California Surgeon General Nadine Burke Harris, M.D., and Karen Mark, M.D., Medical Director at the state Department of Health Care Services (DHCS), recently unveiled an initiative to address the public health crisis of toxic stress from childhood trauma. Called the ACEs Aware initiative, it is a first-of-its-kind statewide effort for California health care providers to screen patients for Adverse Childhood Experiences (ACEs) that increase the likelihood of ACE-associated health conditions due to toxic stress.

Detecting ACEs early and connecting patients to interventions, resources and other support can significantly improve the health and well-being of individuals and families.

California is offering provider training to screen pediatric and adult patients for 10 categories of ACEs, which include abuse, neglect and household dysfunction. The two-hour online curriculum will be easy to access for a wide range of health care professionals and will provide continuing medical education (CME) and maintenance of certification (MOC) credits. Beginning January 1, 2020, Medi-Cal physicians can be paid for ACEs screenings for Medi-Cal patients.

ACEs are stressful or traumatic events experienced by age 18. A consensus of scientific research demonstrates that cumulative adversity, especially when experienced during critical periods of early development, is a root cause to some of the most harmful, persistent, and expensive health challenges facing our state and nation.

Last month, the U.S. Centers for Disease Control and Prevention issued a special report on Adverse Childhood Experiences and suggested that prevention of ACEs may lead to reduction in a large number of health conditions including heart disease, stroke, cancer and diabetes, as well as depression, unemployment, and substance dependence.

“The ACEs Aware initiative is harnessing and building upon the momentum and expertise that has been growing in the scientific community for more than a decade now. We have set a bold goal to cut ACEs in half in a generation and this initiative represents an historic step in tackling one of the greatest public health threats of our time,” said Dr. Burke Harris, California’s first Surgeon General.

According to the most recent California Department of Public Health data reporting from the Behavioral Risk Factor Surveillance System (BRFSS, 2017), 63.5 percent of Californians have experienced at least one of the ACEs and 17.6 percent of Californians have experienced four or more. Nationally, the prevalence rate is similar.

Additionally, research shows that individuals who experienced ACEs are at greater risk of numerous ACE-Associated Health Conditions, including nine of the 10 leading causes of death in the United States, and that early detection, early intervention and trauma-informed care can improve outcomes.

“I am proud that California is leading the way on this important work,” said Dr. Mark. “Identifying a history of trauma in children and adults and providing treatment can lower long- term health costs and support individual and family wellness and healing.”

All providers are encouraged to receive training on how to screen patients for ACEs and respond with trauma-informed care. By screening for ACEs, providers can better determine the likelihood a patient is at increased health risk due to a toxic stress response, which can inform patient treatment. Trauma-informed care recognizes and responds to the signs, symptoms and risks of trauma to better support the health needs of patients who have experienced ACEs and toxic stress.

Funding for the ACEs Aware initiative comes from the Proposition 56 tobacco tax and is part of Gov. Gavin Newsom’s “California for All" initiative, which aims to improve health and bolster early interventions for the state’s youngest Californians. In the 2019-20 budget, Gov. Newsom provided $40.8 million to DHCS for ACEs screenings for children and adults enrolled in Medi-Cal, California’s Medicaid program.

Additional details about the ACEs Aware initiative are available at ACEsAware.org.