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The ACEs Aware initiative is a first-in-the nation effort to screen patients for Adverse Childhood Experiences (ACEs) to help improve and save lives.

Initially led by the Department of Health Care Services (DHCS) and the Office of the California Surgeon General (CA-OSG) as part of Governor Gavin Newsom’s California For All initiative, ACEs Aware strives to create a better world for children, families, and communities by working together across the health, human services, education, and non-profit sectors to prevent and address the impact of ACEs and toxic stress (watch the 2020 launch event).

On October 1, 2021, the ACEs Aware initiative transitioned to a new organizational home within the University of California. The newly created University of California ACEs Aware Family Resilience Network (UCAAN) is a multi-campus initiative that leverages the substantial interdisciplinary resources of the University of California, San Francisco (UCSF) and the University of California, Los Angeles’ (UCLA) public health sciences campuses to develop, promote, and sustain evidence-based methods to screen patients for ACEs and create treatment plans to help patients heal from the impacts of trauma and toxic stress. UCAAN is led and administered through the Department of Pediatrics at the David Geffen School of Medicine at UCLA and the UCSF Center to Advance Trauma-Informed Health Care (watch a webinar with UCAAN leaders).

More than 60 percent of Californians have experienced at least one ACE, and 16.7 percent have experienced four or more. [ 1 ] The good news is toxic stress is treatable. A consensus of scientific data demonstrates that early detection and early intervention significantly improves health outcomes. 

ACEs Aware is bringing communities together in ways never before imagined to prevent, screen for, treat, and heal trauma-induced toxic stress. Together, we are getting to the root cause of some of the most harmful, persistent, and expensive health challenges facing our state and nation. 

“Decreasing the burden of ACEs is not only an ethical and moral imperative, but critical to our economic vitality. This work is a key preventive measure to improve health and societal outcomes for our state’s residents for generations to come.”

- California Governor Gavin Newsom

Initially funded through the 2021-22 budget under Proposition 56, ACEs Aware has become a vital part of the Medi-Cal program’s response to the COVID-19 public health emergency, helping providers identify, treat, and prevent the secondary health effects caused by the stress of the pandemic. The initiative is making great progress, but there is more work to be done.

“We have set a bold goal to cut ACEs and toxic stress in half in one generation. I believe that we can get there with shared vision, shared understanding, and cross-sector collaboration.”

- Former California Surgeon General Dr. Nadine Burke Harris

Get Involved

Every person and organization can play a vital role in transforming health outcomes and improving the lives of Californians. Here’s how to engage with the ACEs Aware initiative, whether you are new to ACEs and trauma-informed work or long-standing leaders in this area:

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May 13, 2025 | Announcements

Introducing the Stress Busters Toolkit for Community-Based Organizations

We’re pleased to announce a new toolkit designed to help community-based organizations (CBOs) leverage Stress Busters, which are seven evidence-based strategies for managing day-to-day stress and countering toxic stress from Adverse Childhood Experiences (ACEs).

If you’re part of a CBO team, this toolkit equips you with information, skills, and resources to help clients prevent and heal toxic stress. It also helps you strengthen and develop organizational programming and services aligned with an equitable and trauma-informed approach.

With this toolkit, you and your organization will be able to:

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References
1: California Department of Public Health, Injury and Violence Prevention Branch (CDPH/IVPB), University of California, Davis, Violence Prevention Research Program, California Behavioral Risk Factor Surveillance System (BRFSS), 2011-2017.

END USER SUBLICENSE AGREEMENT

PLEASE READ CAREFULLY: This End User Sublicense Agreement (the “Agreement” or “Sublicense”) is a legally binding agreement between you (an individual or an entity, hereinafter “You” or “Sublicensee”) and the Department of Health Care Services (“DHCS”) for the use of the Pediatric ACEs and Related Life-events Screener (“PEARLS”) for children and adults up to the age of 21.

BY WAY OF DOWNLOADING, COPYING, ACCESSING, OR OTHERWISE USING THE PEARLS TOOL, YOU ARE AGREEING TO BE LEGALLY BOUND BY THE TERMS OF THIS AGREEMENT. IF YOU DO NOT AGREE TO BE BOUND BY THE TERMS OF THIS AGREEMENT, THEN YOU HAVE NO RIGHTS TO THE PEARLS TOOL AND MAY NOT DOWNLOAD, COPY, ACCESS, OR OTHERWISE THE PEARLS TOOL.

