By Sue Grinnell, Kathryn Stewart, Shauna Olsen, and Lisa Tadlock, Public Health Institute, July 20, 2021

The impact of Adverse Childhood Experiences (ACEs) can be seen in communities across the state of California and beyond. The prevalence of ACEs varies across counties yet, rural Northern California has a toxic stress crisis that affects not only the current well-being of the communities but also future generations: the region has the highest rate of ACEs in the state, per capita.

This research focuses on the six-county region in rural Northern California served by the PHI Population Health Innovation Lab’s (PHIL) Northern ACEs Collaborative through a multisector collaborative of 28 agencies, which include Butte, Colusa, Glenn, Shasta, Tehama, and Trinity counties. Through nine key informant interviews with Medi-Cal providers in rural Northern California, this paper identifies barriers and solutions in the implementation of ACEs screening; and best practices for trauma-informed care in the region. Additionally, the interviews explored the impact of the COVID-19 crisis on the screening process, particularly with respect to referral resources and supportive interventions.

Through interviews with nine pediatric and family practice physicians, nurse practitioners and physician assistants, the paper identifies common factors that helped support screening practices, including: the presence of a champion that strongly advocates for ACE screening; and having an inventory of referral resources readily available.

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