Screening Tools

Several versions are available for different patient populations

female doctor smiling at young patient held by smiling father

Select the appropriate screening tool

Screening for ACEs helps primary care clinicians assess risk for toxic stress and guide effective responses. To receive Medi-Cal payment for conducting ACE screenings, clinical team members in California must use the following screening tools for children, adolescents, and adults.

The tools are available in 17 languages and in de-identified and identified formats so providers can choose the approach that works best for them and their patients:

  • De-Identified Screening: Respondents count the number of ACE categories on the screening tool and indicate only the total score — without identifying which ACE(s) they or their child experienced.
  • Identified Screening: Respondents count the number of ACE categories on the screening tool and indicate which ACE(s) they or their child have experienced.

Pilots of the pediatric ACE screening tool in a large pediatric setting indicate that randomization via the de-identified (as opposed to the identified) format may facilitate higher rates of disclosure and greater patient comfort with the screening experience.

For Children and Adolescents

The Pediatric ACEs and Related Life-events Screener (PEARLS) is used to screen children and adolescents ages 0-19 for ACEs. PEARLS was developed by the Bay Area Research Consortium on Toxic Stress and Health (BARC), a partnership between the Center for Youth Wellness, the University of California, San Francisco (UCSF), and UCSF Benioff Children’s Hospital Oakland. The PEARLS tool includes a screening for ACEs (Part 1) as well as a screen for additional adversities (Part 2). There are three versions of the tool available, based on age and reporter:

  • PEARLS child tool, for ages 0-11, to be completed by a parent/caregiver.
  • PEARLS adolescent tool, for ages 12-19, to be completed by a parent/caregiver.
  • PEARLS for adolescent self-report tool, for ages 12-19, to be completed by the adolescent.

PEARLS in All Available Languages >

 

For Adults

The ACE questionnaire for adults is adapted from the work of Kaiser Permanente and the Centers for Disease Control and Prevention. The adult screening tool was compiled by the Office of the California Surgeon General and Department of Health Care Services in consultation with the California Surgeon General’s Clinical Advisory Subcommittee. If an alternative version of the ACE questionnaire for adults is used, it must contain questions on the 10 original categories of ACEs to qualify for Medi-Cal payment. For 18 and 19 year olds, either tool may be used.

ACE Questionnaire for Adults in All Available Languages >

END USER SUBLICENSE AGREEMENT

PLEASE READ CAREFULLY: This End User Sublicense Agreement (the “Agreement” or “Sublicense”) is a legally binding agreement between you (an individual or an entity, hereinafter “You” or “Sublicensee”) and the Department of Health Care Services (“DHCS”) for the use of the Pediatric ACEs and Related Life-events Screener (“PEARLS”) for children and adults up to the age of 21.

BY WAY OF DOWNLOADING, COPYING, ACCESSING, OR OTHERWISE USING THE PEARLS TOOL, YOU ARE AGREEING TO BE LEGALLY BOUND BY THE TERMS OF THIS AGREEMENT. IF YOU DO NOT AGREE TO BE BOUND BY THE TERMS OF THIS AGREEMENT, THEN YOU HAVE NO RIGHTS TO THE PEARLS TOOL AND MAY NOT DOWNLOAD, COPY, ACCESS, OR OTHERWISE THE PEARLS TOOL.

THE PEARLS TOOL IS PROTECTED BY COPYRIGHT LAWS AND IS OTHERWISE PROTECTED INTELLECTUAL PROPERTY. THE PEARLS TOOL IS LICENSED AND IS NOT SOLD.

    1. The PEARLS Tool. The PEARLS tool is a unique tool that assess for both Adverse Childhood Experiences (“ACEs”) such as abuse, neglect, and household challenges, and related events, such as discrimination, food insecurity, and community violence, thought to be risk factors for toxic stress. The PEARLS tool was made in the course of research under the auspices of the Children’s Hospital Research Center at Oakland (“BCHO”) and the University of California, San Francisco. BCHO has licensed the PEARLS tool to DHCS and provided DHCS with the right to sublicense the PEARLS tool.
    2. Sublicensee Attestation. By agreeing to this Agreement, You attest that You are a provider of health care services to Medi-Cal beneficiaries, a Medi-Cal Managed Care Plan, a Medi-Cal beneficiary, a parent or guardian of a Medi-Cal beneficiary, or an Electronic Health Records (“EHR”) vendor.
    3. The Sublicense. Subject to the terms of this agreement, DHCS hereby grants to Sublicensee a non-exclusive, royalty-free, non-assignable, non-transferable sublicense (the “Sublicense”) to the PEARLS tool. Under the Sublicense, Sublicensee may use the PEARLS tool as directed, and may save, download, print, copy, reproduce, or distribute the PEARLS tool to facilitate such use.
    4. Use in a Remote Patient Portal. The PEARLS tool was developed as a screener of risk for toxic stress and has been tested for safe, reliable screening when used during in-person (i.e., synchronous) visits. The questions and responses of the PEARLS tool may be administered using the EHR as structured data fields to facilitate record and follow-up. Because the PEARLS tool was never studied under asynchronous screening formats, DHCS cannot provide recommendations regarding its use in a remote patient portal. This includes information around safety and adequate windows of response. Sublicensee acknowledges that DHCS is not responsible for providing any recommendations regarding the use of the PEARLS tool in a remote patient portal, and that DHCS is not responsible for overseeing implementation and use of the PEARLS tool in a remote patient setting. This includes information around safety and adequate windows of response.
    5. Disclaimer of Warranty. This Sublicense and the associated PEARLS tool are provided WITHOUT WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE OR ANY OTHER WARRANTY, EXPRESS OR IMPLIED. DHCS MAKES NO REPRESENTATION OR WARRANTY THAT THE PEARLS TOOL WILL NOT INFRINGE ANY COPYRIGHT, PATENT, OR OTHER PROPRIETARY RIGHT.
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      1. IN NO EVENT WILL DHCS BE LIABLE FOR ANY INCIDENTAL, SPECIAL OR CONSEQUENTIAL DAMAGES RESULTING FROM EXERCISE OF THIS SUBLICENSE OR THE USE OF THE PEARLS TOOL.
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    8. Governing Law. This Agreement is to be interpreted and construed in accordance with the laws of the State of California.
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      1. The relationship between DHCS and Sublicensee established by this Agreement is that of independent contractors. No joint venture or partnership is established by this Agreement. Neither party is the agent, broker, partner, employee, or legal representative of the other for any purpose.
      2. The headings of any sections are inserted for convenience of reference only and are not intended to be part of, or to affect the meaning or interpretation of this Agreement.
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