The California Department of Health Care Services (DHCS) has approved the use of a screening tool for Medi-Cal patients that helps pediatricians identify Adverse Childhood Experiences (ACEs) that can lead to increased health risks in their patients. It is the only tool of its kind to qualify for pediatric Medi-Cal payments.
Known as PEARLS, for Pediatric ACEs and Related Life-Events Screener, the tool was developed by pediatricians and researchers from UCSF Benioff Children’s Hospital Oakland, the UCSF School of Medicine and the Center for Youth Wellness (CYW).
ACEs are a root cause of many of the greatest public health challenges we face today — increasing the risk of serious conditions ranging from asthma, diabetes, and obesity, to school failure, teen pregnancy, and substance dependence.
The PEARLS tool screens and measures children for experiences in their daily environment that can cause stress. As part of the ACEs Aware initiative, an advisory group convened by the Office of the California Surgeon General, in partnership with DHCS, evaluated multiple existing tools and programs, and selected PEARLS as providing the best evidence overall for obtaining the desired results.
“ACEs are a root cause of many of the greatest public health challenges we face today — increasing the risk of serious conditions ranging from asthma, diabetes, and obesity, to school failure, teen pregnancy, and substance dependence. Scientific consensus supports that early detection and early intervention improve outcomes,” said Nadine Burke Harris, MD, California Surgeon General. “By systematically addressing ACEs and toxic stress we can transform some of our intractable health and social outcomes.”
Beginning Jan. 1, 2020, DHCS will provide payments to Medi-Cal providers who use PEARLS to identify stressors associated with increased health risks in children. In California alone, PEARLS will be available to 8,800 clinics and almost 100,000 physicians, and could improve the health of 7 million children on Medi-Cal.
PEARLS was developed as part of a three-year study co-led by researchers Dayna Long, MD, and Neeta Thakur, MD, with CYW to enable providers to identify children with ACEs who are at risk for toxic stress. Results of the pilot study were published in the Dec. 2018 issue of the journal PLOS ONE.
“Our goal is for all children to be as healthy as possible,” said Long, who is director of the UCSF Benioff Children’s Hospital Oakland Center for Child and Community Health. “By identifying children who are exposed to adversity early on in life, we can try to reduce their chances of incurring harmful health consequences as adults and support them and their families to achieve better health overall. The state’s support of this tool alongside payments for screening will go a long way to incentivize providers to screen all patients for ACEs.”
Using PEARLS, caregivers complete a questionnaire with responses about the child’s early life experiences. Adult caregivers answer questions like “Has your child lived with a parent or caregiver who went to prison?”, “Has your child ever been separated from their parent or caregiver due to foster care or immigration?”, or “Has your child experienced discrimination?“ Physicians then use a screening/scoring algorithm to identify the children facing low-, intermediate- or high risks of symptoms and health problems associated with ACEs. The PEARLS tool and information about training is available here.
"As a provider for adult populations, I regularly see the consequences of early-life adversities in my patients, whether it is COPD or heart disease,” said Thakur, assistant professor, UCSF School of Medicine. “By identifying children early, decades before disease manifests, and linking them to effective interventions, there is the potential to improve the overall health of a generation.”
Disclosure: Dr. Burke Harris participated in the research behind PEARLS during her tenure at CYW.
About UCSF Benioff Children’s Hospitals: UCSF Benioff Children’s Hospitals are among the nation’s finest pediatric medical centers, according to U.S. News & World Report’s annual rankings. Their expertise covers virtually all pediatric conditions, including cancer, heart disease, neurological disorders, pulmonology, diabetes and endocrinology, as well as the care of critically ill newborns, in the Bay Area, California and beyond. The UCSF Benioff Children’s Hospitals are known worldwide for basic and clinical research and are at the forefront of translating research into interventions for treating and preventing pediatric disease. The Oakland campus is one of only two Pediatric Level I Trauma Centers in the Bay Area, as designated by the American College of Surgeons. The hospitals are affiliated with UC San Francisco, whose schools of Medicine, Pharmacy, Dentistry and Nursing are among the nation’s leaders in graduate-level health science education, as well as research grants from the National Institutes of Health.