Case 1: 33-Month-Old Boy with Poor Growth


  • Devika Bhushan, MD, Pediatrician and Chief Health Officer, Office of the California Surgeon General 
  • Ken Epstein, PhD, MSW; Principal at PREP for Change Consulting; Trauma Informed Systems Specialist, East Bay Agency For Children; Clinical Professor (WOS) at the University of California, San Francisco
  • Nancy Goler, MD, Obstetrician/Gynecologist and Associate Executive Director for The Permanente Medical Group
  • Leigh Kimberg, MD, Internist, Professor of Medicine at University of California, San Francisco (UCSF); Program Director of the Program in Medical Education for the Urban Underserved (PRIME-US) in the UCSF School of Medicine; Interpersonal Violence Prevention Coordinator for the San Francisco Department of Public Health (SFDPH)
  • Alicia Lieberman, PhD, Irving B. Harris Endowed Chair in Infant Mental Health; Professor and Vice Chair for Faculty Development at the University of California, San Francisco, Department of Psychiatry; Director of the Child Trauma Research Program at San Francisco General Hospital
  • Dayna Long, MD, Director, Center for Child and Community Health, UCSF Benioff Children's Hospital Oakland
  • Edward Machtinger, MD, Internist; Professor of Medicine; Director of the Women’s HIV Program (WHP) and the Center to Advance Trauma-Informed Health Care (CTHC) at the University of California, San Francisco
  • Brigid McCaw, MD, MPH, MS, Internist, The Permanente Medical Group (retired); former Medical Director of the Kaiser Permanente Family Violence Prevention Program
  • Connie Mitchell, MD, MPH, Deputy Director of the Center for Family Health at the California Department of Public Health
  • Sheela Raja, PhD, Project Co-Director, Office of Women’s Health Trauma-Informed Care Curriculum; Licensed Clinical Psychologist; Associate Professor; Director of Clinical Behavioral Sciences, Colleges of Dentistry and Medicine at the University of Illinois at Chicago
  • Leena Singh, DrPH, MPH, Program Director for the National Pediatric Practice Community on ACEs at the Center for Youth Wellness
  • Shannon Thyne, MD, Chief of Pediatrics at the Olive View-UCLA Medical Center; Professor of Pediatrics at the David Geffen School of Medicine at UCLA; Director of Pediatrics at the LA County Department of Health Services
  • Shairi Turner, MD, MPH, Project Co-Director, Office of Women's Health Trauma-Informed Care Curriculum; Florida Department of Health
  • Karen Mark, MD, PhD, Medical Director, California Department of Health Care Services
  • Nadine Burke Harris, MD, MPH, Pediatrician and California Surgeon General

Learning Objectives

After completing this case, the learner should be able to:

  • Define Adverse Childhood Experiences (ACEs), their prevalence, and health disparities in the prevalence data; toxic stress physiology; and related impacts on health, including underlying biological mechanisms.
  • Identify how to introduce and integrate ACEs and toxic stress screening into clinical care, aligning with trauma-informed care principles.
  • Apply the ACEs and Toxic Stress Risk Assessment Algorithm for assessing risk for toxic stress, which includes a combination of screening for ACEs, identifying the presence and extent of ACE-Associated Health Condition(s), and identifying protective factors, in determining an appropriately tailored treatment and follow-up plan, including referrals, if indicated.
  • Identify the Medi-Cal payment requirements for administering ACE screening as a part of assessing for risk of toxic stress.
CME/MOC Credits Available
Course opens: 
Course expires: 
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Method of Participation and Request for Credit 

There are no fees for participating and receiving CME/CE and MOC credit for this activity. During the period from November 27, 2019 through November 14, 2021, participants must read the learning objectives, faculty disclosures, and complete the educational activity to receive credit.  

To complete the training and receive education credit, learners will need to:

  1. Watch the 11-minute video with California Surgeon General, Nadine Burke Harris, MD, MPH in Section 1; 
  2. Complete either case 1 (featuring a child patient) or case 2 (adult patient) in Section 2; 
  3. Complete four of nine cases, based on clinical interests and patient population, from among cases 3-11 in Section 3; and 
  4. Submit the course evaluation in Section 4.


You will complete a total of five cases (At least one case in Section 2 and four cases in Section 3). You will not be able to complete the course evaluation in Section 4 until you have completed the required cases in Sections 1-3. 

You will have an opportunity to complete additional cases for credit once you have completed this training.

Once you have met the requirements above, you will be able to claim credit by accessing the claim credit tab on the Becoming ACEs Aware Training.  The claim credit tab will only appear once you have completed all the requirements.

To access one of the introductory cases in this section click on the title and then click on the ENROLL button.

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