RAND Publishes Findings on Promising Practices for Implementation and Sustainability of Key CalAIM Services | | |
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RAND has published a new report and research brief that unveils promising practices for implementing California Advancing and Innovating Medi-Cal (CalAIM) services that are key to efforts to prevent and respond to Adverse Childhood Experiences (ACEs) and toxic stress. The report focuses on four CalAIM services and benefits: adult and pediatric Enhanced Care Management (ECM), community health worker (CHW) benefits, and dyadic services.
The report findings emerge from the ACEs Aware PRACTICE Collaborative, which included 25 teams comprised of primary care clinics, community-based organizations, and Medi-Cal managed care plans across 15 California counties that received grant funding to leverage CalAIM benefits and services to prevent, identify, and respond to ACEs and toxic stress.
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Key Takeaways:
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Effective Referrals: In-house referrals, built upon trusted relationships with primary care providers and clinic staff, were the most effective approach for referring patients to CalAIM services.
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Trauma-Informed Approaches: Co-locating providers, maintaining open door policies, utilizing bilingual staff, offering phone interactions, and normalizing service use to reduce stigma were other foundational, trauma-informed strategies that facilitated successful referrals to CalAIM services.
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Patient Impact: Patients and families valued the CalAIM services and felt supported, empowered, and hopeful after using them.
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Clinician Impact: Successful referrals to CalAIM services reduced clinician stress and helped them provide better, more focused, care.
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Robust Staff Training: Combining coursework with on-the-job training was crucial for service delivery.
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Integration Success: Referrals and services worked best when integrated into clinics’ electronic health records, workflows, and existing referral systems.
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New Study Finds that Clinicians are More Likely to Take Action as Number of ACEs Increases | |
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The fourth and final study from the California ACEs Learning and Quality Improvement Collaborative (CALQIC) was recently published, finding that clinicians were twice as likely to document taking an action after an ACE screening in which ACEs were present. The study found that as the number of ACEs increased, clinicians’ likelihood of acting also increased, and the types of actions they took changed as the number of ACEs increased, with increased referrals to mental health, social work, and community-based resources.
This study adds to findings from three previous CALQIC evaluations, which found:
- Clinicians, clinical staff, pediatric patients, and caregivers perceived ACE screening to be feasible, acceptable, and beneficial, and that no adverse effects on patients were reported in the six weeks following screening.
- A trauma-informed environment of care is a crucial foundation for ACE screening.
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The objective of this latest study, Clinician Actions in Response to Adverse Childhood Experience (ACE) Screening (Preventive Medicine Reports, November 2024), was to improve understanding of how clinicians respond to ACE screenings, for which there is little published data. Clinicians from five California pediatric clinics that serve Medi-Cal members participated, conducting a total of 2,652 ACE screens over a six-month period.
CALQIC was launched in 2020 to identify promising practices, tools, resources, and partnerships to inform the ACEs Aware initiative as it scaled across California. ACE screening and response was piloted in 48 clinic sites across seven California regions that collectively serve nearly 250,000 patients covered by Medi-Cal.
Read the previously published CALQIC studies:
ACEs Aware continues to produce a variety of free resources, including how-to guides and online trainings, to assist health care teams in implementing ACE screening initiatives and addressing common challenges. Visit the ACEs Aware Learning Center at training.acesaware.org to learn more.
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CDC Study Examines ACEs, Health Conditions, and Risk Behaviors Among High School Students | |
A new report from the Centers for Disease Control and Prevention (CDC) suggests that ACEs are common in U.S. high school students and have significant associations with negative health conditions and risk behaviors. | | |
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The authors suggest that preventing ACEs has considerable potential public health impacts in adolescence and beyond and might translate into sizable reductions in suicidal behaviors, substance use, sexual risk behaviors, violence, and persistent feelings of sadness and hopelessness when these children reach adolescence.
Adverse Childhood Experiences and Health Conditions and Risk Behaviors Among High School Students — Youth Risk Behavior Survey, United States, 2023 presents the first lifetime national prevalence of self-reported individual and cumulative ACEs among U.S. high school students under 18 years of age, associations between cumulative ACE exposure and negative health conditions and risk behaviors in adolescence, and population-attributable fractions related to ACEs for each condition and behavior.
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Findings include:
- Students with four or more ACEs had significantly increased prevalence ratios for 15 of 16 measured negative health conditions and risk behaviors compared with students with zero ACEs, demonstrating the marked association between cumulative ACEs and negative outcomes.
- The strongest associations were observed between experiencing four or more ACEs and attempted suicide (OR = 12.42), seriously considered attempting suicide (OR = 9.15), and current prescription opioid misuse (OR = 8.95).
