Adverse Childhood Experiences Screening: A Guide for Providers

• Screening takes about 5 minutes to complete.
• Supports trauma-informed care and strengthens patient relationships.
• Supports preventive care and can improve both physical and mental health outcomes.
• Connects members to appropriate resources

• Completing the ACEs Aware Training qualifies providers for a $29 reimbursement* per eligible screening for pediatric and adult patients (up to age 64).
• Healthcare Common Procedure Coding System (HCPCS) Codes:
  • G9919 (positive screen with patient score of 4 or greater)
  • G9920 (negative screen with patient score of 0 to 3)
• Frequency:
  • Children/adolescents (up to 21 years): Recommended annually and is screening billable once per year.
  • Adult patients (21-64 years): Screening billable only once in adult lifetime.
  • Providers are encouraged to review the adult patient’s medical record to confirm that an ACEs screening has not been administered as duplicate screenings are not reimbursable.
  • *Excludes those dually eligible for Medicare and Medi-Cal including CenCal Care Connect.
• Document: Validated tool used, score, clinical response level, referrals.

• PEARLS (Pediatric ACEs and Related Life Events Screener) for ages 0–19: Pediatric ACEs and Related Life Events Screener (PEARLS)
• Adult ACE Questionnaire for patients 18+: Adverse Childhood Experience Questionnaire for Adults

A comprehensive ACE screening includes understanding three key areas:

1. A patient’s exposure to adversity (ACE score)
2. Clinical signs of toxic stress (ACE-Associated Health Conditions)
3. Protective factors

Although there is currently no conclusive diagnostic test for toxic stress, the first two elements help determine the patient’s clinical risk. All three inform appropriate care and response. As with any clinical assessment, treatment planning should draw on multiple information sources, including the ACE screening, results from other screenings, medical and family history, and the physical exam.

After screening, follow the ACEs Aware Clinical Response Framework to assess the patient’s risk for toxic stress and establish next steps.

• Low risk (ACE score 0-3 and no ACE-related health conditions):
  • Reinforce protective factors and strengths, provide anticipatory guidance on stress and healthy development. Re-screen periodically as part of routine care, when applicable.
• Intermediate risk (ACE score 1-3 with ACE-related health conditions): Educate patients and families on the health effects of toxic stress, make targeted referrals to behavioral health and other community supports. Address ACE-associated conditions to prevent progression.
• High risk (ACE score >4 with or without ACE-related health conditions): Recognize high risk for toxic stress, refer promptly to trauma-informed mental health and social services. Coordinate care and follow-up.

When completing screenings, systems should be in place to ensure connection to treatment options including mental health specialists, and appropriate follow-up.

• For further information on ways to access services, please see the Mental Health Services Flyer.
• To connect a member with a CenCal Health navigator to coordinate care for psychotherapy and medication management, please complete the Behavioral Health Care Coordination Request Form.
• If you have any questions or need further support, please reach out to the CenCal Behavioral Health Call Center at 1-877-814-1861.

• Train staff: Ensure all team members understand ACEs, toxic stress, and trauma-informed care.
• Delegate appropriately: Allow trained staff to administer screeners.
  • Screeners may be administered by trained staff (e.g., medical assistants, nursing staff, behavioral health or care coordination personnel) or directly by a licensed clinician (e.g., MD/DO, NP, PA, LMFT, LCSW, PsyD, LPCC).
  • Administration can be through patient self-completion (paper or electronic) or verbal administration by staff.
  • A licensed clinician is responsible for interpreting the results and providing appropriate follow-up, counseling, and referrals as indicated.
• Normalize screening: Explain its routine role in promoting health.
• Use a trauma-informed approach: Prioritize safety, trust, and patient empowerment.
• Integrate into routine care: Well-child, preventive, or annual visits.
• Enhance accessibility: Provide screeners electronically if possible and in multiple languages.
• Utilize EHR workflows: Alerts, reminders, and reporting can be used to monitor completion rates.
• Support education & referrals: Educate patients on effects of ACEs and connect patients to community resources as needed.

• ACEs Aware homepage: https://acesaware.org/
• ACEs Aware training page (Becoming ACEs Aware in California; CME/CE): Training
• Screenings and Trauma-Informed Care Provider Trainings: https://www.dhcs.ca.gov/provgovpart/Pages/TraumaCare.aspx

• DHCS APL 23-017 (Supersedes APL 19-018): Directed Payments for Adverse Childhood Experiences Screening Services