Adverse Childhood Experiences (ACEs)

Adverse Childhood Experiences (ACEs) and toxic stress are public health crises. ACEs are stressful or traumatic events experienced by age 18, identified in the landmark Centers for Disease Control and Prevention (CDC) and Kaiser Permanente (KP) Adverse Childhood Experiences Study, to be strongly associated with increased health and social risks. Early detection and early intervention can help prevent or reduce the health risks associated with ACEs.

Integration of ACEs screening and trauma-informed care (TIC) can improve the overall health of your patients. The We Are Not Our Numbers: Understanding Adverse Childhood Experiences initiative includes a wide range of activities for family physicians and their practice teams. 


We’re adding the very latest updates - stay tuned for the monograph!

This case-based monograph, addresses the burden of ACEs, screening, special populations, integrating ACEs scores into treatment, trauma informed care, team and practice approaches and more. The monograph writing team, led by CAFP Editor Brent Sugimoto, MD, MPH, includes family medicine residents from three programs, who offer evidence- and case-based learning. The monograph is sponsored for 4 AAFP Prescribed credits, 4 AMA PRA Category 1TM credits and 4 California Bureau of Registered Nursing credits.

TEDTalk: Nadine Burke Harris, "How childhood trauma affects health across a lifetime"

Childhood trauma isn’t something you just get over as you grow up. Pediatrician Nadine Burke Harris explains that the repeated stress of abuse, neglect and parents struggling with mental health or substance abuse issues has real, tangible effects on the development of the brain. This unfolds across a lifetime, to the point where those who’ve experienced high levels of trauma are at triple the risk for heart disease and lung cancer. An impassioned plea for pediatric medicine to confront the prevention and treatment of trauma, head-on.

Watch Here

Community Conversation: ACEs with Adia Scrubb, MD (Susan Hogeland, CAE Health Policy Fellow)

Watch the Community Conversation: ACEs with Adia Scrubb, MD, MPP, PGY3 - inaugural Susan Hogeland, CAE Health Policy Fellow (recorded on April 26, 2020)

Watch Here

Coming Soon: ACEs on Homeroom

In addition to the PDF monograph, we are pleased to offer the The We Are Not Our Numbers: Understanding Adverse Childhood Experiences cases on the CAFP’s Homeroom platform. Learners can read one chapter at a time, complete cases, and earn 4 AAFP Prescribed credits, 4 AMA PRA Category 1TM credits and 4 California Bureau of Registered Nursing credits.


Medi-Cal Payment

A key part of the work of Surgeon General Burke-Harris is the ACEs Aware initiative. Beginning January 1, 2020, DHCS will provide a $29/patient payment to Medi-Cal providers for screening their patients for ACEs. Eligible Medi-Cal providers who screen Medi-Cal patients for ACEs can receive payment as of January 1, 2020. Beginning on July 1, 2020, Medi-Cal providers must have taken a certified Core Training and self-attested to completing the training to continue to receive Medi-Cal payment for ACE screenings.  The CAFP’s monograph and Homeroom module are both certified Core Training activities. 

Billing and coding are based upon the beneficiary’s total ACE score. The ACE score refers to the total reported exposure to the ten ACE categories indicated in the adult ACE assessment tool or the first box of the PEARLS tool. ACE scores range from 0 to 10.

To bill Medi-Cal, providers should use the Healthcare Common Procedure Coding System (HCPCS) billing codes based upon the results of the screening.

  • HCPCS code G9919 is used for screens that have a score of 4 or greater (high risk)
  • HCPCS code G9920 is used for screens that have a score of 0 to 3 (lower risk)

Billing requires that the completed screen was reviewed, the appropriate tool was used, results were documented and interpreted, results were discussed with the beneficiary and/or family, and any clinically appropriate actions were documented. This documentation should remain in the beneficiary’s medical record and be available upon request.

For more information on payment please go to:  https://www.acesaware.org/about-aces-aware/faq/

To receive Medi-Cal patient screening payment you must attest to completing an educational training module:  https://www.medi-cal.ca.gov/TSTA/TSTAattest.aspx

COVID-19 Stress Management

All of us are experiencing some level of anxiety during this time of uncertainty.  Buffering you and your patients from this anxiety may help prevent a toxic stress response.  Resources for COVID-19 stress management: https://www.acesaware.org/heal/covid19/.  For the latest information on COVID-19 in California, visist:  COVID19.ca.gov, check with your local department of public health or go to https://www.cdc.gov/coronavirus/2019-ncov/hcp/index.html

Tools and Resources

We have included five screening tools for you to use as you integrate screening into your practice. The screening tools on this page are all de-identified. For identified tools, please go to the links below. Rather than replicate work effectively vetted and curated by the Office of the Surgeon General, we encourage you and your practice team to follow this link to find additional tools, resources videos, coding-billing information and more.

Screening Tools: 

Clinical Assessment and Treatment Planning:

ACEs Resources: 

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