1. Watch a TED talk video on Youtube (How childhood trauma affects health across a lifetime | NadineBurke Harris)
– Copy and Paste Link in Browser
2. Review the article related to the ACEs study-
3. Review ACE Provider Tool Kit-
Provider Toolkit
Screening and Responding to
the Impact of ACEs and Toxic Stress
May 2020
Cover Letter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i
Dr. Nadine Burke Harris and Dr. Karen Mark
ACEs Aware Initiative
ACEs Aware Initiative: Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
The Science of ACEs and Toxic Stress . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
01 Screen: Training and Payment
Screening Tools Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Suggested Clinical Workflows for Screening . . . . . . . . . . . . . . . . . . . . 18
Medi-Cal Certification and Payment . . . . . . . . . . . . . . . . . . . . . . . . . . 22
02 Treat: Clinical Practice
Trauma-Informed Care Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Clinical Response to ACEs and Toxic Stress . . . . . . . . . . . . . . . . . 33
03 Heal: Resources and Support
Patient Tools and Informational Handouts . . . . . . . . . . . . . . . . . 38
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
For more ACEs Aware information and
resources visit the ACEs Aware website at
ACEsAware.org.
Contents
This Provider Toolkit provides information on the ACEs Aware
initiative, including how to screen for and respond to ACEs, and
how Medi-Cal providers can get trained and receive payment for
conducting ACE screenings. This toolkit is composed of a series of
fact sheets that are designed to be read individually.
May 2020
Dear Providers,
Adverse Childhood Experiences (ACEs) and toxic stress represent a
public health crisis that has been, until recently, largely unrecognized
by our state’s health care system and society. A consensus of scientific
research demonstrates that cumulative adversity, especially when
experienced during critical and sensitive periods of development, is
a root cause to some of the most harmful, persistent, and expensive
health challenges facing our state and nation.
But there is hope. We can take action now to change and save lives.
The impacts of ACEs and toxic stress are treatable. We can screen
for ACEs, respond with evidence-based trauma-informed care, and
significantly improve the health and well-being of individuals and
families. These efforts can also reduce the risk of intergenerational
transmission of the significant health and societal consequences of
toxic stress.
As a provider, you are on the frontlines of administering ACE s
CONTINUING EDUCATION
Getting to Why: Adverse
Childhood Experiences’ Impact
on Adult Health
Rebecca Hilgen Bryan, DNP, AGNP
ABSTRACT
Exposure to adverse childhood experiences (ACEs) c
ontributes to 7 of the 10 leading causes of death in the
United States as well as health risk behaviors, including substance abuse, physical inactivity, and high-risk sex
behaviors. ACEs are traumatic childhood events that effect biopsychosocial health across the lifespan. It is
vital for health care providers to view individuals from a trauma-informed perspective to guide best practice,
but few are aware of ACEs, particularly those who treat adults. A review of the science of ACEs research,
feasibility of screening for ACEs, and effective responses to trauma-impacted patients is presented in this
report.
Keywords: ACEs, ACE screening, adult health, adverse childhood experiences, primary care, trauma-
informed care
� 2018 Elsevier Inc. All rights reserved.
Rebecca Hilgen Bryan, DNP, AGNP, is affiliated with Urban Promise Ministries, Camden, NJ. She is available at rhbryan64@
gmail.com. In compliance with national ethical guidelines, the author reports no relationships with business or industry that would pose a
conflict of interest.
n the 1990s, the Centers for Disease Control and
Prevention together with Kaiser Permanente
Idiscovered that traumatic events during child-
hood, termed adverse childhood experiences (ACEs),
were common, with 64% of the original 17,337
mostly white, mostly college-educated study partic-
ipants having 1 ACE, 40% having 2, and 12.5%
having 4 or more.1 The traditional 10 categories of
ACEs are physical, emotional, and sexual abuse;
physical and emotional neglect; witnessing domestic
violence, having a family member affected by mental
illness, substance abuse, or incarceration, and losing a
This CE learning activity is designed to augment the knowledge, skills, and attitudes of A
across the lifespan, as well as how to respond to trauma-impacted patients, as measu
At the conclusion of this activity, the participant will be able to:
A. Describe how ACE increase the risk of physical and mental health diseases
B. Explain how and why to assess for childhood maltreatment in adult patients
C. Identify how to respond to patients with ACE exposure
The author, reviewers, editors, and nurse planners all report no financial relationships
The author does not present any off-label or non-FDA-approved recommendations for
This activity has been awarded 1 Contact Hours of which 0 credit is in the area of Phar
www.npjournal.org
parent to separation or divorce2 (see the
Supplementary Appendix, available online at http://
www.npjournal.org).
Importantly, this seminal ACEs study demon-
strated a dose-response relatio
Unit 4 Assignment 3- Clinical Preparation Journal
Instructions
Each week you will be given a prompt to write a reflective journal assignment that will allow you to investigate areas for clinical preparation in psychiatric mental health. The reflective journal should be substantive, containing a minimum of 250 words. Supporting evidence for your thoughts and ideas should come from a minimum of one scholarly source. Sources should have in-text citations where appropriate and be referenced on a reference page according to APA 7th Edition standards.
Review video about Adverse Childhood Experience
: Link Attached
Review the article related to the ACEs study
: Attached
· Hilgen Bryan, R., DNP, AGNP. (2019, February 01).
Getting to why: Adverse childhood experiences’ impact on adult healthLinks to an external site.
.
The Journal for Nurse Practitioners, 15(2). p153-157. https://www.npjournal.org/article/S1555-4155(18)30843-2/fulltext
Review Tool Kit:
Attached
· Aces Aware. (2020).
Provider toolkitLinks to an external site.
. State of California Department of Health Care Services. https://www.acesaware.org/heal/provider-toolkit/
What are the main components of trauma-informed care why is the ACEs model of screening is so important in primary care and psychiatric mental health care for ALL patients?
Rubric
Clinical Preparation Journal Rubric
|
Criteria |
Ratings |
Pts |
|||
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This criterion is linked to a Learning Outcome. The psychiatric/mental health area investigated is identifiable in the submission. |
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5 pts |
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This criterion is linked to a Learning Outcome. The reflection submitted is focused on the identified psychiatric/mental health area investigated 
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