This document includes the following materials developed by the Office of the California Surgeon General for both pediatric and adult patients: ACE Screening Clinical Workflow, ACEs and Toxic Stress Risk Assessment Algorithm, and ACE-Associated Health Conditions. (ADA Version)

This ACEs Aware-developed workflow provides tips and sample scripts for approaching conversations with patients about ACEs and toxic stress. It covers how to introduce the ACE screening purpose and tool to patients/caregivers, review screening results and the treatment plan with them, and following up on the treatment plan.

In partnership with its Family Medicine Residency Program, Saint Agnes Medical Center launched an ACEs Aware training and implementation program. This pilot program aims to reduce the burden of chronic diseases in the patient population and create an interdisciplinary model that can be scaled to residency programs across California.

The “ACEs Aware Clinical Team Toolkit: Preventing, Screening, and Responding to the Impact of ACEs and Toxic Stress” offers clinicians and practices comprehensive information and resources. This toolkit is composed of a series of fact sheets that are designed to be read individually.

The purpose of this Resource Guide is to provide strategies and information to help you learn more about how your health plan can be an active part of Trauma-Informed Networks of Care in your service areas.

This is an ACEs Aware-developed sample school letter from a pediatrician to a school regarding a patient’s toxic stress symptoms and treatment plan.

The Department of Health Care Services approves specific tools to be used and questions to be asked for both pediatric and adult screenings.

This fact sheet explains why providers should screen for ACEs and describes the tools that should be used to screen children, adolescents, and adults for ACEs.

An ACEs Aware-developed tool for patients to use in developing a self-care plan to enhance well-being and decrease stress — for adults.

An ACEs Aware-developed tool for patients to use in developing a self-care plan to enhance well-being and decrease stress—for children and families.

This exam room poster gives an overview of what ACEs are, what they mean for our health, and how we can heal from them. Developed in collaboration between ACEs Aware and NumberStory.org.

This is an ACEs Aware fact sheet on the science of trauma and toxic stress.

This joint letter from the California Department of Social Services, the California Department of Health Care Services, and the Office of the California Surgeon General provides clarifying guidance on the responsibilities of health care clinical teams who conduct screenings for Adverse Childhood Experiences (ACEs) in the context of the state’s mandated reporting requirements.

This case study describes the experience of FPA Women’s Health in getting multi-clinic ACE screening implementation off the ground and provides an example of how to pilot ACE screening at one clinic and then expand to other clinics over time. This case study reinforces the importance ACEs Aware places on ongoing training and education and giving clinicians and staff the tools and language to discuss sensitive issues with patients.

This case study describes the experience of Marin Community Clinics in obtaining buy-in for piloting and designing the implementation process for organization-wide ACE screening. It reinforces the importance ACEs Aware places on developing a robust implementation team, training staff on trauma-informed care and ACE screening, and expanding internal and external resources to respond to ACEs and toxic stress.

The removal of children by the child welfare system is both a result and cause of ACEs. This paper outlines data which reveal inequities in the current child welfare system of California, reviews the evidence suggesting harms of over-surveillance and separation, and highlights policy actions and community-based solutions that have the potential to shift agency and resources to families who have been marginalized.

“How childhood trauma affects health across a lifetime.”

Early Childhood OC collaborated with the Multi-Ethnic Collaborative of Community Agencies (MECCA) and Children’s Cause Orange County to develop an understanding of the perspective of community providers who are, and will be, implementing ACE screening tools. Additional insight was provided by content experts with knowledge related to the intersectionality between ACE screenings and structural racism. 

This paper expands on existing best practices around ACE screening, with a focus on family and local CBO experiences, to inform large-scale systems change of incorporating ACE screening into systems of care for children and families in L.A. County and other similar jurisdictions.

To support providers in adopting ACE screening, the Center for Health Care Strategies (CHCS) conducted interviews with 14 Medi-Cal providers, including pediatricians, family medicine providers, behavioral health clinicians, and a certified nurse midwife, from 12 clinics in regions in California. Although the report focuses on California perspectives, the insights can inform health care organizations and providers across the country seeking to adopt an effective ACE screening approach. 

ACEs Aware-developed resource on using a tiered clinical response framework to determine the patient education, level of intervention, and additional supports that may be needed for patients at different levels of risk for toxic stress.

This paper presents findings from interviews with school stakeholders that help to identify promising practices for school-based integrated systems of care as well as barriers and facilitators to implementing and sustaining school-based integrated models.

This page lists the provider types eligible for Medi-Cal payment for screening for Adverse Childhood Experiences (ACEs).

This practice paper examines ACEs and ACE screening with immigrant youth, including qualitative research conducted with adolescent health providers and adolescents to understand their perspectives on this topic, and offers recommendations for adolescent health providers to effectively implement ACE screening with immigrant youth in primary care settings. This paper is a companion document to the authors’ practice paper entitled Screening Adolescents for Adverse Childhood Experiences (ACEs): Incorporating Resilience and Youth Development.

This practice paper examines ACEs and ACE screening with adolescents, including qualitative research conducted with adolescent health providers and adolescents to understand their perspectives on this topic, and offers recommendations for adolescent health providers to effectively implement ACE screening with adolescents.

This paper offers a roadmap to help smaller healthcare practices (those that employ 7 or fewer providers) implement trauma-informed approaches. Smaller practices are well positioned to implement trauma-informed approaches, as they often serve tight-knit populations and can tap into the needs and insights of their community and families.

Easy-to-use app for practicing mindfulness meditation with the guidance of the UCLA Mindful Awareness Research Center.