California initiative to combat toxic stress makes significant strides in first four years, study shows

Since the ACEs Aware initiative was launched in 2019, more than 2.3 million ACE screens have been conducted of more than 1.5 million Medi-Cal members, according to a report released May 10 by the UCLA-UCSF ACEs Aware Family Resilience Network (UCAAN) and the California Department of Health Care Services (DHCS).

Adverse childhood experiences (ACEs) include experiencing or witnessing violence, abuse or neglect; growing up in a home environment with substance abuse or mental health problems; or experiencing family or parental separation.

“In California, more than 70 percent of adults and 30 percent of children have faced at least one ACE, such as having a caregiver with mental health challenges or witnessing domestic violence. The science now reveals that the toxic stress response is a key biological factor causing ACEs to lead to long-term health issues affecting individuals and communities statewide,” wrote California Surgeon General Diana Ramos. “Consider this: an individual with four or more ACEs faces a 70 percent higher risk of kidney disease, more than double the risk of heart disease, and triple the risk of chronic lung disease. Additionally, they are 4.7 times more likely to experience depression and 10.2 times more likely to face substance use disorders, with ACEs increasing the risk of homelessness by two to four times.

“The good news is that ACEs are not predetermined,” she continued. “Research indicates that early detection and evidence-based interventions can significantly reduce negative outcomes.”

Key findings from the report show positive impacts from scaled up ACE screening and response, improved benefits to patients and more. Among the findings:

  • More than 35,000 individuals have completed the Becoming ACEs Aware in California core training, with nearly half being providers who are now certified to receive a $29 reimbursement from Medi-Cal for each eligible ACE screen they conduct.
  • $65 million has been invested in clinics and communities across the state to support local and regional approaches to preventing, identifying and responding to ACEs and toxic stress.
  • Evaluations by RAND indicate that ACE screening has a positive impact on providers, their clinics and their patients, including no adverse effects on patients having been reported in the six weeks following screening, clinics becoming trauma informed and providers being more likely to make referrals when ACEs were present.
  • Early findings in Los Angeles County suggest that ACE screening and response initiatives are advancing DHCS’ statewide goals to improve quality of care and reduce health disparities for the most vulnerable Californians.

“Identifying ACEs and toxic stress in children and adults can have long-lasting effects on health and health care,” the DHCS stated. “Early identification coupled with targeted support and intervention can improve quality of care, reduce health system costs, and improve health and well-being for California’s 15 million Medi-Cal members.”