Handout from ACEs Aware grantee the Kyer Group that uses scuba diving as a useful metaphor for practicing and building resiliency.

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.

This paper focuses on the six-county region in rural Northern California served by the Public Health Institute’s (PHI) Population Health Innovation Lab’s (PHIL) Northern ACEs Collaborative (NAC) where exist some of the highest rates of ACEs per capita in the entire state. Through key-informant interviews, Medi-Cal providers shared barriers for implementing ACE screening and identified factors that helped support screening.

After providing an overview of Adversities, their prevalence, and impact on individuals and communities, this Practice Paper incorporates a case study exploring the increasing prevalence of ACEs after the onset of the pandemic, the relationship between Adversities and mental health diagnoses and functioning, and evidence-based practices linked to improvements in mental health functioning among children who have experienced many Adversities. The paper concludes with a discussion of common challenges and best practices for providers in screening, preventing, and intervening for Adversities based on information gathered from providers through ongoing provider engagement sessions.

Communities across the nation are building community information exchanges (CIEs) to support cross-sector collaboration and coordination to address the needs of residents. This paper explores opportunities, challenges, and recommendations for utilizing CIEs to enhance a communities’ ability to improve ACE screening and response, as well as to support proactive, holistic, person-centered care.

This toolkit is a guide for primary care providers and care teams who intend to implement routine screening for ACEs into practice. It offers a framework for planning and implementing these screenings, provides context that is essential to effective implementation, describes change concepts and offers resources to support practice changes.

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.

Eisner Health, a federally qualified health center in Los Angeles County, has incorporated trauma-informed principles into both patient care and internal practices since February 2019, resulting in reduced escalations, supported staff wellness, and improved the patient experience across three clinics.

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.

This practice paper provides strategies for planning and implementing ACE screening in community-based clinics and organizations, including practical tools and templates.

Accountable Communities for Health (ACHs) are community-based partnerships formed across multiple sectors that develop a shared vision and take action to improve the health and wellbeing of a community. This paper explores how ACHs can leverage their experience leading multi-sector partnerships to support the Network of Care Milestones for Communities set out in the ACEs Aware Trauma-Informed Network of Care Roadmap.

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. 

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 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 explores strengths and barriers to administering ACE screening in tribal, urban Indian, and rural clinics. 12 key informant interviews were conducted with tribal, urban Indian, and rural organizations in California. Key informants included clinic directors with decision-making power, providers, and community health workers interacting directly with American Indian/Alaska Native patients and rural community members.

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.

This practice paper aims to describe some emerging practices and barriers and facilitators to implementing trauma-informed care, ACE screening, and care coordination for the prevention and treatment of toxic stress in school-based health centers. Practice and research recommendations are also provided.

This practice paper identifies the needs and experiences of trauma and resilience specific to Native communities in California. This paper explores how screening tools and trauma-informed care responses could be more responsive to Indigenous experiences and communities.