By Emily Underwood, Science, January 29, 2020
On 1 January, California became the first U.S. state to screen for adverse childhood experiences (ACEs)—early life hardships such as abuse, neglect, and poverty, which can have devastating health consequences in later life. The project is not just a public health initiative, but a vast experiment. State officials aim to cut the health impacts of early life adversity by as much as half within a generation. But critics say the health benefits of screening are unproven, and it could create demand for services the state cannot provide.
The $160 million initiative applies to 7 million children on Medi-Cal, California’s insurance for low-income people. Health care providers who complete 2 hours of online training are encouraged to screen children up to age 18 for ACEs. The questionnaire, filled out by children’s caregivers or teenagers themselves, includes 10 categories of ACEs, such as domestic violence, neglect, and substance abuse, with questions such as “Has your child ever seen or heard a parent/caregiver being screamed at, sworn at, insulted or humiliated by another adult?” and “Have you ever felt unsupported, unloved and/or unprotected?”
If a child has a worrying score, the provider is instructed to give information about helpful resources such as food stamps or housing assistance, discuss how trauma and stress affect the developing body and brain, and, if necessary, make referrals to specialists, such as psychologists.