Adam Schickedanz, MD, PhD, is an affiliate at the UCLA Center for Health Policy Research as well as a general pediatrician, health services researcher, and assistant professor in the Department of Pediatrics at the David Geffen School of Medicine and the Department of Health Policy & Management in the Fielding School of Public Health at UCLA. He practices clinically within the Los Angeles County Department of Health Services. His research connects health care services and quality, policy across sectors, clinician education, and social and structural drivers of population health equity. His projects include implementing and evaluating new models of care delivery to address childhood adversity and families' social and economic drivers of health, especially in pediatric primary care.

Schickedanz received his undergraduate medical education and graduate medical training in pediatrics at the University of California, San Francisco (UCSF). He was a Health Policy Fellow at the National Academy of Medicine from 2008-2009. Following his chief residency at UCSF, he pursued a fellowship in health services research as a Robert Wood Johnson Clinical Scholar at UCLA. He received his doctorate in health policy and management at the UCLA Fielding School of Public Health, focusing on the relationships between adverse childhood experiences (ACEs) and life course and intergenerational health.

In 2011, Schickedanz cofounded the San Francisco General Hospital Financial Fitness Clinic, a medical-financial partnership offering on-site financial coaching and free tax preparation services to patients with low income as a cross-sector health intervention. Since 2018, he has been co-director for the Medical-Financial Partnerships at Harbor-UCLA and Olive View-UCLA, two of the largest medical centers in Los Angeles’ Department of Health Services, the public health system serving the most populous county in the nation.

Schickedanz has worked with health systems around the country to design and implement clinical services that address not only material hardships (such as food and housing insecurity) but the economic circumstances that create them. He is currently funded by the National Institutes of Health to evaluate the health and developmental impact of medical-financial partnerships in pediatric care. 

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Positive Childhood Experiences and Adult Health Outcomes
Journal Article
Journal Article

Positive Childhood Experiences and Adult Health Outcomes

Adverse childhood experiences (ACEs) can drive poor adult mental and physical health, but the impact of early life protective factors should not be overlooked. Positive childhood experiences (PCEs) measures quantify protective factors, but evidence is lacking on their link to health conditions independent of ACEs in nationally representative studies. This study examines associations between composite PCE score and adult health, adjusting for ACEs.

Findings: Adults with 5 to 6 PCEs had 75% of the risk of fair/poor overall health and 74% of the risk of any psychiatric diagnosis compared with those with 0 to 2 PCEs, independent of ACEs. In survival analysis models accounting for PCEs and ACEs, reporting 5 to 6 PCEs was associated with a 16% lower annual hazard of developing any adult psychiatric or physical condition; reporting 3+ ACEs was associated with a 42% higher annual hazard (CI, 1.27–1.59).

PCEs were independently associated with lower risks of fair or poor adult health, adult mental health problems, and developing any physical or mental health condition at any given age after adjusting for ACEs.
 

Clinic-Based Financial Coaching and Missed Pediatric Preventive Care: A Randomized Trial
Journal Article
Journal Article

Clinic-Based Financial Coaching and Missed Pediatric Preventive Care: A Randomized Trial

This study evaluated the impact of clinic-based financial coaching on adherence to recommended preventive care pediatric visits and vaccinations in the first 6 months of life.

Authors examined the impact of the longitudinal financial intervention delivered by trained coaches addressing parent-identified, strengths-based financial goals (employment, savings, public benefits enrollment, etc.). They also examined social needs screening and resource referral on rates of missed preventive care pediatric visits and vaccinations through the 6-month well-child visit.

Findings: Eighty-one parent-infant dyads were randomized (35 intervention, 46 control); nearly all parents were mothers and more than one-half were Latina. The rate of missed visits among those randomized to clinic-based financial coaching was half that of controls. Intervention participants were more likely to have up-to-date immunizations each visit with fewer missed vaccinations by the end of the 6-month preventive care visit period.

A medical-financial partnership embedding financial coaching within pediatric primary care improved low-income families’ adherence to recommended visits and vaccinations. Clinic-based financial coaching may improve care continuity and quality in the medical home.
 

Positive Childhood Experiences and Adult Health Outcomes
Journal Article
Journal Article

Positive Childhood Experiences and Adult Health Outcomes

Adverse childhood experiences (ACEs) can drive poor adult mental and physical health, but the impact of early life protective factors should not be overlooked. Positive childhood experiences (PCEs) measures quantify protective factors, but evidence is lacking on their link to health conditions independent of ACEs in nationally representative studies. This study examines associations between composite PCE score and adult health, adjusting for ACEs.

Findings: Adults with 5 to 6 PCEs had 75% of the risk of fair/poor overall health and 74% of the risk of any psychiatric diagnosis compared with those with 0 to 2 PCEs, independent of ACEs. In survival analysis models accounting for PCEs and ACEs, reporting 5 to 6 PCEs was associated with a 16% lower annual hazard of developing any adult psychiatric or physical condition; reporting 3+ ACEs was associated with a 42% higher annual hazard (CI, 1.27–1.59).

PCEs were independently associated with lower risks of fair or poor adult health, adult mental health problems, and developing any physical or mental health condition at any given age after adjusting for ACEs.
 

Clinic-Based Financial Coaching and Missed Pediatric Preventive Care: A Randomized Trial
Journal Article
Journal Article

Clinic-Based Financial Coaching and Missed Pediatric Preventive Care: A Randomized Trial

This study evaluated the impact of clinic-based financial coaching on adherence to recommended preventive care pediatric visits and vaccinations in the first 6 months of life.

Authors examined the impact of the longitudinal financial intervention delivered by trained coaches addressing parent-identified, strengths-based financial goals (employment, savings, public benefits enrollment, etc.). They also examined social needs screening and resource referral on rates of missed preventive care pediatric visits and vaccinations through the 6-month well-child visit.

Findings: Eighty-one parent-infant dyads were randomized (35 intervention, 46 control); nearly all parents were mothers and more than one-half were Latina. The rate of missed visits among those randomized to clinic-based financial coaching was half that of controls. Intervention participants were more likely to have up-to-date immunizations each visit with fewer missed vaccinations by the end of the 6-month preventive care visit period.

A medical-financial partnership embedding financial coaching within pediatric primary care improved low-income families’ adherence to recommended visits and vaccinations. Clinic-based financial coaching may improve care continuity and quality in the medical home.
 

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