Credit: Alison Yin for EdSource
Redwood Heights Elementary School in Oakland, Calif., Wednesday, May 17, 2017.

Has your child ever lived with a parent or caregiver who had mental health issues, such as depression?

Witnessed a parent or caregiver being screamed at, insulted or humiliated by another adult?

Been separated from their parent or caregiver due to foster care or immigration?

Those are some of the questions on a survey that California pediatricians will use to screen millions of children for traumatic experiences beginning Jan. 1, 2020. Many more of these screenings are expected, after the 2019-20 budget just approved by the state Legislature allocated $45 million to reimburse doctors for screening MediCal patients for trauma, and $50 million to train doctors on how to conduct trauma screenings. The funding is in addition to funding for screenings for developmental and other disabilities.

The new screenings are part of a push by Gov. Gavin Newsom to focus on adverse childhood experiences, underscored by his appointment of Dr. Nadine Burke Harris as California’s first surgeon general earlier this year. Burke Harris is recognized as a pioneer in the study of how these experiences can affect children’s developing brains and cause a number of lifelong health and mental health problems. Research has shown that experiencing a large number of traumatic events in childhood can increase the risk of cancer, heart disease, diabetes and depression, among other chronic illnesses.

The nonprofit organization Burke Harris founded in San Francisco, Center for Youth Wellness, has screened children for traumatic experiences for years and helped develop the survey for children, known as the PEdiatric ACEs and Related Life-events Screener (PEARLS). The survey was chosen by a statewide task force to be used for the new screenings. The results help doctors determine whether children or adults need mental health counseling or other preventative treatments to help them avoid some of the long-term effects caused by the trauma they have experienced.

The new funding is significant, said Dr. Jonathan Goldfinger, chief medical officer and vice president of innovation for the Center for Youth Wellness.

“As far as understanding the causes and determinants of health, it’s one of the most momentous changes in health care policy out there,” Goldfinger said.

The screening will not be required, but having the list of questions to ask and reimbursements available is expected to encourage more doctors to screen their patients for trauma. The goal is to get more doctors to screen children for traumatic experiences so they will be able to treat them earlier.

Goldfinger said in addition to mental health counseling, there are also ways that doctors themselves can change the way they treat patients for asthma or other chronic disease, based on their patients’ trauma score.

“What we’ve learned and what we’ve been able to teach providers is that that number may actually relate to additional risk for disease,” Goldfinger said. “There are things the pediatrician can actually do differently, based on that score.”

Doctors routinely conduct screenings for developmental challenges. Some doctors also currently screen children and adults for trauma, but they have to bill MediCal and other insurance companies for it as a standard preventive screening.

With the new funding, the California Department of Health Care Services will pay MediCal providers $29 extra for each trauma screening. There are about 5.5 million children enrolled in MediCal. Under the new reimbursement program, MediCal would cover screening of children every 1 to 3 years for children. Adults can be screened once about the events they experienced as children.

The questions on the children’s survey focus on experiences that range from sexual and physical abuse to parents separating or getting a divorce. Goldfinger said parents often don’t realize that some of these experiences could cause lasting harm.

“More risk than smoking comes from adversity,” Goldfinger said.

Department of Health Care Services Director Jennifer Kent said the department is currently translating the surveys into 13 languages. After the budget is signed, Kent said department staff will be working closer with Burke Harris and other experts to develop guidelines for doctors on how to treat patients with high levels of trauma.

“A lot of providers don’t know what to do,” Kent said. “Her goal is making sure that we create a set of clinical guidelines.”

Advocates for children’s health welcomed the prospect of new trauma screenings.

“We’re really excited that that’s called out specifically,” said Molly Pilloton, project director for the California School-Based Health Alliance, which represents school health centers. Pilloton helps train teachers and school staff on how to help students who have experienced trauma.

“We see that there is difficulty paying attention in class, remaining focused,” Pilloton said. “Especially if they are activated by some kind of trauma cue in class, they immediately go into survival mode, fight, flight, freeze. Teachers might think the student is acting out, or the student is not listening.”

Pilloton said it’s important for school staff to not only screen for traumatic experiences but to receive training to provide counseling or support for children and adults to heal.

“You don’t want to screen a giant school and find you have a really high percentage of trauma experiences, symptoms and then not have the capacity to serve those students,” Pilloton said.

Erin Gabel, deputy director of external and governmental affairs for First 5 California, a commission focused on children newborn to 5 years old, said trauma screenings are especially powerful when coupled with the budget’s expanded funding for screening infants and toddlers for developmental delays.

