Today the number of doctors screening patients for adverse experiences is growing, but the state is failing to track whether patients receive the follow-up services or support they might need. State officials say they are working on identifying this information about patients from state medical databases, but it could be a few years off.
More than 6 in 10 Californians have experienced at least one adverse childhood experience, and 1 in 6 have experienced four or more, according to a state report. These include physical, emotional or sexual abuse, physical or emotional neglect, growing up in a home with substance use, mental illness, incarceration, parental separation or divorce or intimate partner violence. Research shows the higher the number of adverse experiences, the higher the risk of chronic health or mental health conditions later in life.
Since the Office of the California Surgeon General began the program, about 900,000 children and adults on Medi-Cal, the state’s health insurance plan for low-income people, have been screened. The program, known as ACEs Aware, tracks only the screenings done by Medi-Cal doctors who choose to incorporate them into their practice. Medi-Cal reimburses providers $29 per screening. Last year, the state mandated private insurers pay for screenings too, but the state does not require or track those.
After screening a patient, physicians may make referrals to therapists, nutritionists, social workers and other support services. A score of four adverse childhood experiences is used as a marker for doctors to offer referrals but they assess patients based on a wide variety of factors. They may make referrals for someone with one adverse experience or only talk with someone with six adverse experiences because they have been able to buffer their experiences.
Physicians aren’t required to report whether patients receive support services or if the services are available to them. That’s part of the challenge. The state’s serious shortage of mental health professionals, social workers and other support health care workers, like nutritionists and physical therapists, makes it even harder for physicians to make referrals and for patients to get help.
“Right now, with our patients, we give them a referral or a list of options/therapists,” said Reshmi Basu, a pediatrician and president-elect of the American Academy of Pediatricians – Orange County Chapter. “But once we do that, we don’t know what happens. We don’t know if they are taking new patients.”
With another 9,614 ballots counted, some leads widened while others shrank slightly, but overall the votes fell along the same lines as election night.
If adopted by the air board at its Dec. 15 meeting, the plan would radically reshape California’s economy, alter how Californians’ vehicles, buildings and appliances are powered, and ultimately serve as a blueprint for other states and countries to follow.
“Failure is not an option,” said air board Chair Liane Randolph. “There is too much at stake and we need to move as fast and as far as we can to lessen the worst impacts of climate change and leave future generations a livable and healthy California.”
The five-year climate change strategy, called a scoping plan, outlines in its 297 pages how California could end its reliance on oil and also clean up the nation’s worst air pollution.
The staff’s final draft plan adds bolder commitments, reducing fossil fuel use by 94 percent from 2022 levels by 2045 — up from a goal of 91 percent in the September version of the plan.
The plan also sets a more aggressive goal of cutting carbon emissions 48 percent below 1990 levels by 2030 – up from the 40 percent by 2030 required under state law — until reaching net-zero emissions in 2045. (Net-zero or carbon neutrality means striking a balance between the carbon dioxide added to the air and the carbon that’s removed.)