20-485 Learn How to Use Approved ACEs Screening Tools
Date: 06/19/20
Take online training and use the right tools to get paid for screening for ACEs
To continue to get paid for screening Medi-Cal patients for adverse childhood experiences (ACEs), Medi-Cal providers must take required training, self-attest to having completed training and use approved screening tools.
Screening for ACEs can help you know how likely a patient is at increased health risk due to a toxic stress response and provide trauma-informed care. Identifying and treating cases of trauma in children and adults can lower long-term health costs and support the well-being of individuals and families.
Complete ACEs training by June 30, 2020
Contracted Medi-Cal providers who plan to screen for ACEs must train on trauma-informed care, including how to use the Pediatric ACEs Screening and Related Life-events Screener (PEARLS) tool and the ACEs questionnaire. The training requirement is waived for dates of service prior to July 1, 2020. However, effective July 1, 2020, Medi-Cal providers must have taken a certified training and self-attested to completing the training to receive payment.
- To get started, register for the two-hour online training.
- To self-attest, complete the Department of Health Care Services (DHCS) Trauma Screening Training Attestation form.
Which tools are approved?
The DHCS has identified and approved specific screening tools for children and adults for the 10 categories of ACEs grouped under three sub-categories: abuse, neglect and household dysfunction. Providers should retain all completed screenings in the member’s medical record, as the forms will be subject to audit.
For children and adolescents, use PEARLS
PEARLS is designed and licensed by the Center for Youth Wellness. Providers can screen once during a 12-month period, per member. The PEARLS screening tools are also available in additional languages. There are three versions of the tool based on age:
- PEARLS for children ages 0–11, to be completed by a caregiver
- PEARLS for teenagers ages 12–19, to be completed by a caregiver
- PEARLS for teenagers ages 12–19, self-reported
For adults, use the ACE assessment tool
The ACE assessment tool is adapted from the work of Kaiser Permanente and the Centers for Disease Control and Prevention (CDC). Other versions of the ACEs questionnaires can be used, but to qualify, questions must contain the 10 categories mentioned above.
| Ages | Use this tool | To receive directed payment |
|---|---|---|
| 0-17 | PEARLS | Not given more than once during a 12-month period, per provider, per member. |
| 18 or 19 | ACEs or PEARLS | Not given more than once during a 12-month period, per provider, per member. |
| 20-64 | ACEs screening portion of the PEARLS tool (Part 1) can also be used. |
|
The approved tools are available in two formats:
- De-identified screening tool: Patients have the option to choose a de-identified screening, which counts the numbers of experiences from a list without specifying which adverse experience happened.
- Identified screening tool: Patients can opt in for an identified screening in which respondents specify the experience(s) that happened to their child or themselves.
Due to the sensitive questions being asked on the screening tools, patients may feel uncomfortable answering. Providers are encouraged to use the de-identified format to reduce the fear and anxiety patients may have.
Administering the screening
There are several ways to administer the screening. Providers are encouraged to use the tools appropriate for their patient population and clinical workflow. Before administering, providers should consider the following:
- Identify which screening tools and format to use for adults, caregivers of children and adolescents, and adolescents.
- Determine who should administer the tool, and how.
- Determine which patients should be screened.
It is recommended to give the screening at the beginning of an appointment. Providers or office staff will provide an overview of the questionnaire and encourage the patients (adolescent, adults or caregivers) to complete the form themselves in a private space to allow members to disclose their ACEs without having to explain their answers. Patients may take up to five minutes to complete the screening tool.
Calculating scores
The ACE score refers to the total reported exposure to the 10 ACE categories indicated in the adult ACE assessment tool or the top box of the pediatric PEARLS tool. ACE scores range from 0 to 10 based on the number of adversities, protective factors and the level of negative experience(s) that have impacted the patient. Providers will obtain a sum total of the number of ACEs reported on the screening tool.
For children and adults, two toxic stress risk assessment algorithms based on the score were developed to determine the level of risk and referral needs. According to the algorithm, risk and scores are determined as follows:
| Risk | Score | Action |
|---|---|---|
| Low | 0 | If a patient is at low risk, providers should offer education on the impact of ACEs, anticipatory guidance on ACEs, toxic stress and buffering factors. |
| Intermediate | 1-3 | A patient who scores 1–3 has disclosed at least one ACE-associated condition and should be offered educational resources. |
| High | 1-3 with associated health conditions, or a score of 4 or higher | The higher the score, the more likely the patient has experienced toxic stress during the first 18 years of life and has a greater chance of experiencing mental health conditions, such as depression, post-traumatic disorder, anxiety and engaging in risky behaviors. |
ACEs and toxic stress risk algorithm
Learn more about adult and pediatric screening clinical workflow and risk assessment algorithms.
Take these steps after screening
As part of the clinical workflow, providers should be prepared with a treatment plan and referral process so patients who have identified behavioral, social or trauma can be connected to trained professionals and resources. Building a strong referral network and conducting warm hand-offs to partners and services are vital to the treatment plan. In addition, it is critical to build a follow-up plan to effectively track the patient’s process to ensure they get connected to the support needed.
Referral resources
MHN
Health Net* Medi-Cal members can obtain individual and group mental health evaluation and treatment. Providers can contact MHN at 1-844-966-0298 or access the MHN website.
Health Net Community Connect
Health Net Community Connect, powered by Aunt Bertha, is the largest online search and referral platform that provides results customized for the communities you and your health care staff serve or where members live. To use the tool:
- Go to the website.
- Click on the tile that says Find Social Services.
- Enter a ZIP code and click Search.
myStrength
For members with ACEs, the myStrength program can provide an additional resource. If a member needs emergent or routine treatment services, call MHN at 1-888-327-0010. To refer a member to the myStrength program, members can sign up online or download the myStrength app at Google Play or the Apple Store. To join online:
- Visit myStrength website.
- Click Sign Up.
- Complete the myStrength sign-up process with a brief wellness assessment and personal profile.
References: www.acesaware.org/; www.acesaware.org/wp-content/uploads/2019/11/ACEs-Aware-FAQ-updated-2.25.20-WEB-VERSION.pdf; and www.chcs.org/media/TA-Tool-Screening-for-ACEs-and-Trauma_020619.pdf.