Identify and Treat Trauma
Screen Patients for Trauma
As organizations adopt trauma-informed approaches to care, many are integrating trauma screening into care models to assess patient exposure to adverse childhood experiences and trauma. While variation exists regarding when and how to screen for exposure to ACEs and trauma in adult and pediatric populations, following are core considerations to guide screening approaches:
- Treatment setting and patient population should guide screening. Upfront, universal screening may be more effective in primary care settings and later screening more appropriate in behavioral health settings to allow relationships to form. Variations in the frequency and type of screening might also exist between adult and pediatric populations.
- Screening should benefit the patient. Providers screening for trauma must have a clear strategy for utilizing the information in a way that supports patients’ health, including an established referral network.
- Care coordination should be employed to avoid rescreening. Sharing results across treatment settings with appropriate privacy protections may help reduce re-screening and the potential for re-traumatization. In pediatric populations, screening is often done frequently to detect exposure to ACEs and identify the risk of toxic stress.
- Ample training should precede screening. Health care professionals should be proficient in trauma screening and conducting patient follow-up in a manner that is sensitive to cultural and ethnic characteristics.
Adverse Childhood Experiences Revised Questionnaire is a screening tool adapted from the original ACE questionnaire that is used to assess childhood adversity in adult populations. ACEs Aware, 2019
ACEs Clinical Workflows, Algorithm, & ACE-Associated Health Conditions: Pediatric & Adults supports Medi-Cal providers in assessing a patient’s risk of toxic stress physiology and addresses how to incorporate ACEs screening results into clinical care and follow-up plans. ACEs Aware, 2019
Original ACE Questionnaire was used to assess participants in the original Adverse Childhood Experiences study, and is a widely used and validated tool. Centers for Disease Control and Prevention/Kaiser Permanente, 1998
technical assistance tool
Screening for Adverse Childhood Experiences and Trauma offers various approaches and considerations for screening adults and children for adverse childhood experiences and trauma. CHCS, 2019
What is a Trauma Screening Tool or Process? defines different types of screening tools and how to engage families in the screening process. Additional information can be found in their Screening and Assessment: Considerations for Implementation guide. National Child Traumatic Stress Network, 2018
From Treatment to Healing: Inquiry and Response to Recent and Past Trauma in Adult Health Care details key prepatory steps for inquiring about and responding to trauma, as well as four options when inquiring about trauma with patients. Women’s Health Issues, 2019
Montefiore Patient Information Sheet for ACEs Form is designed to inform patients prior to being screened for ACEs. It is also available in Spanish. Montefiore Medical Group, 2017
National Pediatric Practice Community on Adverse Childhood Experiences is a community and resource center for pediatricians interested in screening for ACEs within their own practices. National Pediatric Practice Community on ACEs, 2018
Becoming Trauma-Informed & Screening for ACEs: Learning from Montefiore Medical Center details Montefiore Medical Group’s approach to screening adult and pediatric populations for ACEs within its outpatient practice network. Center for Care Innovations, 2018