Supporting Clinics Addressing Adverse Childhood Experiences in California Farmworker Communities: NACES Pilot Project...

The authors evaluated Phase II of the No More Adverse Childhood Experiences (NACES) pilot project that aimed to improve farmworker health and health access by increasing knowledge about Adverse Childhood Experiences (ACEs) and toxic stress among farmworkers and providing support to community health clinics that address ACEs in these rural communities. ACEs are traumatic or stressful events that occur in childhood and can negatively impact long-term mental and physical well-being and disproportionately affects low-income populations. More than 60 percent of Californians have experienced at least one ACE in their lifetime, and prior research found that as many as 87 percent of California farmworkers reported experiencing one ACE. In 2023, the California Department of Health Care Services (DHCS) funded the Futures Without Violence National Health Initiative on Violence and Trauma to implement the NACES Phase I pilot project to develop community- and clinic-based approaches to address ACEs in farmworker communities. RAND evaluated the clinic-based implementation of NACES Phase I and found early evidence for the feasibility and acceptability of an ACE education, screening and response model that is informed by farmworker voices. This phase of the project refined the training approach developed in Phase I and tested it in two additional clinic sites while adding a virtual clinical training option that is more accessible to clinicians across the state. Results from the NACES Phase II evaluation support Phase I findings on the feasibility and potential for the positive impact of an ACE education, screening, and response model informed by farmworkers.