Will screening for adverse childhood experiences (ACEs) in California be mandatory? No, but it’s recommended.
Will there be training for physicians and staff on how to screen? Yes.
Who will be reimbursed for screening patients in California? Physicians who serve patients in the state’s Medi-Cal program — for now.
For more answers to these and other questions that surfaced during a Dec. 4 webinar introducing Californians to a new statewide initiative, read on.
Come January 1, California will become one of the first states in the country to reimburse doctors to screen their patients for adverse childhood experiences. In preparation for this sea change, California’s Surgeon General, pediatrician Dr. Nadine Burke Harris, and the Department of Health Care Services Medical Director Dr. Karen Mark unveiled the state’s newly-launched ACEs Aware initiative, and laid the groundwork for why this new recommendation is a call to action.
For each child and adult in the state’s Medi-Cal program who are screened for ACEs, physicians will be eligible for a $29 supplemental payment. (For information on training and screening tools, visit the ACEs Aware initiative website.)
And why would doctors want to screen their patients for trauma? Burke Harris, a trailblazer promoting universal ACEs screening for children, referred to the study and data that had upended her own approach to patient care, which she chronicled in her book The Deepest Well and her Ted Talk on ACEs.
“Here in California 62.7 percent of Californians have at least one ACE,” she said. ACEs refers to adverse childhood experiences, a term that came from the landmark 1998 CDC/Kaiser Permanente ACE Study, which tied 10 types of childhood adversity — such as physical, emotional or sexual abuse or living with a parent who abuses alcohol or is diagnosed with depression or other mental illness — to an increase in chronic disease, mental illness, violence and being a victim of violence in more than 17,000 adults. Based on a subsequent statewide study, 17.6 percent of Californians, she explained, have an ACE score of 4 or more. Most US states have done their own ACE surveys, and the data are comparable across the country.
Burke Harris pointed to data that show the link between ACE scores and health risks, noting dramatic increases in risk among those with ACE scores of 4 or more in nine out of the 10 leading causes of death. An ACE score of 4 or more, she explained, doubles the risk of heart disease, more than doubles the risk of cancer, and the risk of chronic respiratory disease.
But, counseled Burke Harris, those health risks need not be destiny. With early detection through ACEs screening and interventions, she explained, they can be reduced or prevented. The culprit, according to research, explained Burke Harris, is toxic stress: “The science shows us that the mechanism by which early adversity leads to health, mental health, and social outcomes has to do with the toxic stress response,” the result of repeated activation of the “fight, flight and freeze” response.
In response to a question asking if private insurance will be required to reimburse for ACEs screening in the future, Burke Harris said, “Recognizing that this is a pretty groundbreaking initiative, we wanted to start by offering an incentive payment for providers in the Medicaid population. But we recognize that this is only a first step. Ultimately, we want ACE screening to be the standard of care for everyone.”