Step 1: Determine Who and How You Will Screen

The first step is to determine the key features of ACE screening administration – who and when to screen, which screening tool to use, and where to conduct the screening.

Who and When to Screen

The ACEs Aware initiative recommends that all children are screened annually for ACEs to assess risk of toxic stress. Adults should be screened at least once in adulthood.  Although ACEs, by definition, occur in childhood and therefore do not change, patient comfort with disclosure of these experiences may change over time, so re-screening for adults may be considered.

As discussed in Stage 1 Step 4, many clinics start screening for ACEs with a pilot project and adjust and expand it over time. For an overview of approaches to ACE screening implementation, review No One Size Fits All: Different Approaches to Piloting ACE Screening and Toxic Stress Treatment.

Which Screening Tool to Use

To receive Medi-Cal payment for conducting ACE screenings, clinical teams must use the PEARLS or the Adult Questionnaire, depending on the patient’s age. These tools are available in 17 languages and in both de-identified and identified formats so clinicians can choose the format that works best for them and their patients. Review additional information on the screening tools.

How and Where to Administer the Screening Tool

It is important to consider how your clinic will administer ACE screenings. Using trauma-informed care principles and lessons learned in communicating with patients and caregivers about ACEs and toxic stress is critical to success. Provide these ACE Screening Sample Scripts for Pediatric Clinical Teams to your clinicians and staff. Additionally, try to identify a private space in the clinic/office where the patient/caregiver can complete the screening tool.

Note: ACEs Aware is also developing scripts for clinical teams that serve adults.

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