California Is Giving Doctors Incentives To Ask Patients About Childhood Trauma

California health officials want children and adults on Medi-Cal to get screened for traumatic childhood events that can cause negative health effects down the line. Now the state has started giving doctors and nurses tools to do the screenings. 

People who experience adversity early in life have much higher chances of substance abuse, depression, or chronic diseases than their peers, according to national research. 

Gov. Gavin Newsom’s 2019 budget included more than $40 million to reimburse doctors who can screen Medi-Cal patients for certain traumatic events, known as “adverse childhood experiences,” or ACEs. Examples include physical and verbal abuse, emotional neglect, or having a family member who is mentally ill, addicted or incarcerated. 

The goal is for providers to figure out a patient’s ACEs score and create a treatment plan accordingly.

Primary care providers can start screening people and billing Medi-Cal for the service starting Jan. 1 if they take a two-hour training course released by the state last week. They must take the course by July 1, 2020 in order to be eligible for a reimbursement of $29 per screening.

California Surgeon General Nadine Burke Harris said the state wants to incentivize doctors to screen patients for traumatic events.

“Individuals who’ve been exposed to adversity, often times it’s not identified,” she said. “And that means that biological process, particularly that overactive stress response, may be ongoing in a way that can be harming health.”

She said doctors who spot ACEs early can make recommendations for sleep, exercise, nutrition and healthy relationships, but only if they’re aware of a patient’s history.  

A major study conducted by the U.S. Centers for Disease Control and Prevention and Kaiser Permanente found that people who experience four or more ACEs are twice as likely to be smokers and seven times more likely to develop an alcohol addiction than people with no exposure to ACEs. The CDC estimates that preventing ACEs could substantially reduce national rates of obesity, heart disease, asthma and other conditions. 

Anna Martin, a nurse in a UC San Diego neurological unit, said she went through nursing school with the goal of integrating a patient’s mental health history and social circumstances into their treatment plan. 

She took the state’s new training and said it has the potential to help providers across the board better connect with patients. 

“It creates a trauma-sensitive staff,” she said. “By being aware of the problem, it increases our compassion and our empathy.”

She feels asking about a patient’s trauma is just as important as asking about their family’s disease history.

“It’s about making the right referrals, it’s about integrating physical activity,” she said. “It just means we’re going to keep our eyes open for certain other chronic health conditions that could come up in the future.”

The state will reimburse doctors for once-a-year screenings of children on Medi-Cal, and once-a-lifetime screenings of adults, according to the California Surgeon General’s office. 

The curriculum roll-out this month is just the first phase of a larger effort to educate primary care providers about the importance of screening for trauma, Burke Harris said. California’s push is part of a broader national shift to incorporate trauma-informed care into doctor’s offices and schools.