California is Becoming ACEs Aware: 130,000 Medi-Cal Beneficiaries Screened in Year 1

Since the fall of 2019, Aurrera Health Group has been working closely with the Office of the California Surgeon General (CA-OSG) and the California Department of Health Care Services (DHCS) to launch the ACEs Aware initiative – a first-in-the-nation, statewide effort to promote screening for early detection of Adverse Childhood Experiences (ACEs) and mitigate against the health and societal impacts of ACEs and toxic stress. Specifically, California’s Surgeon General, Dr. Nadine Burke Harris, has established a goal of reducing ACEs by half within a generation.To achieve this ambitious goal, ACEs Aware is educating primary care providers on how potentially traumatic experiences that occur during childhood can play a role in their patients’ long-term physical and mental health. Screening for ACEs to provide early intervention and trauma-informed care is critical to improving the health of children and adults. To facilitate screening and treatment, ACEs Aware offers a free, online training for California providers, which is also available to anyone interested across the country.  California is the first state to provide a $29 supplemental payment to Medi-Cal providers for screening children and adult Medicaid beneficiaries for ACEs.Understanding the connection between patient experiences and health is even more critical today as we seek to reduce the cumulative stress families are experiencing due to the impacts of the COVID-19 pandemic.

ACEs & the Potential Impact on Health

ACEs are potentially traumatic events – abuse, neglect, or household challenges – experienced during childhood. According to the Centers for Disease Control and Prevention, the majority of adults in California and throughout the nation (62 percent) have at least one ACE, and 16 percent of people have four or more ACEs. ACEs cost California $112.5 billion annually in downstream health care costs.Continuous stress resulting from ACEs can impact brain development and biological systems, which can lead to current and long-term physical and mental health conditions – known as “toxic stress.” For example, researchers have found that when a child repeatedly goes into the “fight or flight” stress response, health conditions – such as asthma, heart disease, and substance use disorders – can be exacerbated.Research shows that ACEs and toxic stress are causally associated with an increased risk for many of the leading causes of death in the U.S. While the ACEs Aware initiative focuses on 10 categories of ACEs, there are other experiences – such as racism and discrimination – that are clearly contributing to toxic stress.However, it is important to note that toxic stress is treatable and preventable. We know that access to evidence-based “buffering” supports – like healthy relationships, exercise, high-quality sleep, and mindfulness – can prevent and/or alleviate the effects of toxic stress.This spring, Aurrera Health Group is in the process of launching a second round of ACEs Aware grants designed to support local communities across California in establishing or augmenting Trauma-Informed Networks of Care. In total, the ACEs Aware initiative has awarded $45 million in grants to 137 organizations. The goal of these grants is to ensure that health care providers have relationships with organizations in their communities that are ready and able to connect families to these important buffering supports, based on their ACE screening results.

ACEs Aware Progress to Date

Medi-Cal Claims for ACEs Screenings

Aurrera Health Group assists the state in tracking data on the number of providers who have completed the ACEs Aware training and the number of screening claims submitted.  On March 2, 2021, the ACEs Aware initiative released its second provider training data report and the first ACE screening claims data report.As noted above, the ACEs Aware training is free and publicly available to all interested parties. Since launching the initiative, more than 15,500 providers have taken the ACEs Aware training. Medi-Cal providers in California have conducted ACE screenings for more than 130,000 unique Medi-Cal beneficiaries. Of those beneficiaries screened, six percent had high-risk ACE scores (a score of four or more ACEs out of ten), indicating a high risk for toxic stress.Of note, after completing the training, 81 percent of participants indicated they plan to implement routine ACE screening in their practice. In addition, 97 percent indicated that they plan to implement additional practice changes reinforced by the training.

Next Steps

Given the ongoing obstacles caused by the COVID-19 pandemic – including stress brought on by a disruption to everyday routines and health care access – the ACEs Aware initiative’s work to increase understanding of ACEs and toxic stress is more relevant than ever before. ACEs Aware is supporting providers and patients to manage stress and secondary health impacts of COVID-19 with trauma-informed care resources and educational webinars.Aurrera Health Group looks forward to continuing to provide comprehensive support to the ACEs Aware initiative by expanding its efforts to educate and empower providers to screen, treat, and heal the impacts of ACEs and toxic stress. The newly released data reports offer an optimistic indicator that providers across California are getting trained, beginning to screen for ACEs and toxic stress, and putting trauma-informed principles and evidence-based interventions into practice. Check out our previous blogs on the ACEs Aware initiative and why we are proud to be doing this work. 

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Authors

Chelsea Ji [Senior Policy Consultant]

Alisa Chester [Director]