Screen

California patients and communities have weathered many storms over the past year. Screening for Adverse Childhood Experiences (ACEs) and responding to the symptoms of toxic stress will improve patient health now and in the future, unlocking the potential of an entire generation. Join the movement today to become ACEs Aware.

Training & Payment


By screening for ACEs, providers can better determine the likelihood a patient is at increased health risk due to a toxic stress response.

ACEs Aware is an initiative to offer Medi-Cal providers training, clinical protocols, and payment for screening children and adults for ACEs. Learn more about how to get trained to screen for ACEs, start screening, receive Medi-Cal payment for screenings, and help advance our state’s systems of care to be more effective and efficient.


Screening for Adverse Childhood Experiences


Screening for ACEs and toxic stress and providing targeted, evidence-based interventions for toxic stress can improve efficacy and efficiency of health care, better support individual and family health and well-being, and reduce long-term health costs.



What are ACEs?

The term Adverse Childhood Experiences (ACEs) comes from the landmark 1998 study by the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente. ACEs describe 10 categories of adversities in three domains experienced by age 18 years: abuse, neglect, and/or household challenges (as reframed by the CDC in 2015; originally phrased as household dysfunction). (1)

A child or adolescent who experiences ACEs without the buffering protections of trusted, nurturing caregivers and safe, stable environments can develop a toxic stress response, which can impact brain development, hormone and immune systems, and genetic regulatory systems.

ACEs are strongly associated, in a dose-response fashion, with some of the most common and serious health conditions facing our society today, including at least 9 of the 10 leading causes of death in the United States. (2) (3) Identifying a history of trauma in children and adults and responding with trauma-informed care, can improve the health and well-being of individuals and families and lower long-term health costs.

How does an ACE screening evaluate children and young adults for ACEs experiences?

  • Abuse: physical, emotional, and sexual abuse

  • Neglect: physical and emotional neglect

  • Household challenges: growing up in a household with incarceration, mental illness, substance dependence, absence due to separation or divorce, or intimate partner violence

How do you screen for ACEs?

The following screening tools must be used to obtain Medi-Cal payment – find the tools on the screening tools page:

For Children & Adolescents (Ages 0 – 19) – Pediatric ACEs Screening and Related Life-events Screener (PEARLS), developed by the Bay Area Consortium on Toxic Stress and Health (BARC), a partnership between the Center for Youth Wellness, University of California, San Francisco (UCSF), and UCSF Benioff Children’s Hospital Oakland.

Providers receive a single Medi-Cal payment if the adolescent or their caregiver completes the tool. However, the best practice is for both the adolescent and the caregiver to each complete a tool.

There are three versions of the tool based on age, reporter, and format:

  • PEARLS for children, for ages 0-11, to be completed by a caregiver

  • PEARLS for adolescents, for ages 12-19, to be completed by a caregiver

  • PEARLS for adolescents self-report tool, for ages 12-19, to be completed by the adolescent


For Adults – ACE Questionnaire for Adults adapted from the work of CDC and Kaiser Permanente.

If an alternative version of the ACE Questionnaire for Adults is used, it must contain questions on the 10 original categories of ACEs to qualify. Visit the Screening Tools page to find the ACE Questionnaire for Adults compiled by the Office of the California Surgeon General and the Department of Health Care Services, in consultation with the ACEs Aware Clinical Advisory Subcommittee.

For 18- and 19-year olds, either tool may be used. For patients 20 years and older, the adolescent self-report version of the PEARLS tool is also acceptable.

Medi-Cal payment is available for ACE screenings based on the following schedule:

  • Children and adolescents under age 21: Permitted for periodic ACE screening as determined appropriate and medically necessary, not more than once per year, per provider (per managed care plan).

  • Adults age 21 through age 64: Permitted once in their adult lifetime (through age 64), per provider (per managed care plan). Screenings completed while the person is under age 21 years do not count toward the one screening allowed in their adult lifetime.