September 23, 2022
California’s expansion of screening for childhood trauma is being hailed as a model for other states, according to a briefing recently published in the Journal of the American Board of Family Medicine.
The briefing, written by researchers at UC Davis Health and other University of California institutions, said the screenings have the potential to reveal the current prevalence of adverse childhood experiences (ACEs) and their impact on adult health.
Adverse childhood experiences (ACEs) are a set of potentially traumatic events that occur before adulthood, including various forms of abuse, neglect, parental divorce, separation or death, domestic violence, and a family member’s psychiatric illness. ACEs and toxic stress are at the root of some of the most damaging, persistent, and costly societal and health challenges facing the world today. Research has found that people exposed to negative childhood experiences are more likely to suffer from chronic illnesses and have a shorter lifespan.
Because 62% of California adults have experienced at least one ACE and 16% have experienced four or more, California is taking aggressive steps to address ACEs and toxic stress through ACEs Aware, the nation’s first initiative to establish routine screening, primary care, and build a care network .
In October 2021, California enacted the ACEs Equity Act. The law expanded ACE screening by requiring it to be covered by commercial insurance. Screening for Medi-Cal patients has been required since early 2020.
The UC research team analyzed the impact, benefits, and risks of universal screening for ACEs in children and adults. They highlighted several policy considerations:
Screening and health equity: For screening to provide equal health benefits across communities, access to effective interventions is required for all patients who may score high on the ACEs questionnaire. Otherwise, screening may become a well-intentioned intervention that does not provide the support and services intended.
Weight all aces equally: There is no current evidence that each ACE has the same impact on a given individual’s health outcome. While overall high ACE levels correlate with a higher risk of adverse health outcomes, additional research is needed at the individual level. A person may do well on an ACE screening, but there is still little evidence that the person will later have a specific negative health outcome.
Cost: Using estimates from Medi-Cal enrollees, the authors estimate reimbursement of $29 per ACEs screening for commercial plans and policies, representing a 0.03% increase in total costs.
Possible damage: There is a need to adequately train providers in conducting and discussing screening while having adequate resources to refer patients for follow-up.
The researchers also said that awareness of the potential advantages and disadvantages is key to discerning how healthcare systems can use ACE screening as a tool to provide trauma-informed care to better meet patients’ needs .
Get an ACEs Aware Training Today (Free!)
The California Medical Association (CMA) encourages all physicians, especially Medi-Cal providers, to do so receive the free two-hour training session to learn how screening, risk assessment and evidence-based care can effectively intervene in toxic stress.
By screening for ACEs, providers can better determine the likelihood that a patient is at increased health risk due to a toxic stress response, a critical step in the response trauma-informed care that connects patients to a supportive care network to mitigate the effects of ACEs.
Physicians can – and can – earn 2.0 Continuing Medical Education (CME) and 2.0 Maintenance of Certification (MOC) credits after completing them receive Reimbursement for providing ACEs screenings to Medi-Cal beneficiaries.