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

Incentives will be paid to the linked primary care provider (PCP) on an annual basis, following the end of Quarter 4. For additional information, refer to the CBI Technical Specifications.

Documentation must include a standardized ACE screening tool. Screening tools do not need to be sent to the Alliance. However, please make sure the medical record includes the standardized ACE screening tool used, the date of the screening, that the completed screen was reviewed, the results of the screen, the interpretation of results, what was discussed with the Member and/or family, and any appropriate actions taken. score.

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

For more information on the types of screening tools, please see the ACES AWARE Screening Tools resources.

Online training and attestation are required to receive payment and to be compliant for the measure. Providers will qualify for a onetime payment for completing the training and attestation.

After training and attestation is completed, providers can start submitting claims after the following month (i.e., training and attestation is completed in July, start submitting claims in August) to ensure payment will go through.

Data will be collected via claims. 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.
• G9920 - score between 0 – 3 (lower risk), results are negative.

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

https://www.acesaware.org/learn-about-screening/billing-payment/

• 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 new staff, as well as have an annual refresher.
• Utilize community health workers to assist in completing ACE screenings in and monitoring referral completion.
  • The California Department of Health Care Access and Information (HCAI) State-Issued Community Health Worker Certificate Guidance Letter
  • Grants from the Alliance are available under the Community Health Worker (CHW) Recruitment Program
• Refer Alliance members to Care Management services, including Complex Case Management and Care Coordination, by calling Case Management at 800-700-3874, ext. 5512.
• Refer Alliance members to Enhanced Care Management (ECM) Services and Community Supports through the Alliance Provider Portal, email ([email protected]), mail or fax, or by phone at 831-430-5512.
• Alliance interpreting services are available to network providers:
• Telephonic interpreting services are available to assist in scheduling members.
• Face-to-face interpreters can be requested to be at the appointment with the member.
  For information about our Cultural and Linguistic Services Program, please call the Alliance Health Education Line at 800-700-3874, ext. 5580 or email us at [email protected].

• Refer patients who have transportation challenges to the Alliance’s Transportation Coordinator at 800-700-3874, ext. 5577. This service is not covered for non-medical locations or for appointments that are not medically necessary.
• 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[i].
• For members 0-20 who receive dyadic services, Medi-Cal also reimburses dyadic caregiver services including ACE screening, 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.
• ACE Screening Implementation How-To-Guide. Select an ACE screening champions to engage staff and create a small group for making key decisions on the implementation process. These champions should represent different departments of work in 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 the ACE screenings to patients and then discuss as a clinic of what improvements to the workflow can be made.
• When mandatory reporters are screening for ACEs, they are required to report suspicion of child abuse; see Joint letter from California Department of Social Services and California Department of Health Care Services, and Office of the California Surgeon General.
• Raise awareness of ACEs[ii]:
  • Enhanced primary care.
  • Victim-centered services.
  • Treatment to lessen the harms of ACEs.
  • Treatment to prevent problem behavior and future involvement in violence.
  • Family-centered treatment for substance use disorders.
• Provide parents, adult, and adolescent patients with Self-Care Tools:
  • ACEs Aware Self-Care Tool for Adults
  • ACEs Aware Self-Care Tool for Pediatrics

[i] CDC-Kaiser ACE Study https://www.cdc.gov/violenceprevention/aces/about.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fviolenceprevention%2Facestudy%2Fabout.html

[ii] CDC’s Preventing Adverse Childhood Experiences https://www.cdc.gov/violenceprevention/aces/fastfact.html

• Train clinic staff on ACE and toxic stress screenings:
  • Provider training (PCPs, physician assistants, nurse practitioner): Becoming ACEs Aware in California Training.
  • Clinic staff training (medical assistants, nurses, office managers, etc.): Screening for Adverse Childhood Experiences (ACEs) and ACE Screenings Resource Guide.

• California’s ACEs Aware Initiative offers Medi-Cal providers training, screening tools, clinical protocols, and payment for screening children and adults for ACEs.
  • Effective January 1, 2020, qualified Medi-Cal providers are eligible for a $29 payment for screening patients up to age 65 with full-scope Medi-Cal using a qualified screening tool.
  • Sign up to receive ACEs Aware news, updates, and educational events.
  • ACEs Aware Training website includes recorded webinars on how to implement ACE screenings, information on trauma informed care, and more.
• California Surgeon General Understanding ACEs Toolkit
• Safe Spaces website created by California Surgeon General was created for training early care providers (TK-12)
• ACEs Aware Number Story Exam Room Poster
• ACEs Aware Patient/Family Education Handouts
• ACE Overcomers offer provider trainings (across all counties), parent and community classes, and host community events for awareness ACEs and stress busters.
• PACEs Connection: Parent Handouts
• Healthy Steps: ACEs, Toxic Stress & Resilience – Caregiver Handouts (English)
• CDC Violence Prevention – Adverse Childhood Experiences
• CDC’s ACE resources
• American Academy of Pediatrics (AAP) Trauma-Informed Care
• Video on administering a PEARLS Resilience De-identified, positive and negative screening.
• The Burke Foundation: “Building Strong Partnerships for Community and Care in the First 1,000 Days”
• ACE Screening Clinical Workflows.
• Trauma-Informed Network of Care Roadmap
• ACES Too High News