THE PEARLS TOOL IS PROTECTED BY COPYRIGHT LAWS AND IS OTHERWISE PROTECTED INTELLECTUAL PROPERTY. THE PEARLS TOOL IS LICENSED AND IS NOT SOLD.

    1. The PEARLS Tool. The PEARLS tool is a unique tool that assess for both Adverse Childhood Experiences (“ACEs”) such as abuse, neglect, and household challenges, and related events, such as discrimination, food insecurity, and community violence, thought to be risk factors for toxic stress. The PEARLS tool was made in the course of research under the auspices of the Children’s Hospital Research Center at Oakland (“BCHO”) and the University of California, San Francisco. BCHO has licensed the PEARLS tool to DHCS and provided DHCS with the right to sublicense the PEARLS tool.
    2. Sublicensee Attestation. By agreeing to this Agreement, You attest that You are a provider of health care services to Medi-Cal beneficiaries, a Medi-Cal Managed Care Plan, a Medi-Cal beneficiary, a parent or guardian of a Medi-Cal beneficiary, or an Electronic Health Records (“EHR”) vendor.
    3. The Sublicense. Subject to the terms of this agreement, DHCS hereby grants to Sublicensee a non-exclusive, royalty-free, non-assignable, non-transferable sublicense (the “Sublicense”) to the PEARLS tool. Under the Sublicense, Sublicensee may use the PEARLS tool as directed, and may save, download, print, copy, reproduce, or distribute the PEARLS tool to facilitate such use.
    4. Use in a Remote Patient Portal. The PEARLS tool was developed as a screener of risk for toxic stress and has been tested for safe, reliable screening when used during in-person (i.e., synchronous) visits. The questions and responses of the PEARLS tool may be administered using the EHR as structured data fields to facilitate record and follow-up. Because the PEARLS tool was never studied under asynchronous screening formats, DHCS cannot provide recommendations regarding its use in a remote patient portal. This includes information around safety and adequate windows of response. Sublicensee acknowledges that DHCS is not responsible for providing any recommendations regarding the use of the PEARLS tool in a remote patient portal, and that DHCS is not responsible for overseeing implementation and use of the PEARLS tool in a remote patient setting. This includes information around safety and adequate windows of response.
    5. Disclaimer of Warranty. This Sublicense and the associated PEARLS tool are provided WITHOUT WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE OR ANY OTHER WARRANTY, EXPRESS OR IMPLIED. DHCS MAKES NO REPRESENTATION OR WARRANTY THAT THE PEARLS TOOL WILL NOT INFRINGE ANY COPYRIGHT, PATENT, OR OTHER PROPRIETARY RIGHT.
    6. Limitations of Liability.
      1. IN NO EVENT WILL DHCS BE LIABLE FOR ANY INCIDENTAL, SPECIAL OR CONSEQUENTIAL DAMAGES RESULTING FROM EXERCISE OF THIS SUBLICENSE OR THE USE OF THE PEARLS TOOL.
      2. DHCS WILL NOT BE LIABLE FOR ANY LOST PROFITS, COSTS OF PROCURING SUBSTITUTE GOODS OR SERVICES, LOST BUSINESS, ENHANCED DAMAGES FOR INTELLECTUAL PROPERTY INFRINGEMENT OR ANY INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE OR OTHER SPECIAL DAMAGES SUFFERED BY SUBLICENSEE, JOINT VENTURES, AFFILIATES, OR DEVELOPMENT PARTNERS ARISING OUT OF OR RELATED TO THIS AGREEMENT. DHCS WILL NOT LIABLE FOR ANY CAUSES OF ACTION OF ANY KIND (INCLUDING TORT, CONTRACT, NEGLIGENCE, STRICT LIABILITY, AND BREACH OF WARRANTY) EVEN IF DHCS HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES.
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    8. Governing Law. This Agreement is to be interpreted and construed in accordance with the laws of the State of California.
    9. Miscellaneous
      1. The relationship between DHCS and Sublicensee established by this Agreement is that of independent contractors. No joint venture or partnership is established by this Agreement. Neither party is the agent, broker, partner, employee, or legal representative of the other for any purpose.
      2. The headings of any sections are inserted for convenience of reference only and are not intended to be part of, or to affect the meaning or interpretation of this Agreement.
      3. This Agreement embodies the entire understanding of DHCS and Sublicensee and supersedes all previous communications, representations or understandings, either oral or written, between them relating to the subject matter of this Agreement.
      4. In the event that any provision of this Agreement is unenforceable or held to be unenforceable, all other provisions of this Agreement have force and effect and will not be affected thereby.
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