In this report, the authors present results and recommendations based on an evaluation of the impact of California's UCLA/UCSF ACEs Aware Family Resilience Network on its goals of promoting screening for adverse childhood experiences (such as abuse and neglect) and trauma-informed health care for Medi-Cal beneficiaries.

Evaluation of the Early Impact of the UCLA/UCSF ACEs Aware Family Resilience Network (UCAAN)

Joshua Breslau, Graham DiGuiseppi, Gabriela Alvarado, Avah Mousavi, Elizabeth Roth, Suzanne Perry, Priya Gandhi, Cristina Glave, Vanessa Miller, Nicole K. Eberhart

ResearchPublished Apr 15, 2025

In this report, the authors present results and recommendations based on an evaluation of the impact of the UCLA/UCSF ACEs Aware Family Resilience Network (UCAAN) on its goals of promoting screening for adverse childhood experiences (ACEs; for example, abuse and neglect) and trauma-informed health care (TIHC) for Medi-Cal beneficiaries.

The authors found that UCAAN has had a major impact on the capacity of individual clinicians who treat Medi-Cal beneficiaries to provide TIHC, largely through the Becoming ACEs Aware (BAA) training program. The BAA course has trained and continues to train a significant proportion of Medi-Cal primary care clinicians, and the survey results indicate that the impact of the training on care and on patients is lasting. UCAAN's impact on system-level change has understandably been more gradual. There have been positive impacts, most clearly demonstrated by the fact that clinics have been reimbursed for providing ACE screening and response to more than 2 million Medi-Cal beneficiaries. However, Medi-Cal clinicians who have been trained to provide ACE screening and response indicate that they continue to face barriers to providing TIHC in the clinics in which they work. UCAAN is making important contributions to addressing these barriers. Most importantly, the pilot programs have made major contributions to knowledge of how ACE screening and response and TIHC more generally can be implemented throughout the health care system.

Key Findings

UCAAN has dramatically increased the clinical capacity to screen for ACEs

  • The BAA training has been taken by nearly 45,000 individuals.
  • Ninety percent of respondents to the follow-up survey indicated that they currently screen patients for ACEs, and 75.1 percent indicated that the training has had a positive impact on their patients.
  • During the first three years of implementation, 16.5 percent of Medi-Cal beneficiaries received at least one ACE screening.
  • Although 31.0 percent of Medi-Cal–enrolled children have been screened, only 6.3 percent of Medi-Cal adults have been screened.

There is widespread demand for UCAAN training from diverse audiences

  • Many participants in UCAAN trainings are not clinicians, and many were in behavioral health.
  • Learners appreciated the ease of access to the training programs, the clarity and scientific grounding of the content, and the use of clinical cases to relate the knowledge to clinical practice.
  • There was broad interest in further training.

Pilot projects have built an impressive body of knowledge about implementation of ACE screening and TIHC in diverse health care settings

  • UCAAN's pilot project program has focused on challenging aspects of implementing ACE screening and TIHC across the health system from high-intensity settings (such as inpatient pediatric care) to underserved populations in the community (such as migrant farm workers).
  • The pilot project findings underline the importance of developing clear implementation models.
  • Guidance on implementation should be tailored to clinical settings, patient populations, and staff roles, including non-clinical staff, and should prioritize developing trusting relationships over collection of screening data.

Recommendations

  • Expand the reach of the BAA training, and develop additional courses to support TIHC. Outreach efforts should aim to increase the number of trainees in the Inland Empire and Southern San Joaquin Valley regions. Trainings for non-clinician staff, including administrative leaders and office staff, could improve clinic-level capacity.
  • Translate pilot project findings into practical implementation guidance; consider adopting a knowledge translation model.
  • Improve guidance and support for ACE screening and TIHC in clinics serving adults. The California Department of Health Care Services should consider changes to reimbursement policy that would support TIHC for adults beyond the initial once-per-lifetime screening. Follow-up services, such as supplemental payments for outpatient visits, would have broader reach while directly supporting primary care clinics.
  • Develop whole clinic training and implementation support materials. The materials should cover not only implementation of ACE screening but also extensive planning related to TIHC more generally, including appropriate screening response and referral procedures. An initial step could focus on developing materials for one type of clinic.
  • Streamline technical assistance by managing the volume of requests (via clarified language in a screening tool and new procedures for rapid referral to assistance) and standardizing technical assistance responses.
  • Improve referral networks. Local providers could be better used as referral resources. Navigation services, supported by evidence from the pilot projects, could play a role.

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Citation

RAND Style Manual

Breslau, Joshua, Graham DiGuiseppi, Gabriela Alvarado, Avah Mousavi, Elizabeth Roth, Suzanne Perry, Priya Gandhi, Cristina Glave, Vanessa Miller, and Nicole K. Eberhart, Evaluation of the Early Impact of the UCLA/UCSF ACEs Aware Family Resilience Network (UCAAN), RAND Corporation, RR-A2152-4, 2025. As of April 30, 2025: https://www.rand.org/pubs/research_reports/RRA2152-4.html

Chicago Manual of Style

Breslau, Joshua, Graham DiGuiseppi, Gabriela Alvarado, Avah Mousavi, Elizabeth Roth, Suzanne Perry, Priya Gandhi, Cristina Glave, Vanessa Miller, and Nicole K. Eberhart, Evaluation of the Early Impact of the UCLA/UCSF ACEs Aware Family Resilience Network (UCAAN). Santa Monica, CA: RAND Corporation, 2025. https://www.rand.org/pubs/research_reports/RRA2152-4.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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