ACE Screening Implementation How-To Guide

Step 1: Get Informed

Ensure the implementation team is grounded in ACEs and toxic stress science. In addition, learn about the overall ACE screening implementation process and make a plan to bring other screening champions and your practice leadership on board.

What you will accomplish in this step

  • Get certified by taking the Core Training and attesting to completion
  • Check understanding of the fundamentals
  • Get familiar with the process of implementation

Get certified

Effective January 1, 2020, California began paying eligible Medi-Cal clinicians for conducting ACE screenings for children and adults up to age 65 with full-scope Medi-Cal. It is not too late to qualify for Medi-Cal payment. If you have not done so already, take the certified Core Training developed by the Office of the California Surgeon General and the Department of Health Care Services and attest to completing it to qualify to receive payment for screening. After completing the training, come back to this How-To Guide and complete Stage 1-Step 1.

Check understanding of the fundamentals

Ensure you know the science of ACEs and toxic stress and how to provide evidence-based interventions and trauma-informed care to treat toxic stress to improve health outcomes. After reviewing the information in the ACE Fundamentals section, come back to this How-To Guide and complete Stage 1-Step 1.

Get familiar with the process of implementation

It can help to first understand the ACE screening implementation process at a high-level and to explore different approaches to implementation before focusing on the specific details and logistics of what your practice will need to do. You can use Stages 1-4 of this How-To Guide as a framework for implementation planning.


To Do:


The “Becoming ACEs Aware in California” training takes approximately two hours to complete.

Yes. You can earn 2.0 Continuing Medical Education (CME) credits and 2.0 Maintenance of Certification (MOC) credits by taking the “Becoming ACEs Aware in California” training. You can earn additional education credit by completing additional cases.

  • The Postgraduate Institute of Medicine accredited the “Becoming ACEs Aware in California” training for:
    • 2.00 American Medical Association (AMA) Physician’s Recognition Award (PRA) Category 1 Credit™
    • 2.00 American Academy of Family Physicians (AAFP) Prescribed credits
    • 2.00 American Nurses Credentialing Center (ANCC) contact hours
    • 2.00 American Academy of PAs (AAPA) Category I CME credits
    • 2.00 American Psychological Association (APA) Continuing Education (CE) credits
    • 2.00 Association of Social Work Boards (ASWB) CE credits
    • 2.00 NAADAC (the Association for Addiction Professionals) credits
    • 2.00 American Board of Internal Medicine’s (ABIM) points in the MOC II program
    • 2.00 American Board of Pediatrics’ (ABP) points in the MOC program

Learners may also take the course for attendance only. More information about credit types is available on the “Becoming ACEs Aware in California” training page.

The training is available to any clinician team or staff members, but it is particularly geared towards primary care clinicians. Clinicians who will implement ACE screening in their practice should take the training and attest to completing it to qualify for Medi-Cal payment. Other clinicians and staff may also benefit from taking the training, but are not required to attest.

For more information on eligibility to receive Medi-Cal payment for ACE screenings, view eligible provider types.

There is no set timeline for ACE screening implementation. The timeline depends on a variety of factors such as staff availability, leadership buy-in, previous experience, existing partners, size of practice, and other factors. Consider past efforts of integrating new practices at your clinic to estimate your timeline.

Not necessarily. Becoming more trauma-informed as an organization is a journey that consists of many steps over time. You can develop an ACE screening implementation plan while working to integrate trauma-informed care. In fact, preparing for and implementing ACE screening can be an effective early step in helping to move a practice toward a more trauma-informed approach to care. 

The stages and steps in the ACE Screening Implementation How-To Guide will take you through the process of preparing your practice for ACE screening and responding to the results. The guide’s recommended staged approach to piloting and scaling up will enable you to start small and build on what you learn, working incrementally to augment your resources and referral partners, and engage others at your practice.

The How-To Guide helps practices identify multiple response strategies, such as patient education, anticipatory guidance, and medical follow-up for ACE-Associated Health Conditions (AAHCs). It also recommends how to expand the network of referral partners to include those who are specialists focused on AAHCs, and who can help meet unmet basic needs, provide social support, and support evidence-based strategies to treat toxic stress (e.g., high-quality, sufficient sleep; balanced nutrition; regular physical activity; mindfulness and meditation; experiencing nature; and mental health care, when indicated).

Stage 1-Step 1 Complete

Once you’ve completed all of the work in Stage 1-Step 1, it’s time to move on to Stage 1-Step 2, Engage Leadership and Peers.

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