Combining ACEs and PEARLS Assessments to Provide Healing Solutions

We know that when adversities in childhood are not addressed it can lead to physical, mental, and emotional health concerns in adults. A simple, yet impactful shift is happening in mental health assessments by asking the question ‘what happened to you?’

But the good news is that this can be changed by working together to create systemic changes and inclusive systems that build and support healthy individuals, families, and communities.

Practitioners are beginning to ask this question along with inquiring about the symptoms they are experiencing. When a medical provider has a better understanding of the patient and their environment, they can identify, treat, and prevent the secondary health effects associated with ACEs and stress.

About the ACEs Aware initiative

ACEs Aware is an initiative of the Office of the California Surgeon General and the California Department of Health Care Services, it’s led by Dr. Nadine Burke Harris, California Surgeon General, and Dr. Karen Mark, Medical Director of the Department of Health Care Services. The ACEs Aware effort is part of Gov. Newsom’s California For All initiative and the California Surgeon General, Dr. Nadine Burke Harris has set a bold goal to cut ACEs in half in one generation. The ACEs Aware website is a wealth of information, visit there often to keep up to date on ACEs and their good work.

As an ACEs Aware grantee recipient, Western Youth Services (WYS) is a part of the team bringing awareness about ACEs and the effects of toxic stress to Medi-Cal and other healthcare providers. Resources  include training, screening tools, clinical protocols, and payment for screening children and adults for ACEs to improve the health and well-being of children, families, and communities.

According to a  report released in July 2021, between December 2019 and March 31, 2021, 17,100 individuals completed a Core Training. More than 9,700 of those who completed the training are Medi-Cal providers that became ACEs Aware-certified.

As an agency and as individuals, we here at Western Youth Services fully embrace the ACEs Aware mission into every aspect of our organization—from education and outreach to screening and treatment. In our commitment to continually improve our services and advance the larger body of ACEs research, we share the work we’ve done to enhance our client treatment plans and expand our Network of Care community.

Tools to Understand Levels of Adversity

We’ve used the Adverse Childhood Experiences Study (ACE Study or ACEs), the landmark 1998 study by the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente in our work as a mental health agency for children for many years. It describes ten categories of adversities in three domains experienced by age 18 years:

• Abuse: physical, emotional, and sexual abuse
• Neglect: physical and emotional neglect
• Household challenges: growing up in a household with incarceration, mental illness, substance dependence, absence due to parental separation or divorce, or intimate partner violence

The ACE Study and the science behind it have become integral components of our work. It’s an invaluable tool in determining the course of treatment for our clients. We have also had the opportunity to grow our educational platform and train other professionals and agencies on how to incorporate ACEs into the work they do.

We learned that this information has also had a personal and professional impact on our clinicians and our staff when we asked how knowing about ACEs has changed them:

The Addition of the Pediatric ACEs and Related Life-events Screener (PEARLS)

The original ACE Study was conducted in 1998 and included a narrow margin of society. To broaden the scope, additional tools have been designed, including a child and adolescent screening tool. The Pediatric ACEs and Related Life-events Screener (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 original ACE Study provides insight into the traumatic experiences that occurred in a child’s life. PEARLS was developed to learn more about the impact of related life experiences such as discrimination, community violence, food and housing insecurity, bullying, or a caregiver’s physical illness or death. This tool can enable more effective referrals, guidance, and support around preventing and addressing cumulative risk for toxic stress.

These assessments work together to gain a more complete vantage point. On an individual level, this expanded knowledge allows us to look for patterns in a family and coordinate our services and resources available through our collaborative relationships to provide lasting solutions that benefit the child and the family. On a community level, we can apply these collaborative solutions to create systemic change. Whether we are helping one child or an entire community, the ripple effect can benefit so many lives now and into future generations.

Learn more about the different types of assessments on the ACEs Aware Screening Tools web page.

The Benefit of Using ACEs and PEARLS Screening Tools Together

When Applied in a Mental Health Agency

The ACE Study is an incredible tool that has changed the way we treat clients. When we know ‘what happened’ we can understand the root cause of trauma and address it where it started instead of only treating a symptom of the trauma.

When the PEARLS assessment was introduced, we began using it in our client assessments and were able to have a deeper understanding. The additional seven questions that are focused on Related Life Events (RLEs) provided a broader view of the life of the child and the dynamic of the family. It also helped us to leverage our collaborative relationships and resources to bring together a collection of mental health and other services that are available for the entire family.

Expanding Awareness Through Trauma-Informed Networks of Care

The science behind ACEs illuminates that our life experiences and the environments in which we live shape our biology. This is exactly what the combination of the ACEs and PEARLS uncover. Clinical interventions are absolutely necessary, and it will take a village to significantly reduce the health impacts of ACEs and create safe, stable, and nurturing relationships and environments.

this is why the Network of Care is such an important approach.  It is a group of interdisciplinary health, education, and human service professionals, community members, and organizations that support adults, children, and families by providing access to evidence-based “buffering” resources and supports that help to prevent, treat, and heal the harmful consequences of toxic stress.

The village consists of cross-sector coordination of individuals and organizations that can do more together than individually. Through our work in the grantee program, we have been able to expand our network and our collaborative relationships which have always been part of the foundation of WYS. A trauma-informed network of care is an impactful group and can include:

Over the past year, we have hosted numerous Network of Care and Peer-to-Peer sessions that were educationally driven. We started with inviting Medi-Cal providers in Orange County, but it quickly expanded, and there were attendees from different walks of life, from all over California, and from around the world.

Many attendees had never heard of ACEs and even less knew about PEARLS. First, we listened to the questions that were asked and the feedback as we connected the dots. We created a series of topics, such as Provider Compassion: Coming to Terms with One’s Own Adversity, Art and Creativity: Resilience-Building Interventions for Youth, Resilient Parenting: Tools and Strategies that Work, Best Practices in Administering ACEs and PEARLS, and ACEs Response: Navigating the Trauma-Informed Network of Care. It was fascinating to learn how this information would be brought out into the world and humbling to think about the ripple effect that this growing village would generate.

We will continue to learn and share our expertise and experience as the village continues to grow.

If you would like to learn more about our trainings and workshops visit the ACEs Aware page of our website.

Lorry Leigh Belhumeur, Ph.D.
Chief Executive Officer
Western Youth Services
Pronouns: She/Her/Hers