dell Medical School site. Beyond the physical progress on the construction site, the medical school's team is growing too, with new department chairs on board and  the addition of 600 plus faculty and residents earlier this year. Dell Medical School will also play a key role in this year's new SXSW Health and MedTech Expo, with Dean Clay Johnston giving the opening presentation on March 16th.

Seton Medical Center at the University of Texas


On January 27, 2015, the Michael & Susan Dell Foundation announced a major challenge grant to pay for construction of  Seton Healthcare Family's new teaching hospital in downtown Austin and solidify a community-wide plan to provide better care closer to home.


The foundation will match, dollar for dollar, up to $25 million to help The Seton Fund raise $50 million for the new 211-bed hospital now under construction at 15th and Red River streets.


The new hospital - to be called Dell Seton Medical Center at The University of Texas when it opens in 2017 - is estimated to cost $295 million. The first $245 million has been pledged by Seton and Ascension, the nation's largest Catholic and non-profit health care system of which Seton is a part.