“We see those things together and are incredibly excited about the power of prevention and how that may lead to truly addressing the achievement gap,” Gabel said. She said 70 percent of developmental delays are not identified before kindergarten. “By the time children have entered kindergarten, we’ve lost a peak era of brain development for them. Ninety percent of brain development is happening before the age of 5.”

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  1. Renaldo Sanders 4 months ago4 months ago

    Trauma impacts a child’s life tremendously. Many problems with the child’s optimal development are jeopardized due to trauma, such as trust, fear and the inability to concentrate which are key factors for the child to experience, exploring, enjoy and be excited about learning!

  2. Ame 5 months ago5 months ago

    I am a childhood trauma survivor, in active treatment, and would be happy to help in any way possible. I have grown children of my own but am still held hostage to the trauma experiences of my childhood. Please feel free to contact me if there is anything I can do to help this project come to fruition for other suffering children.

  3. Donna 5 months ago5 months ago

    This is very exciting news for the children that are suffering and for the adults that have to tend to them hope this can be spread across the country and especially coming to Ohio, where I’m from, we really need it

  4. Shelley 5 months ago5 months ago

    Is there a link to a questionnaire?

  5. Jenny Dew 6 months ago6 months ago

    We are a parenting group in Utah creating a community for children with high ACEs scores. Our children have Reactive Attachment Disorder aka Developmental Trauma Disorder. We will create proven special schooling techniques taught at New Hope Academy, along with the different therapies created to help children with neuron damage from the PTSD they have suffered. We love the work Dr. Nadine Burke Harris is doing. For more info contact jennydew1@yahoo.com or go to our … Read More

    We are a parenting group in Utah creating a community for children with high ACEs scores. Our children have Reactive Attachment Disorder aka Developmental Trauma Disorder. We will create proven special schooling techniques taught at New Hope Academy, along with the different therapies created to help children with neuron damage from the PTSD they have suffered. We love the work Dr. Nadine Burke Harris is doing. For more info contact jennydew1@yahoo.com or go to our public Facebook page CARES Meadow. CARES is an acronym for Children At Risk Emotionally Safe Meadow. We also have another public Facebook page called Parents Driving Change-RAD. Anybody can join. Let’s make a difference.

  6. Veronica B Vale 6 months ago6 months ago

    This project and research is a much needed thing on trauma. Both my daughter and I have had trauma. Thanks for doing this.

  7. Private 6 months ago6 months ago

    I had a narcissist ex who always verbally abused me in front of our son. My son was 2 at the time. He started to mimic some if that abuse to me. I always told him by abusing me in front of our son that you he was teaching him to do the same but he never listened. I ended up getting a restraining order against him because he wouldn't stop. Because I reported the … Read More

    I had a narcissist ex who always verbally abused me in front of our son. My son was 2 at the time. He started to mimic some if that abuse to me. I always told him by abusing me in front of our son that you he was teaching him to do the same but he never listened.

    I ended up getting a restraining order against him because he wouldn’t stop. Because I reported the verbal abuse it was reported to Child Protective Services. Filing the restraining ordered it was used against me which didn’t make sense but I’m dealing with it. I’m glad this article was written and I will forwarded to my ex. Hopefully he will read it and understand that his verbal abuse in front of our kids does traumatize children.

  8. Gail Monohon 6 months ago6 months ago

    Until schools have adequately trained and fully competent personnel to deal with this information, gathering it might be considered simply as an invasion of family privacy, resulting in more harm than good?

  9. Kristen Brown 6 months ago6 months ago

    This screening of child trauma is long overdue. I hope it will fill in many gaps for epidemiologists who have long written about the disparity in the data that exists. I just want to clarify, if the funding is there, will the screening be mandated? My son was traumatized by public school staff (principal and vice principal) who placed him in a prone restraint on January 28, 2015. He had a hooded jacket that … Read More

    This screening of child trauma is long overdue. I hope it will fill in many gaps for epidemiologists who have long written about the disparity in the data that exists. I just want to clarify, if the funding is there, will the screening be mandated?

    My son was traumatized by public school staff (principal and vice principal) who placed him in a prone restraint on January 28, 2015. He had a hooded jacket that covered his face and they did not see he could not breathe. We send our kids to school assuming it is safe, but I was not aware until this restraint was used on my own son that it is legal – specifically on students with disabilities.

    My son has Autism, and just this last fall a child with Autism did not walk away from his prone restraint and his family suffers the tragedy of the loss they incurred. I think the state and nation need to look carefully at what is allowed to further traumatize students in public systems and place safeguards to prevent them. Some states have already banned the use of prone restraint, and I am working on my state of California.