Research supports expansion of insurance-covered trauma screening nationwide

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September 23, 2022

California’s expansion of childhood trauma screening is being hailed as a model for other states, according to a brief recently published in the Journal of the American Board of Family Medicine.

The brief – written by researchers from UC Davis Health and other institutions at the University of California – says the screenings have the potential to demonstrate the current prevalence of adverse childhood experiences (ACE) and how they affect health outcomes for adults.

Adverse childhood experiences (ACE) are a set of potentially traumatic events that occur before adulthood, including various forms of abuse, neglect, parental divorce, separation or death, domestic violence and psychiatric illness of a family member. ACEs and toxic stress are at the root of some of the most harmful, persistent and costly societal and health challenges facing the world today. Research has found that people exposed to negative childhood experiences are more likely to suffer from chronic diseases and have a shorter life expectancy.

With 62% of California adults having experienced at least one ACE and 16% having experienced four or more, California is taking aggressive action to combat ACEs and toxic stress through ACEs Aware, the nation’s first initiative to establish a routine screening in primary care and developing a care network.

In October 2021, California enacted the ACEs Equity Act. The law expanded ACE screening by requiring it to be covered by commercial insurance. Screening of Medi-Cal patients has been mandatory since early 2020.

The UC research team analyzed the impacts, benefits, and risks of universal ACE screening in children and adults. They highlighted several political considerations:

Screening and health equity: For screening to have equitable health benefits in all communities, access to effective interventions is necessary for any patient likely to score high on the ACE questionnaire. Otherwise, screening can become a well-intentioned intervention that does not actually deliver support and services as intended.

Weighing all aces equally: There is no current evidence that supports that each ACE has the same impact on a given individual’s health outcome. While overall, high ACE scores are correlated with a higher risk of negative health effects, more research is needed at the individual level. An individual may score high on an ACE screening, but there is still little evidence to support that the individual will continue to have a specific negative health outcome.

Cost: Using estimates from Medi-Cal enrollees, the authors estimate a reimbursement of $29 per ACE screening for commercial plans and policies, which translates to a 0.03% increase in overall costs.

Potential damage: There is a need to properly train providers to administer and discuss screening, while having adequate resources to refer patients for follow-up care.

The researchers also said that raising awareness of potential benefits and harms is key to recognizing how healthcare systems can use ACE screenings as a tool to deliver trauma-informed care to better meet patient needs.

Get ACEs Aware training today (free!)

The California Medical Association (CMA) encourages all physicians, especially Medi-Cal providers, to receive the free two-hour training learn how screening, risk assessment and evidence-based care can effectively intervene on toxic stress.

By screening for ACEs, providers can better determine the likelihood that a patient is at increased health risk due to a toxic stress response, a critical step in responding with trauma-informed care that connects patients to a network of supportive care to mitigate the impact of ACEs.

Physicians can receive 2.0 Continuing Medical Education (CME) credits and 2.0 Maintenance of Certification (MOC) credits upon completion – and can receive reimbursement for providing ACE screening to Medi-Cal beneficiaries.

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