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In the first four years of the ACEs Aware initiative, significant progress has been made towards scaling ACE screening and response initiatives across California. Now there’s new data available that supports the acceptability and feasibility of screening for ACEs in pediatric care settings. In two recently published papers, the RAND Corporation shared the results of evaluations they conducted in five Los Angeles County pediatric clinics as part of the California ACEs Learning and Quality Improvement Collaborative (CALQIC). They found that clinicians, clinical staff, and pediatric patients and caregivers find ACE screening “feasible, acceptable, and beneficial”.
The first RAND study, published in the Journal of Pediatric Healthcare in August 2023, explored the perspectives of adolescents ages 12 to 19 and caregivers of children under age 12 on the acceptability of ACE screening. Most participants reported they felt ACE screening was acceptable and that they felt comfortable discussing ACEs with their providers. For some, ACE screening helped them build trust with a clinician. Participants reported no adverse effects from ACE screening.
Patients and caregivers expressed challenges and concerns as well, including issues around privacy. Caregivers attending to multiple children, foster parents, and monolingual Spanish speakers disclosed unique challenges to ACE screening. A recommendation that emerged from the evaluation was that clinics planning to adopt routine ACE screening should ensure clear messaging on why screening is occurring, anticipate and address privacy concerns, and adopt workflows to discuss screening results.
The second study, which was published in the Annals of Family Medicine in September 2023, reports on clinicians and clinical staff perspectives on the implementation of routine ACE screening in pediatric primary care settings. RAND found that, overall, clinical teams consider ACE screening feasible, acceptable, and beneficial to improve trauma-informed care. Participants reported no adverse effects from ACE screening. The evaluation also found that ACE screening could be strengthened by addressing time constraints and the limited referral resources available.
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