Adverse Childhood Experiences (ACEs) are potentially traumatic events that occur before age 18. These experiences can lead to long-term behavioral and social challenges. People with higher ACE scores are at greater risk for chronic disease, mental health conditions, and toxic stress.
ACEs can impact people across the lifespan.
- Children and adolescents (primary focus for screening)
- Adults with a history of ACEs
- Families and caregivers impacted by trauma
ACEs in California:
- 3 in 5 adults report at least one ACE
- 1 in 6 adults report four or more ACEs
*Source: Office of the California Surgeon General
Where do ACEs occur?
ACEs can occur across multiple settings, including:
- Home environments
- Schools
- Community and social systems
Who should be involved?
A team-based approach is essential, and should include:
- Primary care / pediatric providers
- Behavioral health providers
- Caregivers (especially for younger children)
What should providers do?
- Screen for ACEs using DHCS-approved tools when clinically appropriate.
- Follow screening guidance:
- Children and adolescents (under 21): Screen once per year, per provider
- Adults (21 to 65 years of age): Screen once per lifetime, per provider
- Understand Medi-Cal reimbursement:
- Providers may receive $29 per qualifying ACE screening
- Use a trauma-informed care approach that:
- Is patient-centered
- Builds trust
- Avoids re-traumatization
Approved Screening Tools
- ACEs Questionnaire
- PEARLS (Pediatric ACEs and Related Life Events Screener)
- CANS (Child and Adolescent Needs and Strengths-Trauma Module)
- IP-CANS (California Integrated Practice CANS) and guide
- CATS (Child and Adolescent Trauma Screen)
- CTS (Child Trauma Screenings)
- LEC-5 (Life Events Checklist for DSM-5)
- PEARLS (Parent/Caregiver & Self-Report versions)
- UCLA PTSD Reaction Index (DSM-5 Brief Form)
Training and Additional Resources
- ACEs Aware Training - Required for Medi-Cal reimbursement
- ACEs in Youth - California data
- Safe Spaces Training
