In the second step, we removed irrelevant studies based on the review of titles and abstracts and retained 20 studies that focused on screening for ACE. endobj Finally, 12 of the 13 studies focused on the acceptability of ACE screening from the perspectives of patients or clinicians; 9 studies addressed feasibility. endobj Client and provider discomfort with an adverse childhood experiences survey.
All children should be able to learn in a supportive environment, within a school culture that promotes and supports the health and safety of students and adults. Screening for childhood adversity among adult primary care patients. Vanessa Sacks is a research scientist in youth development at Child Trends. Clinicians are integral in identifying childhood adversities and offering supportive measures to minimize negative effects. 2 0 obj 25 0 obj 12, Documentation of the high prevalence of ACEs in the United States offers justification for screening programs and interventions to mitigate ACEs. All the studies examined in this literature review found most patients willing to complete ACE screenings. For student behaviors that may reflect underlying unmet needssuch as bullying and truancypunitive practices may be especially counterproductive. <>479 0 R]/P 616 0 R/S/Link>> Although many clinicians voiced concerns that patients would find ACE screenings to be too invasive, the studies included in this review suggest that the majority of patients find the ACE screening to be acceptable.7 Jee Hye Yoo, MSN, is a PhD candidate at Saint Louis University, Saint Louis, MO. American Psychological Association, Resilience Guide for Parents & Teachers,. One mechanism responsible for the effects of ACEstoxic levels of stresscan be substantially buffered by stable and supportive relationships with caregivers. Clinicians serving low-income families underestimate prevalence of ACEs and note barriers to screening and desired additional support to manage positive screens. Compared with non-Hispanic white children, Latino children in the U.S. experience ACEs at higher rates (42 percent have experienced at least one ACE compared to 36 percent of their non-Hispanic white peers), according to the report. , Nguyen M.W., Heberlein E., Covington-Kolb S., Gerstner A.M., Gaspard A., Eichelberger K.Y. D. Almond and J. Currie, Killing Me Softly: The Fetal Origins Hypothesis,, 13. , Pediatric clinic can successfully screen for ACE. endobj 216 0 obj <> endobj ACE training can prepare nurse practitioners to effectively screen. 28 0 obj Moore and Ramirez, Adverse Childhood Experience., 19. Feasible to incorporate ACE screening during routine primary care. Major disruptions were not noted in office flow or visits. Two small focus groups of adolescents from across the state highlighted the importance of answering such personal questions in the presence of a trusted adult. Office staff and clinician education lead increase in screenings. endobj There is growing interest in understanding the prevalence of these adverse experiences across different communities in the United States, as well as their implications for families, schools, and other child-serving institutions. %PDF-1.7 % Parental perspectives of screening for adverse childhood experiences in pediatric primary care. Rural primary care; race not included in study. Studies were included if they were written in English and conducted in the US. government site. <>44 0 R]/P 6 0 R/S/Link>> <>552 0 R]/P 624 0 R/S/Link>> Conn A.-M., Szilagyi M.A., Jee S.H., Manly J.T., Briggs R., Szilagyi P.G. , One effective implementation strategy was a 4-hour training on ACE health impacts and trauma-informed care; the sessions increased clinician comfort, knowledge, and screening confidence.16 Marsicek etal26 trained clinicians and staff to improve screening rates and recognized the need for annual curriculum for medical students and staff and onboarding training of new staff when turnover occurs. For more information, email Chelsea Prax at cprax@aft.org. , Screening Adolescents for Adverse Childhood Experiences (ACEs): Addressing the Unique Needs of Immigrant Youth. ). 572 0 obj Trained interviewers conducted follow-up phone calls to parents. 21 Publication dates were limited from January 2012 to October 2019. endobj 15 0 obj
WebinarsTalking with youth about suicide preventionHow to support children exposed to violenceHelping kids heal from trauma and manage stress. Christina Rariden, DNP, FNP-BC, PMHNP-BC, is an assistant professor at Saint Louis University in St Louis, MO, and can be contacted at christina.rariden@slu.edu.
