Research indicates that Native American people experience more Adverse Childhood Experiences (ACEs) than other populations in the United States (2019 CDC Morbidity and Mortality Report; Am J Prev Med. 2021 Feb; Richards et al 2021). Studies highlight historical traumas as a consideration for how ACEs manifest in modern day indigenous communities, leading to higher rates of health disparities in suicide, alcoholism, and diabetes, among other conditions.

“As far as social indicators and statistics, we do struggle,” says Kishan Lara-Cooper, a professor at Cal Poly Humboldt. “But those struggles do not define us. They don’t define us as indigenous peoples, and they’re not our identity.”

With ACEs Aware grant funding, Dr. Lara-Cooper and the Humboldt County Department of Health and Human Services created a training called Ka’m-t’em: The Impact of ACEs and Toxic Stress on Indigenous Communities. The training describes how providing “trauma-informed care for communities of California must include an understanding of their histories and how these experiences relate to intergenerational transmission of adversity and protective factors from an Indigenous perspective.” The seven training modules contain information about indigenous tribes in California, protective factors and activities to interrupt the toxic stress response and support healing, and testimonials from people from indigenous communities.

In addition to the Ka’m-tem training (which is free and available on demand), past ACEs Aware grantees have examined the impact of ACEs on indigenous communities and published practice papers, such as “Strengths and Barriers in Implementing the ACE Screening Tool in Tribal, Urban Indian, and Rural Settings” and “Trauma and Resilience in Native Communities”. These resources help bring into focus the strength and resilience of indigenous culture and communities to address health inequities and to heal from trauma.

New and Noteworthy

Latest Data on ACE Screening and Training Released

The ACEs Aware initiative has released a new quarterly data report detailing the number of ACE screenings conducted for children and adults in California and the number of individuals who have completed the Becoming ACEs Aware in California training.

• Between January 1, 2020, and December 31, 2021, Medi-Cal clinicians conducted more than 1,153,000 ACE screenings of 899,000 unique Medi-Cal beneficiaries.
• Between December 4, 2019, and August 31, 2022, more than 26,900 individuals completed the training, including approximately 12,100 Medi-Cal clinicians in California who are ACEs Aware-certified and are eligible to receive Medi-Cal payment for conducting ACE screenings.

PRACTICE Learning Collaborative Launched

On October 13, 25 grantee partnership teams participated in a kickoff meeting for the PRACTICE: Preventing and Responding to Adverse Childhood Experiences (ACE)-Associated Health Conditions and Toxic Stress in Clinics through Community Engagement learning collaborative. Speakers included California Surgeon General Diana Ramos and California Department of Health Care Services Medical Director Karen Mark. Grantee teams consists of a clinic, community-based organization, and Medi-Cal managed care plan that work together to build workforce capacity and sustainability for ACE screening and response in their local communities.

The ACE Screening Implementation How-To Guide

Events, Resources, and Research

EVENTS

ACEs Aware Trauma-Informed Primary Care (TIPC) Implementation Advisory Committee – Quarterly Meeting

Wednesday, November 16 | 10 am-12 pm PST | UCAAN

(rescheduled from October 19)

The quarterly TIPC Implementation Advisory Committee meeting will be held on November 16, 2022, from 10 a.m. to 12 p.m. PT. Members of the committee advise on promising models, best practices, evolving science, and clinical expertise for the implementation of trauma-informed care systems in California. This meeting is open to the public; registration is required.

Register →

RESOURCES

Ka’m-t’em: The Impact of ACEs and Toxic Stress on Indigenous Communities

Humboldt County Department of Health

An ACEs Aware grantee, the Humboldt County Department of Health and Human Services developed an online supplemental training called Ka’m-t’em: The Impact of ACEs and Toxic Stress on Indigenous Communities.

This training focuses on the impact of ACEs and toxic stress on Indigenous communities, including how providing trauma-informed care for Indigenous communities must include an understanding of their histories and how these experiences contribute to intergenerational transmission of toxic stress, and protective factors from an Indigenous perspective.

Access →

Trauma and Resilience in Native Communities: California Tribal Health Professionals Reflections on Trauma, Resilience, Screening, and Trauma-Informed Care

This practice paper by Cardea and Allyson Kelley & Associates PLLC, and funded by an ACEs Aware grant, identifies the needs and experiences of trauma and resilience specific to Native communities in California. This paper explores how screening tools and trauma-informed care responses could be more responsive to Indigenous experiences and communities.

Access →

Strengths and Barriers in Implementing the ACE Screening Tool in Tribal, Urban Indian, and Rural Settings

This practice paper by Garrow Consulting, LLC and Center for Healthy Children and Communities, Inc., and funded by an ACEs Aware grant, reports on 12 key informant interviews that the authors conducted via telephone with Tribal, urban Indian, and rural organizations in California. Key informants included clinic directors with decision-making power, providers, and community health workers interacting directly with American Indian/Alaska Native (AIAN) patients and rural community members.

Access →

National Native Children's Trauma Center (NNTC)

NNCTC

A set of resources on trauma and resilience, including an AI/AN primer on ACEs, webinars, and more.

Access →

Indian Health Service on ACEs

ihs.gov

The Indian Health Service (ihs.gov) is an agency within the U.S. Department of Health and Human services that provides federal health services to the AI/AN population.

Access →

Tribal Epidemiology Centers

TEC

There are 12 nationally recognized Tribal Epidemiology Centers. Click on the map to find one that serves your community.

Access →

Case Study: Learning from Alaska's ACE Story

Centers for Disease Control and Prevention

This Centers for Disease Control and Prevention (CDC) case study highlights how Alaska used the Behavioral Risk Factor Surveillance System to determine the prevalence of ACEs in their state, developing a response utilizing guidance from the native community. The full report is also available.

Access →

Injury Prevention in American Indian and Alaska Native Communities

Centers for Disease Control and Prevention

Native communities worked with the CDC to identify injury prevention resources and improve overall health and wellness.

Access →

RESEARCH

Adverse Childhood Experiences and Resilience in Native American Families and Communities

November 2021 | North Carolina Medical Journal

Read →

Adverse Childhood Events in American Indian/Alaska Native Populations

February 2021 | National Library of Medicine

Read →

Examining Adverse Childhood Experiences among Native American Persons in a Nationally Representative Sample: Differences among Racial/Ethnic Groups and Race/Ethnicity-sex Dyads

January 2021 | Child Abuse and Neglect

Read →

ACEs and counter-ACEs: How Positive and Negative Childhood Experiences Influence Adult Health

October 2019 | Child Abuse and Neglect

Read →

Adverse Childhood Experiences (ACE) among American Indians in South Dakota and Associations with Mental Health Conditions, Alcohol Use, and Smoking

November 2017 | Journal of Health Care for the Poor and Underserved

Read →

Adverse Childhood Experiences among American Indian/Alaska Native Children: The 2011-2012 National Survey of Children's Health

July 2016 | National Library of Medicine

Read →

ACEs Aware advocates for primary care clinic health care teams to complete the Becoming ACEs Aware in California training to learn about ACE screening and trauma-informed care, so they can provide compassionate and healing-centered education and support to patients.

Take the Becoming ACEs Aware in California training today to get started.

Already completed the training?

Providers with National Provider Identifiers should attest on the DHCS website

so they can become eligible for Medi-Cal reimbursement for screening.

“Humankind has not woven the web of life. We are but one thread within it. Whatever we do to the web, we do to ourselves. All things are bound together. All things connect.”

– Chief Seattle

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