The authors present findings from Phase II of the No More Adverse Childhood Experiences (NACES) pilot project, which aims to address Adverse Childhood Experiences (ACEs) in primary care settings that serve rural farmworker communities. Results from the NACES Phase II evaluation support Phase I findings on the feasibility and potential for positive impact of an ACE education, screening, and response model that is informed by farmworker voices.

Supporting Clinics Addressing Adverse Childhood Experiences in California Farmworker Communities

NACES Pilot Project Evaluation, Phase II

Ingrid Estrada-Darley, Yoselín Mayoral, Cristina Glave, Alejandro Roa Contreras, Cristina Alvarez, Peter Mendel, Nicole K. Eberhart

ResearchPublished Apr 15, 2025

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.

Key Findings

  • Prior to project implementation, clinicians and clinical staff reported that foundational trauma-informed health care and ACE education practices were not consistently in place.
  • The NACES training effectively prepares clinicians and clinical staff for ACE education, screening, and response by increasing confidence in their knowledge of farmworker communities and ACE-related topics.
  • After receiving NACES training, clinicians and clinical staff reported intent to engage in practice changes, such as offering ACE screening to adults and developing collaborative partnerships that support patient referrals.
  • With training and technical assistance, clinics were able to implement a universal ACE education and screening approach within primary care settings.
  • Individuals who attended the newly developed virtual clinical training reported that the training enhanced their knowledge and influenced their intent to make practice changes in response to ACE score and toxic stress risk assessment.

Recommendations

  • Community clinics that are interested in addressing ACEs in rural farmworker communities should take the following two-step engagement approach to preparing for ACE education, screening, and response implementation: first, engage all staff in foundational trainings on TIHC practices and, second, use staff training and patient educational materials developed by the NACES pilot project.
  • ACEs Aware and DHCS should promote the virtual clinical training developed by NACES Phase II project partners, "Addressing the Health Impact of ACEs and Toxic Stress in California Farmworker Communities," to community health centers serving rural, farmworker communities.

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Citation

RAND Style Manual

Estrada-Darley, Ingrid, Yoselín Mayoral, Cristina Glave, Alejandro Roa Contreras, Cristina Alvarez, Peter Mendel, and Nicole K. Eberhart, Supporting Clinics Addressing Adverse Childhood Experiences in California Farmworker Communities: NACES Pilot Project Evaluation, Phase II, RAND Corporation, RR-A2152-3, 2025. As of April 30, 2025: https://www.rand.org/pubs/research_reports/RRA2152-3.html

Chicago Manual of Style

Estrada-Darley, Ingrid, Yoselín Mayoral, Cristina Glave, Alejandro Roa Contreras, Cristina Alvarez, Peter Mendel, and Nicole K. Eberhart, Supporting Clinics Addressing Adverse Childhood Experiences in California Farmworker Communities: NACES Pilot Project Evaluation, Phase II. Santa Monica, CA: RAND Corporation, 2025. https://www.rand.org/pubs/research_reports/RRA2152-3.html.
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This research was funded by the UCLA/UCSF ACEs Aware Family Resilience Network (UCAAN) through a contract with the California Department of Health Care Services (DHCS) and carried out within the Quality Measurement and Improvement Program in RAND Health Care.

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