ACEs Resources for PRACTICE Teams

ACEs Literature

Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults- The Adverse Childhood Experiences (ACE) Study
The landmark ACE Study, supported by Kaiser Permanente and the Centers for Disease Control and Prevention (CDC), was led by Kaiser physician Dr. Vincent Felitti and CDC co-Principal Investigator Dr. Robert Anda from 1995 to 1997. Over 17,000 Kaiser Permanente patients completed confidential surveys regarding their childhood experiences before the age of 18 and their current health status and behaviors. The survey included 10 adverse childhood experiences including: physical, emotional, and sexual abuse, physical and emotional neglect, and household dysfunction such as living with a family or household member who has issues with mental illness, substance abuse, incarceration, domestic abuse toward their mother, or divorce of parents (Appendix A). Felitti et al. (1998) stated that almost two-thirds of study participants reported at least one ACE, and more than one in five reported three or more ACEs.

Vital Signs: Estimated Proportion of Adult Health Problems Attributable to Adverse Childhood Experiences and Implications for Prevention – 25 States, 2015–2017
In November 2019, a newer ACE study was published in the CDC’s Morbidity and Mortality Weekly Report. Merrick et al. (2019) used Behavioral Risk Factor Surveillance System (BRFSS) data collected from 25 states that included state-added adverse childhood experience items during 2015–2017. During the 2015–2017 data collection years, 27 states included state-added adverse childhood experience questions, in addition to the standardized set of BRFSS questions. Merrick et al. (2019) explains that: 11 These 11 state-added questions assess exposure to eight types of adverse childhood experiences: three types of abuse (physical, emotional, and sexual) and five types of household challenges (household member substance misuse, incarceration, mental illness, parental divorce, or witnessing intimate partner violence) before age 18 years.

Adult health burden and costs in California during 2013 associated with prior adverse childhood experiences
Miller et al. (2020) “analyzed five ACEs-linked conditions (asthma, arthritis, COPD, depression, and cardiovascular disease) and three health risk factors (lifetime smoking, heavy drinking, and obesity)” (p. 1). The authors “estimated ACEs-associated fractions of disease risk for people aged 18+ for these conditions by ACEs exposure using inputs from a companion study of California Behavioral Risk Factor Surveillance System data for 2008–2009, 2011, and 2013” (Miller et al., 2020, p. 1). From there, they “combined these estimates with 13 published estimates of personal healthcare spending and Disability Adjusted-Life-Years (DALYs) in the United States by condition during 2013” (Miller et al., 2020, p. 1). Miller et al. (2020) reported that 61% of adults in California reported ACEs. They explained that “those ACEs were associated with $10.5 billion in excess personal healthcare spending during 2013, and 434,000 DALYs valued at approximately $102 billion dollars”.

National Center for Injury Prevention and Control: Adverse Childhood Experiences Prevention Strategy (September 2020)
“This resource outlines CDC’s specific goals and objectives for ACEs prevention and response. The goals and objectives aim to prevent ACEs before they happen, identify those who have experienced ACEs, and respond using trauma-informed approaches in order to create the conditions for strong, thriving families and communities where all children and youth are free from harm and all people can achieve lifelong health and wellbeing” (CDC.gov.)

Videos

ACE Study: Brief Overview (8 minutes)
A brief overview of the ACE Study designed for policy makers, professional leaders, and the public to provide a brief introduction to the study, its major findings and the importance of adverse childhood experiences to health, healthcare and other societal costs.

Ted Talk: Nadine Burke Harris: How childhood trauma affects health across a lifetime (15 minutes)
Listen to pediatrician and California’s first Surgeon General Dr. Nadine Burke Harris 2015 Ted Talk about identifying and addressing ACEs and toxic stress.

Roadmaps & Guides

ACEs Aware Trauma Informed Network of Care Roadmap
Developed by the California Surgeon General’s Network of Care Subcommittee with input from the California Surgeon General’s Clinical Implementation Subcommittee and other stakeholders in collaboration with the Office of the California Surgeon General and the Department of Health Care Services. This Roadmap aims to provide practical steps that health care providers, clinics, community-based organizations, and social service agencies can take within their own communities to grow cross-sector Networks of Care that support providers, individuals, and families in preventing and addressing the impact of ACEs and toxic stress on health.

Becoming ACEs Aware in California Training
The Becoming ACEs Aware in California Training is a free, two-hour training to learn about Adverse Childhood Experiences (ACEs), toxic stress, screening, risk assessment, and evidence-based care to effectively intervene on toxic stress. 

The training is available to any provider, but it is particularly geared towards primary care clinicians who serve Medi-Cal (California’s Medicaid program) beneficiaries. 

Beginning July 1, 2020, Medi-Cal providers must attest to completing a certified core ACE training on the DHCS website to continue receiving payment for ACE screenings. 

Providers Eligible for Medi-Cal Payment
Qualifying ACE screenings are eligible for payment in any clinical setting in which billing occurs through Medi-Cal fee-for-service or to a network provider of a managed care plan. For services provided on or after January 1, 2020, the following enrolled Medi-Cal provider types are eligible to receive payment (Acesaware.org).

Clinical Resources

Attestation Form
This form is for providers to self-attest that they have completed a certified core ACEs Aware provider training. Beginning July 1, 2020, providers must attest to completing a certified core ACEs Aware provider training to continue receiving reimbursement for qualified ACEs screenings. DHCS will maintain a list of providers who have self-attested to their completion of the training and Medi-Cal Managed Care Plans will have access to the list (www.medi-cal.ca.gov).

Provider Directory
To navigate the map:

• Each dot represents an individual provider and their service location and includes their phone number, provider type, and specialty.
• Filter data by county, provider type, and provider specialty by selecting the data filter icon. Activate the filter by selecting the option button.
• The Filtered Point Count adds the total number of providers within your filter and map range. Please note, each provider may list of to six addresses. For this reason, the count function may include the same provider at multiple locations.

Pediatric ACEs and Related Life-events (PEARLS) Screener
Screening for ACEs helps primary care clinicians assess risk for toxic stress and guide effective responses. To receive Medi-Cal payment for conducting ACE screenings, clinical team members in California must use the following screening tools for children, adolescents, and adults.

The tools are available in 17 languages and in de-identified and identified formats so providers can choose the approach that works best for them and their patients.

Provider Toolkit
The ACEs Aware Provider Toolkit provides information on the ACEs Aware initiative, including how to screen for and respond to ACEs, and how Medi-Cal providers can get trained and receive payment for conducting ACE screenings.