At the Center for Youth Wellness, we believe that early identification of children exposed to adverse childhood experiences (ACEs) provides an opportunity to treat and support families to help mitigate the effects on children and reduce their long-term risk of poor health and mental health outcomes.
In concert with our clinical pediatric partner, the Bayview Child Health Center, we have developed a protocol we use to screen our pediatric clients for exposure to ACEs and provide follow-up services and referrals to them and their families. In January, the Zero to Three Journal published an article from members of our clinical and research teams describing that protocol. The following is a brief summary:
Adverse Childhood Experiences and their link to health outcomes were first described in a pathbreaking article published by Vincent Felitti and colleagues in 1998. The ACEs study looked at the association between self-reported adverse experiences (abuse, neglect, exposure to violence, etc.) and current health status. It found that the more such experiences a child had, the greater their chances of having health problems such as heart disease, diabetes, COPD or cancer during their adult years.
Research has shown that early adversity and trauma can trigger a physiological and behavioral stress response that can be so intense, frequent or sustained that it has a dysregulating effect on the body’s neuro-endocrine-immune (NEI) system and can keep the body in a sustained state of “fight or flight” activation. This extreme and unhealthy stress response has been dubbed “toxic stress.” Research has shown toxic stress responses in children can damage their nervous, endocrine, cardiovascular, reproductive, immune and other systems.
We have developed, and are now validating, three screening instruments (for parents of children, parents of teenagers and teens themselves) that seek to identify young people who have been exposed to ACEs. We present the appropriate version of this questionnaire, the ACE-Q, to either a parent/ caregiver or teenager when they check in for a routine appointment, starting at the age of 9 months.
A trained medical assistant presents the ACE-Q as part of a packet of routine assessments and describes its purpose, explaining that the information is gathered from all patients to help keep them healthy. The caregiver or teenager completes the ACE-Q in the waiting room, indicating whether they had been exposed to a list of 17 (or, for teens, 19) adverse experiences. The results are tallied and form a number that indicates how many kinds of adversity a child has experienced.
In the ensuing medical visit, the primary care physician reviews the ACE-Q with the child and/or parent/caregiver, explains the impact of normal and toxic stress on health and development and asks whether the child is experiencing any symptoms that may be related to toxic stress. If a child’s ACE-Q score is 0, or 1 to 3 with no related symptoms, the clinician will provide anticipatory guidance, explaining the concepts of ACEs and toxic stress, strategies for avoiding exposure to ACEs, managing stress and forging consistent, supportive relationships. If the ACE-Q score is 1 to 3 with symptoms, or 4 or higher with or without symptoms, the clinician will recommend integrated care.
If a child is referred for integrated care, a multidisciplinary clinical team will provide support to the patient and family. Care coordinators will educate the family about the impact of ACEs, interact with other providers and collaborate with other members of the CYW clinical team, arranging for home visits, psychotherapy, psychiatry, wellness nursing, biofeedback and other services from CYW or external providers.
If you are a health care professional interested in using the CYW ACE-Q, click here.