Understanding Trajectories of Screening for Adverse Childhood Experiences Among Clinics Serving Medi-Cal...

In January 2020, Medi-Cal began reimbursing clinics for screening for and responding to adverse childhood experiences (ACEs) as part of an effort to promote trauma-informed health care (TIHC). Since that time, ACE screening and response has grown rapidly, but unevenly, across primary care clinics across the state. In this evaluation, the authors examine factors that have contributed to variation in ACE screening rates across clinics that serve Medi-Cal beneficiaries. By improving understanding of the reasons clinics differ in screening practices, the authors aim to help tailor and target efforts to promote continued growth in TIHC. This evaluation had two interrelated components. First, the authors used Medi-Cal claims data on screening-related reimbursements to identify groups of clinics with different screening trajectories. Second, they conducted qualitative interviews with clinic representatives in each of those trajectory groups about the factors that influenced their screening practices. Clinics were selected to ensure diversity with respect to region of the state, rural versus non-rural locations, Federally Qualified Health Centers (FQHCs) versus private clinics, and clinics with versus without pediatric providers. Screening was found to vary based on clinic location and the presence of a pediatric provider. Common barriers to screening included lack of awareness and concerns about the availability of referral resources. The authors make recommendations, based on their findings, for actions that address barriers to screening and TIHC for pediatric and adult primary care clinics serving Medi-Cal beneficiaries.