Are your local pediatricians asking about ACEs?

I work in a pediatric office as a therapist.  I routinely ask about trauma, but not every primary care office has a person like myself on staff. However, I feel like it's important to point out that the ACEs tool is meant to be used with adults.  It talks about experiences that have happened in the past. It has not been used with or normed with children. Asking about ACEs becomes a lot more complicated if a child discloses to you that they are currently happening, which I'm sure is one of the reasons many pediatricians may shy away from asking. It also is complicated because children do not have the ability or right to seek care for ACEs on their own. A child may disclose something and then be punished by the parent at home. In my clinic we do routinely screen for depression in children 10 and up. Nursing staff also ask if our patients feel safe at home. If either of these screenings are positive, I get involved with the family to figure out how we can best support them.

While I support the idea that we need to start identifying ACEs earlier in life, I also think we need to wait  until we have evidence-based tools and protocols that are specifically geared toward children in order to prevent unintended negative consequences that may impact this very vulnerable population.

I agree that the ACES tool is meant to be used with adults, not children. I believe that the way pediatricians can (and are  using it) is to ask the parents these questions about themselves. It can then lead into a discussion about their experience as parents, how they are doing with their children,  what resources they may need to mitigate the impacts of trauma on their parenting and help them provide more safety for their children than they themselves may not have had.

This, if true, would indicate that the data obtained were not truly representative of the ACEs actually experienced by the children: "Do you sexually abuse your children? If you answer yes, we've got a sheriff's deputy here who'd like a word with you".

Mind you, I'm not saying your description of the procedure would not be devoid of value; for most, very much to the contrary.

The more one thinks about it the more ways one can think of potential problems with the data.

In any event, this was a "stock question" put to pediatricians in practice -- even then, 63% of potential participants did not complete the survey, younger doctors in particular did not respond -- see the article for more details. In that, it did not ask the pediatricians about the methods they used to ask the questions, or to whom they put the questions. Dr Kerker was very generous and prompt about sending her article out when asked. But asking it here has provided some useful food for thought.

Several practices are asking just parents; many are asking parents and children. Parents of young children are asked to provide a number, not identify which ACEs. Here's a link to Dr. Burke Harris' expanded ACEs questionnaire and user guide -- http://sgiz.mobi/s3/ab0291ef106d

A family practice clinic in Pueblo, CO, uses an ACE questionnaire as an assessment tool for parents. A pediatric clinic in Portland, OR, uses ACE and resilience surveys with parents. Montefiore Medical Group uses an ACE survey with parents, and parents do a score for their children, as a screening tool for Healthy Steps. Roseland Pediatrics in Santa Rosa, CA, has parents of young children fill out an ACE survey for themselves and their kids; teens take their own survey. The Elsie Allen Health Center, which is on the Elsie Allen High School campus, has integrated ACE questions in their health assessment of teens that come into the clinic.

Yes, it was inevitable that teens would be able to fill out their own somewhere - - "just like birth control". But again, the focus for the research I quoted shouldn't really be on the children's behaviour, but on the pediatricians, and on their knowledge, of ACEs and their implications, as in "problem situations"  it's they,  the pediatricians who may be the most informed, the most powerful and legally obliged, people to "do something" about "the  problem ". 

What are the various consequences of the different practices in the various places? 

But thanks, Jane, valuable information. 

Our pediatric residents are asking about ACEs for age 0-17 coming in for well-child visits.