ACE screening may involve many aspects of your practice, so consider a broad list of potential stakeholders, including those who may champion ACE screening, advance decision-making in the organization, and support the implementation process more directly. To determine which decision-makers to engage, consider who is necessary to get on board to implement screening (e.g., who is on the board of directors), who makes the clinical decisions, who makes financial decisions, and who will evaluate progress. In addition, consider engaging clinical, administrative, and community champions to help build support, influence decision-makers, and inform the implementation team’s planning.

Once you are familiar with the rationale for ACE screening, as well as with ACEs and toxic stress science, you can develop a compelling case for your organization to implement a screening initiative ​by explaining how screening can generate revenue for your clinic through billing and can improve the health outcomes of patients. Other strategies reported by clinics that have successfully implemented ACE screening include offering administrative time to clinician champions, shifting staff responsibilities to free up time for implementation activities, or finding philanthropic and operational funding to pay for staff time. ACE screening is no different than successfully accomplishing other important strategic initiatives in health care.

ACE screening has been successfully integrated into a wide range and size of clinical settings and practice specialities, including pediatric primary care, adult primary care, family medicine, and women’s health, including prenatal care. However, practices encountered questions and concerns from their colleagues as they got started. Commonly referenced questions by leadership include cost, impact on clinical and staff capacity, and availability of support resources. Some areas that clinicians and staff have been concerned about include having insufficient time during appointments to screen and effectively respond, a comfort level talking about ACEs, perceived or actual lack of support services for response, and fear that patients will reject screening. There have also been concerns about patient health literacy about ACEs and screening fatigue. For strategies to help address these concerns, read How to Make the Case for ACE Screening to Practice Leadership.

Strategies that may help include providing education and resources to help leadership and other colleagues build their own knowledge; creating space to test and learn as you go (i.e., piloting and adapting screening and response); and linking to other experts in your community and beyond to help you and others continue with ongoing learning.