September 23, 2022
California’s growth in childhood injury screening is being hailed as a model for other states, according to a summary recently published in the Journal of the American Board of Family Medicine.
The in short-authored by researchers from UC Davis Health and other institutions of the University of California-says that the presentation has the opportunity to show the current prevalence of ACEs in children and how they affect health outcomes for adults.
Adverse childhood experiences (ACEs) are traumatic events that occur before adulthood including various forms of abuse, neglect, parental divorce, separation or death, family violence and family member mental illness. ACEs and toxic stress are responsible for some of the most harmful, persistent and costly social and health problems facing the world. Research has found that people who experience childhood adversity are more likely to develop chronic diseases and live shorter lives.
With 62% of California adults experiencing one ACE and 16% experiencing four or more, California is taking strong action to combat ACEs and toxic stress. ACEs Knowthe first national initiative to establish a routine assessment in primary care and to establish a care partnership.
In October 2021, California enacted the ACEs Equity Act. The law expanded ACE’s scrutiny by mandating that it carry commercial insurance. Screening for Medi-Cal patients has been mandatory since early 2020.
A UC research team analyzed the results, benefits and risks of a national screening for ACEs among children and adults. They emphasized several principles of plasticity:
Monitoring and equality of health: In order for the evaluation to have equal health benefits in all communities, access to interventions is necessary for each patient who will benefit most from the ACE questionnaire. Otherwise, evaluation can be a well-intentioned intervention that does not provide the services and services intended.
To measure all ACEs equally: There is no current evidence to prove that each ACE has the same effect on the health of each person. Although overall, high ACE levels are associated with a higher risk of adverse health outcomes, additional research is needed at the individual level. A person may do well on the ACE test but there is little evidence that the person will go on to have a particular problem.
Cost: Using statistics from Medi-Cal enrollees, the authors estimate a $29 return on ACEs when evaluating plans and marketing strategies, translating to a 0.03% increase in total costs.
Possible risks: There is a need to better train providers in monitoring and discussion of diagnoses, and to have adequate resources to refer patients to follow-up care.
The researchers also stated that awareness of the benefits and potential risks is important to understand how health systems can use ACE screening as a tool to provide risk-informed care to meet the needs of patients.
Receive ACE Aware Training Today (Free!)
The California Medical Association (CMA) encourages all physicians, especially Medi-Cal providers, to receive a free two-hour lesson to learn how screening, risk assessment and evidence-based care can best support toxic stress.
By monitoring ACEs, providers can better determine whether a patient is at risk of health complications due to toxic stress, an important part of the response and risk-informed care which connects patients with a support network to reduce ACE complications.
Doctors can receive 2.0 Continuing Medical Education (CME) and 2.0 Maintenance of Certification (MOC) upon completion – and can accept ACE reimbursement for Medi-Cal beneficiaries.