Research supports expansion of insurance-covered trauma screening nationwide

September 23, 2022

California’s expansion of screening for childhood trauma is being hailed as a model for other states, according to a brief recently published in the Journal of the American Board of Family Medicine.

The brief—written by researchers from UC Davis Health and other University of California institutions—say the screenings have the potential to demonstrate the current prevalence of Adverse Childhood Experiences (ACEs) and how they affect health outcomes for adults.

Adverse childhood experiences (ACEs) are a set of potentially traumatic events that occur before adulthood including various forms of abuse, neglect, parental divorce, separation or death, domestic violence and the psychiatric illness of a family member. ACEs and toxic stress are a root cause of some of the most harmful, persistent and expensive societal and health challenges facing the world today. Research has found that people exposed to adverse childhood experiences are more likely to suffer from chronic diseases and have a shorter lifespan.

With 62% of California adults having experienced at least one ACE and 16% having experienced four or more, California is taking aggressive steps to address ACEs and toxic stress through ACEs Aware, the first-in-the-nation initiative to establish routine screening in primary care and develop a network of care.

In October of 2021, California enacted the ACEs Equity Act. The law expanded ACEs screening by mandating it be covered by commercial insurance. Screening for Medi-Cal patients has been required since early 2020.

The UC research team analyzed impacts, benefits and risks of universal screening for ACEs among children and adults. They highlighted several policy considerations:

Screening and health equity: For screening to have equitable health benefits across communities, access to effective interventions is necessary for any patient that may score highly on the ACEs questionnaire. Otherwise, screening may become a well-intentioned intervention that does not actually provide the support and services as intended.

Weighing all ACEs equally: There is no current evidence that supports that each ACE has the same impact on any given individual’s health outcome. While overall, high ACE scores correlate to a higher risk for negative health outcomes, additional research is needed at the individual level. An individual may score highly on an ACE screening but there is still little evidence to support that the individual will go on to have a specific negative health outcome.

Cost: Using estimates from Medi-Cal enrollees, the authors estimate a $29 reimbursement per ACEs screening for commercial plans and policies, translating to a 0.03% increase in overall costs.

Potential harms: There is a need to properly train providers on administering and discussing screening, while also having the adequate resources available to refer patients for follow-up care.

The researchers also said that awareness of the potential benefits and drawbacks is key to recognizing how health systems can use ACEs screenings as a tool to provide trauma-informed care delivery to better meet patients’ needs.

Receive ACEs Aware Training Today (Free!)

The California Medical Association (CMA)  encourages all physicians, particularly Medi-Cal providers, to receive the free, two-hour training to learn how screening, risk assessment and evidence-based care can effectively intervene on toxic stress. 

By screening for ACEs, providers can better determine the likelihood a patient is at increased health risk due to a toxic stress response, a critical step in responding with trauma-informed care that connects patients with a supportive network of care to mitigate the impact of ACEs.

Physicians may receive 2.0 Continuing Medical Education (CME) and 2.0 Maintenance of Certification (MOC) credits upon completion - and can receive reimbursement for providing ACEs screening to Medi-Cal beneficiaries.


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