Adverse Childhood Experiences (ACEs) Screening in Children and Adolescents Tip Sheet

Incentives are paid to the linked primary care provider (PCP) on an annual basis, following the end of quarter four. For additional information, refer to the CBI Technical Specifications.

• Administrative members at the end of the measurement period.
• Dual coverage members.

Documentation must include a standardized ACE screening tool. Screening tools do not need to be sent to the Alliance. For screenings completed in the clinic or via telehealth, providers must document all of the following in the member’s medical record and have it available upon request:

• The standardized screening tool that was used.
• The date of the screening.
• That the completed screen was reviewed by a provider.
• The results of the screen.
• The interpretation of the results.
• What was discussed with the member and/or family and any appropriate actions taken.

ACE screening tools:

• ACEs questionnaire for adults (18 years of age and older).
• Pediatric ACEs and Related Life-events Screener (PEARLS) for children (ages 0-19 years of age).

For more information on screening tools, please see ACEs Aware Screening Tools.

When screenings are performed, providers must use the following HCPCS codes, depending on the test result.

• G9919 – score 4 or greater (high risk), results are positive and at high risk for toxic stress.
• G9920 - score between 0-3 (lower risk), results are negative.

Online training and attestation are required to receive payment and to be compliant for the measure. Once the DHCS ACEs Aware training and attestation are complete, providers can start submitting claims the following month (e.g., training and attestation are completed in July, start submitting claims in August) to ensure the Alliance receives the DHCS attestation information at the beginning of the following month.

Mid-level providers must include the supervising physician on the claim for compliance in this measure, who also needs to hold an ACEs training and attestation certification.

Note: FQHCs need to bill the HCPCS codes listed above on a separate claim from the office visit.

For members 0-20 years of age who receive dyadic services, Medi-Cal reimburses dyadic caregiver services including ACE screenings that are provided to the caregiver for the benefit of the child. During a child’s visit attended by the child and caregiver, the ACE screening may be billed using the child’s Medi-Cal ID and must be designated using Modifier U1.

Federally Qualified Health Centers (FQHCs) can screen the child and parent under the dyadic benefit. They will need to bill for the child and parent under separate claims for reimbursement. https://www.acesaware.org/resources/faq/.

Data for this measure is collected using claims.

• ACEs are linked to chronic health problems, mental illness and substance use problems in adulthood. ACEs can also negatively impact education, job opportunities and earning potential. All non-clinical staff should receive training on ACEs as part of onboarding and receive an annual refresher.
• Use community health workers (CHW) to assist in ACE screenings. CHWs can help coordinate and monitor referrals to community resources.
  • State-Issued Community Health Worker Certificate Guidance Letter – The California Department of Health Care Access and Information (HCAI).
  • Alliance grants are available to help recruit CHWs and providers under the Workforce Recruitment Programs.
• Incorporate screening procedures into the ongoing healthcare of children and adolescents. This increases the chances that previously undetected ACEs or toxic stress can be identified.
• As recommended in the ACE Screening Implementation How-To Guide, select ACE screening champions to engage staff and create a small group to make key decisions on the implementation process. These champions should represent different departments of work inside and outside of your clinic. For example, the champions could include clinical staff (PCPs, medical assistants, nurses), clinic administration (office manager, senior leadership) and community-based organizations (schools, early-intervention services, referrals sources to provide the “patient voice”).
• Pilot administering ACE screenings to patients and then discuss, as a clinic, what improvements can be made to the workflow.
• When mandated reporters are screening for ACEs, they are required to report suspicion of child abuse. See the joint letter from the California Department of Social Services, the California Department of Health Care Services and California Surgeon General.
• Provide parents, adults and adolescent patients with self-care tools:
  • ACEs Aware Self-Care Tool for Adults
  • ACEs Aware Self-Care Tool for Pediatrics

• ACEs and toxic stress screening:
  • Becoming ACEs Aware in California Training - Provider training (PCPs, physician assistants, nurse practitioner).
  • Screening for Adverse Childhood Experiences (ACEs) and ACE Screenings Resource Guide - Clinic staff training (medical assistants, nurses, office managers, etc.).
• 988 Suicide & Crisis Lifeline is available for patients who are in crisis. Whether they are considering suicide or not, the toll-free 988 Lifeline provides access to free, quality, one-on-one assistance. Skilled, judgment-free counselors are available 24/7/365.
• ACE Screening Sample Scripts for Pediatric Clinical Teams.
• ACE Screening, Clinical Assessment, and Treatment Planning for Toxic Stress.
• ACEs Aware Clinical Team Toolkit.
• Stress Busters: Seven Ways to Manage Stress.
• ACE Overcomers offers provider training across all counties, parent and community classes and hosts community events for ACEs awareness and stress busters.

• ACEs Aware initiative offers Medi-Cal providers training, screening tools, clinical protocols and payment for screening children and adults for ACEs.
  • Sign up to receive ACEs Aware news, updates, and educational events.
  • The ACEs Aware Learning Center includes recorded webinars on how to implement ACE screenings, and information on trauma-informed care and more.
• ACEs Aware Trauma-Informed Network of Care Roadmap.
• ACE Screening Clinical Workflows, ACEs and Toxic Stress Risk Assessment Algorithm, and ACE-Associated Health Conditions: For Pediatrics and Adults.
• How Childhood Trauma Affects Health across a Lifetime – Dr. Nadine Burke Harris TED Talk.
• Trauma-Informed Care - American Academy of Pediatrics (AAP).
• Understanding ACEs toolkit – Office of the California Surgeon General

Patient Education Materials:

• About Adverse Childhood Experiences – Centers for Disease Control and Prevention (CDC).
• ACEs Resources – CDC.
• ACEs Aware Number Story Exam Room Poster.
• ACEs Aware Patient/Family Education Handouts.
• ACEs, Toxic Stress & Resilience – Caregiver Handouts (English) – Healthy Steps.
• Handouts for parents – PACEs Connection.

Alliance Resources:

• Alliance Cultural and Linguistic Services are available to network providers.
  • Language Assistance Services – Request materials at 800-700-3874, ext. 5504.
  • Telephonic Interpreter Service – Directly access a telephonic interpreter 24 hours a day, 7 days a week.
  • Interpreter Services – Can be requested for the appointment with the member.
  • Virtual Remote Interpreter (VRI) Service – When an in-person interpreter might not be available or easy to access.
  • For information about the Cultural and Linguistic Services Program, call the Alliance Health Education Line at 800-700-3874, ext. 5580 or email us at [email protected].
• Alliance Enhanced Care Management (ECM) and Community Supports.
  • Refer Alliance members through the Alliance Provider Portal, email [email protected], mail or fax, or by phone at 831-430-5512.
  • For Complex Care Management and Care Coordination, call the Care Management team at 800-700-3874 (TTY: Dial 711).
• Alliance Transportation Services for patients with transportation challenges.
  • For non-emergency medical transportation (NEMT) services, call 800-700-3874, 5640 (TTY: Dial 711).
  • For non-medical transportation (NMT) services, call 800-700-3874, ext. 5577 (TTY: Dial 711).