California Abuses Patient Trust By Evaluating Children for “Toxic Stress”

Children Will Receive ‘Adverse Childhood Experiences’ Score

ST. PAUL, Minn. — Citizens’ Council for Health Freedom (CCHF) is warning parents about California’s newest push to screen children for “toxic stress.” Starting this year, well-child visits for millions of California children could include questions about highly sensitive and delicate topics, such as divorce, family income, and unstable household environments.

California is now paying doctors to screen their young patients for traumatic events known as ‘adverse childhood experiences,’ or ACEs. The program is designed to target patients covered by Medi-Cal, the state’s version of Medicaid for low-income families. Roughly 5.3 million children (about 40% of all California children) would be impacted.

During clinic visits, parents or ‘caregivers’ will be asked to fill out a state-approved questionnaire about potentially stressful experiences in a child’s life. For children under the age of 12, their caregivers will be asked to complete the questionnaire. For those between the age of 12-19, both the parents and the children will be asked to answer the questions. These surveys will cover a variety of categories of potential hardships over the course of the first 18 years of life: physical or emotional neglect, physical, emotional or sexual abuse, amount of household dysfunction, if a parent has been diagnosed with a mental illness (such as depression or anxiety), addictions, family members with criminal records, availability of housing and food, and more.

For ease of administration, CCHF expects the program will eventually be applied to all children, regardless of financial status. CCHF also expects the answers and the “adverse childhood experiences” score to be entered into the electronic health record.

“What’s truly toxic about this is the government’s push to intrusively categorize, evaluate, and survey children and their families,” said Twila Brase, president of CCHF. “The screenings are voluntary, but parents and children may feel coerced or pressured to fill them out.”

“This information will be a part of every child’s ‘cradle to grave’ electronic health record, which is evolving into a comprehensive ‘dossier’ on the child. What goes in these electronic health records rarely ever comes out. Therefore, as California builds complete profiles of children and their families, this could have serious implications as children age. It could stigmatize and create labels that these children will never be able to escape, even in adulthood,” Brase remarked.

“California is acting first, and asking questions later. The collection and storage of this information is not without risk – and the damage could be irreversible.”

As a result of the federal HIPAA privacy rule, millions of outside entities can be given access to this sensitive information about children and their families – and use or share it without parental consent.

“Proponents of the program claim this information won’t be shared with outside entities or state officials, but we doubt that will be the case,” Brase continued. “Thanks to HIPAA, which is actually a permissive data-sharing rule, this highly sensitive and deeply personal information may be shared with over 2.2 million entities, including other providers, more than one million business associates, and other government agencies.”

“In November, news broke that Google had access to the medical records of 50 million patients, legally acquired through HIPAA. And now, will the ACE scores of California children become similarly available to big tech? We are asking parents to refuse to let their children be scored by the state.”

CCHF maintains a patient-centered, privacy-focused, free-market perspective. CCHF has worked in its home state of Minnesota and at the national level for more than 20 years to protect health care choices, individualized patient care, and medical and genetic privacy rights. In 2016, CCHF launched The Wedge of Health Freedom, an online directory of direct-pay practices. Find more information at

Twila Brase, RN, PHN has been named by Modern Healthcare as one of the “100 Most Powerful People in Health Care.” She was selected as one of 18 leaders to participate in the U.S. Department of Health and Human Services (HHS) Quality Summit, co-chaired by Deputy Secretary Eric Hargan, which will soon provide President Trump with a roadmap for restructuring federal quality measurement programs. She is the host of the daily Health Freedom Minuteradio program heard by over 5 million weekly listeners on more than 800 radio stations nationwide, and the author of the four-time award-winning book, Big Brother in the Exam Room: The Dangerous Truth About Electronic Health Records.”


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