Five years in, is California’s ACE program saving lives?

Saving the world from swaths of lethal disease and mental disorders with a simple screening program remains a fantasy.

CATEGORY: GOVERNMENT PROJECTS

Governor Gavin Newsom

Source: California Office of the Surgeon General
Read time: 2.3 minutes
This Happened
In June 2025, California released the latest annual report on their state-wide screening program for adverse childhood experiences (ACEs), the only such program in the nation.
Who Is Doing This?
The screening program, ACEs Aware, launched in Gavin Newsom’s first year as governor. The program offers training to primary care clinicians in the Medicaid network on how to screen for ACEs and provides $29 reimbursement for each screen. Reimbursement for screenings began on January 1, 2020. The program is paid for by a state tax on cigarettes.
The Premise
Since program inception, 46,270 individuals completed training on how to screen; 21,730 of those are Medi-Cal clinicians. They conducted 4,258,610 ACE screenings of approximately 2,395,440 unique Medi-Cal patients.
For children and adolescents ages 0 to 17, 7% had an ACE score of 4 or greater, which is the legendary cutoff from research that indicates an individual is considered “high risk for toxic stress.” For adults, 17% had an ACE score of 4 or more.
Since the premise of the program is to prevent ACEs, which in turn should prevent the swath of lethal physical illnesses that are allegedly caused by ACES, the key question is, How many lives have been saved? The report didn’t say.
Huh? Isn’t that the whole point of screening for ACEs? What do clinicians do with the screen results? Nothing, it turns out. The ACEs Aware program does not include interventions to prevent ACEs or to treat the alleged harmful impacts of ACEs. Instead, the program surveys clinicians on their intent to change how they practice: 63% said they intend to change their practice based on the screen data, but did not explain how.
Analysis
What is going on here? Some experts in pediatrics have explicitly recommended against ACE screening [1], noting its lack of clinical utility. ACEs Aware is untethered from basic principles of screening that the test must detect disease with sensitivity, and a positive result must lead to actionable next steps such as more in-depth evaluation or treatment.
Even worse, research has shown that retrospective ACE reporting is wildly unreliable [2]. If individuals cannot even consistently recall their childhood stressors, what exactly is being measured?
The strongest blow, however, comes from large-scale studies [3]. Yes, ACE scores correlate with health outcomes at the population level, but their predictive power for any given individual is abysmal—barely better than flipping a coin. In clinical practice, this renders ACE scores meaningless. Another commentary—including Robert Anda, one of the original ACE architects—openly admitted that ACEs as a screen is a fraud [4].

ACEs Aware is not a true screening program in any logical sense. It is a surveillance and indoctrination program.

​Beyond these unworkable logistics, there are the more fundamental scientific problems that the ACE model lacks a proven mechanism of how stress causes a host of mental and physical diseases, and one-hundred percent of ACE studies are cross-sectional with zero causal explanatory power.

The program is one of the most striking examples of bad science being turned into government policy. At its core, the program assumes that a handful of social stressors—parental incarceration, substance abuse, divorce—carry unique biological toxicity, while everyday stressors of taking exams, moving to a new school, or struggling in a demanding job are ignored. This is ideology disguised as medicine: stressors deemed “systemic” by progressive policymakers are elevated as dangerous, while the common challenges of life, which millions overcome without chronic disease, are safe.
Why Is This Happening?
The California ACEs Aware program reflects the state’s deep entrenchment in progressive, neo-Marxist ideology that views individuals, especially children, as perpetually fragile and in need of state protection. It aligns with the broader agenda of social-emotional learning, DEI mandates, and trauma-informed education: redefining resilience as vulnerability, undermining parental authority, and expanding government’s role as the arbiter of personal well-being. The program was not born from strong medical evidence but rather from a cultural shift that equates social problems as oppression-causing disease and positions government as the cure. By labeling children with high ACE scores as biologically damaged, policymakers justify endless expansions of entitlement programs, school interventions, and taxpayer-funded bureaucracies.
 

References
[1] McLennan JD, MacMillan HL, Afifi TO, McTavish J, Gonzalez A, Waddell C. Routine ACEs screening is NOT recommended. Paediatr Child Health. 2019 Jul;24(4):272-273. doi: 10.1093/pch/pxz042.
[2] Baldwin JR, Reuben A, Newbury JB, Danese A. Agreement between prospective and retrospective measures of childhood maltreatment: a systematic review and meta-analysis. JAMA Psychiatry. 2019; 76(6):584-593. doi:10.1001/jamapsychiatry.2019.0097.
[3] Baldwin JR, Caspi A, Meehan AJ, et al. Population vs Individual Prediction of Poor Health From Results of Adverse Childhood Experiences Screening. JAMA Pediatr. 2021;175(4):385–393. doi:10.1001/jamapediatrics.2020.5602.
[4] Anda RF, Porter LE, Brown DW. Inside the Adverse Childhood Experience score: strengths, limitations, and misapplications. Am J Prev Med. 2020;59(2):293-295. doi:10.1016/j.amepre.2020.01.0098.