- As the number of ACEs increased for most conditions and behaviors, adjusted prevalence ratios between cumulative ACEs count and health condition or risk behavior increased in magnitude, indicative of a dose-response relationship.
- Three in four students (76.1%) experienced at least one ACE. Nearly one in five (18.5%) experienced four or more ACEs.
- The most common ACEs were emotional abuse (61.5%), physical abuse (31.8%), and household poor mental health (28.4%).
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News, Events, Resources, and Research | | |
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Kindergarten Readiness Not Impacted by High Number of Adverse Childhood Experiences
September 2024 | K12 Dive
Researchers find that while academic preparedness is not correlated with severe adversity, disruptive and internalizing behaviors are.
Access→
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Upcoming ACEs Aware Webinars
November 7, 12 – 1 pm
Community Spotlight: ACE Screening in a Bilingual Community Mental Health Program
Jose Cardenas, PsyD
Register →
November 14, 12:30 – 1:30 pm
Science and Innovation Speaker Series: When ACEs Present to a Statewide Child Psychiatry Access Program
Rebecca Ferro, MA
Register →
November 21, 12 – 1 pm
Clinical Pilots Series: Diabetes Management and Mitigating Toxic Stress in a Family Medicine Clinic
Monica Hau Le, MD, MPH
John Cheng, MD
Registration coming soon (Subscribe to the series for registration updates)
December 5, 12 – 1 pm
Implementation with Intention: Enhanced Care Management (ECM) for Children and Youth
Ralph Silber
Register →
December 12, 12:30 – 1:30 pm
Science and Innovation Speaker Series: ACE Screening of Adolescents – Psychological Flexibility as a Moderator
Cody Hostutler, PhD
Register →
ACEs Aware Webinars on Demand
We provide continuing education credit for our live webinars as well as for the on-demand versions that are posted a few weeks after the live sessions.
Visit the ACEs Aware Learning Center to access past webinar trainings.
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National Center for PTSD: PTSD and Physical Health
US Department of Veterans Affairs
This page provides information on the relationships between trauma, post-traumatic stress disorder (PTSD), and physical health; specific health problems associated with PTSD; health-risk behaviors and PTSD; mechanisms that help explain how PTSD and physical health could be related; and a clinical agenda to address PTSD and health.
Access →
Daylight Saving Time 2024: What to Know about the Time Change and Tips to Protect Your Health
Today
Daylight saving time ended November 3, 2024. Quality sleep is one evidence-based strategy to mitigate the effects of stress and toxic stress, so it’s important to know how to minimize the impact of the change to your sleep schedule. Here's what to know.
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School-Based Health Alliance Resource Hub
SBHA
From videos to fact sheets and groundbreaking research, this resource hub has information for anyone seeking to learn more about school-based health care.
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The California Child and Adolescent Mental Health Access Portal
Cal-MAP
Cal-MAP is a CalHOPE pediatric mental health care access program designed to increase timely access to mental health care for youth throughout California's communities, especially in the state’s most underserved and rural areas. Cal-MAP’s team of psychiatrists, psychologists, and social workers provide no-cost consultation, education, and resource navigation to California primary care providers caring for mental and behavioral health concerns in youth 0-25.
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Adverse Childhood Experiences Report
National Indian Health Board
A resource guide centered on addressing ACEs in Tribal communities as well as healing and resilience.
Access →
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The Effects of Childhood Adversity on Twenty-Five Disease Biomarkers and Twenty Health Conditions in Adulthood: Differences by Sex and Stressor Type
January 2025 | Brain, Behavior, and Immunity
Childhood trauma can raise the risk of developing major diseases later in life that vary based on a person's unique experiences and even their sex.
Read→
Promising Practices for Integrating Positive Youth Development in the Workplace
August 2024 | Child Trends
A series of three case studies that aim to provide an understanding of specific supervision, professional development, and worker voice practices that align with positive youth development practices.
Read→
Bullying Experiences in Childhood and Health Outcomes in Adulthood
July 2024 | PLoS One
Examines whether the experience of being bullied at school has a long-term impact on three health outcomes in adulthood: subjective health, mental health, and activity restriction due to health conditions.
Read→
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Become ACEs Aware Today
Becoming ACEs Aware in California is a free, two-hour online training for clinics to become trauma-informed and launch an ACE screening initiative.
Completion of the training is required for eligible Medi-Cal providers to be reimbursed for conducting ACE screenings. Ready to help improve health for all and promote health equity through screening for and responding to ACEs and toxic stress? Visit the ACEs Aware Learning Center to take the training today.
This activity is approved for AMA PRA Category 1 Credit™ and other continuing education credit.
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