Matt Reddam's childhood was marked by chaos and heartache. From a very young age, he witnessed violence between his parents. Though his grandparents were eventually able to give him a loving and nurturing home, Matt's vulnerability was exploited by a trusted teacher, who subjected him to two years of sexual abuse. These experiences affected the course of his life, leading to struggles with alcohol, substance use and posttraumatic stress, among other health issues.
In his words, “My early experiences have shaped who I am in every way.”
Fortunately, Matt was able to receive treatment that recognized the role of trauma in his health issues. Today, he is thriving as a licensed marriage and family therapist who works with schools to promote healing in kids affected by trauma. He often hears stories very much like his own.
Indeed, Matt's story is not unusual. An alarming 62 percent of Californians have experienced at least one traumatic experience during their youth, such as abuse, neglect, or household challenges like mental illness or violence, and 16 percent have experienced four or more. Experts call these early traumas “adverse childhood experiences” or ACEs for short.
An alarming 62 percent of Californians have experienced at least one traumatic experience during their youth.
Like Matt, many people who experience these issues face health challenges later in life. Unlike Matt, some are unable to overcome their burdens to live healthy and productive lives.
ACEs can cause longlasting “toxic stress” that interferes with how the brain develops and how the body works. This makes people more likely to develop health problems like high blood pressure, heart disease, diabetes, and depression. While Matt's conditions improved with treatment, others may find themselves in the emergency room, getting in trouble with the law, or even homeless. Health conditions associated with ACEs cost California an estimated $1.5 trillion annually in addition to their sometimes devastating impact on people's lives.
In 2020, California launched ACEs Aware, a first-in-the-nation initiative to help identify and address the impact early trauma has on people's health. As researchers with the nonprofit, independent think tank RAND, we have been evaluating the effectiveness of this program since 2020.
A recent report we published found that while the initiative has improved outcomes, it needs more support to fully realize its potential.
Since the initiative began, screening for childhood trauma by health care providers has scaled up rapidly in California. The screening process is relatively simple: During a regular doctor's visit, patients are given a simple questionnaire. Afterward, the doctor explains how childhood trauma can impact health and then provides referrals for follow-up care if needed.
Before ACEs Aware, this type of screening was rare. Since 2020, Medi-Cal, the state's health program for low-income families, has reimbursed providers for nearly 3.7 million ACE screens for over 2.1 million people. This means that 31 percent of children and teens on Medi-Cal have been screened—and 16.5 percent of all Medi-Cal beneficiaries. This is an impressive accomplishment in just over four years. Our evaluation found that screening is feasible in busy clinics, acceptable to patients and health care providers, and helpful in improving the care that patients receive.
Training health care providers is key.
So far, about 45,000 individuals have been trained in how childhood experiences can impact health and how to treat individuals in a manner that is helpful and sensitive to trauma. Over 20,000 of these providers are now certified to get reimbursed for screening. Our evaluation found that even months after training, many providers still valued what they learned and were more likely to screen for and address childhood trauma in their patients.
Yet while these early successes are exciting, our evaluation also found that ongoing support is needed to continue the progress.
Not all clinics are conducting screening, particularly clinics outside of Southern California and those in rural areas. Most notably, screening is much more common for children than for adults; only 6 percent of adults on Medi-Cal have been screened.
RAND's evaluations have also identified some challenges that need to be addressed.
First, many clinics lack the technology that can streamline the screening process and track results, which reduces workload for already overworked clinic staff. Investing in better health information technology and providing guidance on how to fit screening into daily clinic routines could help busy clinics.
Second, health care providers need more resources, such as mental health services, that they can refer patients to when screening reveals issues. Stronger referral networks can give doctors and nurses the confidence they need to screen their patients for trauma, knowing they have somewhere to send them for additional care if needed.
Continued investment in screening, training, and evaluation is necessary to realize the full benefits of ACEs Aware and ensure that it reaches its goal of improving the health and well-being of all Californians.
Third, many providers expressed a need for additional training on the clinical and administrative sides of ACEs screening. They want to learn more about what to do when their patient discloses childhood trauma, and they also want to learn more about practical matters like how to make screening a smooth part of clinic routines and use technology to make it easier.
For all these reasons, continued investment in screening, training, and evaluation is necessary to realize the full benefits of ACEs Aware and ensure that it reaches its goal of improving the health and well-being of all Californians. At a time when budgets are tight, this may sound like an implausible ask. Yet if we want to improve the health of the millions of Californians affected by childhood trauma and get better results for our existing $1.5 trillion in spending, it's essential.
