Dear Providers, Adverse Childhood Experiences (ACEs) and toxic stress represent a public health crisis that has been, until recently, largely unrecognized by our state’s health care system and society. A consensus of scientific research demonstrates that cumulative adversity, especially when experienced during critical and sensitive periods of development, is a root cause to some of the most harmful, persistent, and expensive health challenges facing our state and nation. But there is hope. We can take action now to change and save lives. The impacts of ACEs and toxic stress are treatable. We can screen for ACEs, respond with evidence-based trauma-informed care, and significantly improve the health and well-being of individuals and families. These efforts can also reduce the risk of intergenerational transmission of the significant health and societal consequences of toxic stress. As a provider, you are on the frontlines of administering ACE screenings and interventions, but you are not alone in this effort. That is why we are so pleased to share our ACEs Aware Provider Toolkit, created in partnership between the Office of the California Surgeon General (CAOSG) and the California Department of Health Care Services (DHCS). The toolkit offers information and resources that providers will find useful as we join forces to screen, treat, and heal patients. This includes how to get trained to screen for ACEs, assess risk for toxic stress, implement evidence-based interventions, receive payment from MediCal for screenings, and help advance our state’s systems of care to be more effective and efficient. The time to act is now. Effective January 1, 2020, DHCS began paying Medi-Cal providers for conducting ACE screenings for children and adults up to age 65 with full-scope Medi-Cal. Together, we can address this public health crisis, advance our health care systems, and lead a national movement to ensure everyone is ACEs Aware.

Sincerely,

Nadine Burke Harris, MD, MPH, FAAP

CALIFORNIA SURGEON GENERAL