endobj Of the 4 studies that included clients who did not speak English, 2 offered interpreters, and 2 offered materials provided in English and Spanish. Screening for Childhood Adversities in Prenatal Care: What Works and Why. Client discomfort may be lessened by ensuring that the clinician is comfortable discussing ACE issues.22 Clinician discomfort is evident to patients in verbal or nonverbal cues, which increases patients discomfort in being screened.22 Patients are willing to discuss trauma exposure and believe their clinicians will be able to provide assistance in a sensitive manner.20 Education and training on ACE screening can mitigate clinician discomfort, a sentiment echoed throughout the studies included in this review. Trauma-responsive care in a pediatric setting: feasibility and acceptability of screening for adverse childhood experiences. In many communities, these services are lacking or inadequate, underscoring the importance of schools as a frontline setting for addressing trauma and other mental health concerns. [. The .gov means its official. , , The 2 most commonly reported ACEs in all states were low socioeconomic status and the separation of parents. Toxic stress can impede learning and affect relationships and other aspects of functioning in school by impairing the areas of the brain responsible for learning, memory, threat detection, emotional regulation, impulse control and executive functioning. Medical assistant offered parent questionnaire; clinicians reviewed with parents. Before endobj Schools and educators play a critical role in that agenda, as well. 19, 20, 21, 22 Screening Adolescents for Adverse Childhood Experiences (ACEs): Incorporating Resilience and Youth Development. 37 0 obj In addition, there is a critical need in schools for more support staff (for example, school social workers, nurses, and psychologists) with the training to serve the needs of students. uuid:4b764c30-b108-11b2-0a00-601e1456fc7f 19 624 0 obj Half of students statewide have at least one parent who is an immigrant to the U.S., and one in five children enrolled in California public schools is an English language learner. 6 0 obj 16 Support locally based, school-driven initiatives to create supportive learning environments. American Federation of Teachers, AFL-CIO. 12 Paraprofessionals & school-related personnel, Safe and welcoming public schools for all, https://store.samhsa.gov/system/files/sma14-4884.pdf, What Educators Can Do to Support Students, Creating Safe Environments for Students with Adverse Childhood Experiences, Teaching Students with Incarcerated Parents, Talking with youth about suicide prevention, How to support children exposed to violence, Helping kids heal from trauma and manage stress. , TIC describes a variety of approaches that acknowledge the impact of trauma, recognize its symptoms, respond to its effects through appropriate practices and policies, and prevent further traumatization. Madigan S., Wade M., Plamondon A., Maguire J.L., Jenkins J.M. 12 0 obj 565 0 obj In 1 study, aggregate-level reporting yielded 11.2% ACEs in parents and was statistically significant compared with 8.1% with a specific item tool.12 Although aggregate-level reporting may prove beneficial for planning broad-level interventions, this approach makes it difficult for clinicians to tailor interventions to individuals based on specific childhood experiences. Adverse childhood experiences (ACEs) are linked with a negative impact on childhood development and an increased risk of chronic disease in adults.1 However, researchers noted that in a recent study, only half of adolescents had time alone with primary care providers and discussed confidentiality with those providers. At the same time, its important that those charged with screening immigrant youth for ACEs recognize that not all immigrants share the same life experiences regarding what motivated them or their families to leave their countries of origin, how they entered this country, their legal status, and the timing and political context of rejection or acceptance of immigrants and refugees all of which may place them at greater risk for ACEs, either before their arrival to this country, as part of their adjustments to their new country, or both.. In the second step, we narrowed down the scope of the search results to include only studies that pertained to clinical implementation, acceptability, and/or feasibility of screening for ACE. 16 endobj County offices play a vital role in supporting community schools, CSBA webinar gives local context to COVID relief spending report, Biden signs executive order with protections for LGBTQ young people, Schools play an important role in ACE screening for immigrant youth, Tool measures how states are prioritizing social-emotional and academic development, Studies examine effects of Californias push for computer science education . Schools and educators can also play a critical role by promoting these kinds of caring relationships, as well as social and emotional skills, that support healthy youth development for all students; removing exclusionary and punitive disciplinary practices; and supporting the physical and mental health needs of students. Austin A., Herrick H., Proescholdbell S., Simmons J. The original research paved the way for expanding the research of health implications from ACEs for adult and child health. Parents preferred to disclose ACE using aggregate levels. The site is secure.
, Once again, ACE screening in schools was found by those surveyed to be helpful in building trust in the process.
The practice papers cover a broad range of topics, some of which apply to local educational agencies and the organizations they partner with. Office staff offered parent questionnaire; clinicians reviewed with parents. Managing ACE risks can be part of primary care interventions. endobj Involving support staff in addition to clinicians is contributory to the successful implementation of an ACE screening program.21 Practice interviews and ACE screening simulations helped prepare staff and clinicians to ask questions and respond with sensitivity.16 endobj 541 0 obj This CSBA series will highlight several of these reports. 14 0 obj Photographs and illustrations, as well as text, cannot be used without permission from the AFT. Appligent AppendPDF Pro 6.3
M. Rutter, Protective Factors in Childrens Responses to Stress and Disadvantage, in, 11. 43 0 obj 1. 567 0 obj Screening for adverse childhood experiences in a family medicine setting: a feasibility study. Over 80% of the 1,678 women assessed indicated they were not uncomfortable or minimally uncomfortable with finishing an ACE screen with the assessor.22 Home screening acceptability offers an additional ACE screening platform for young families.23 Johnson etal23 proposed early intervention and linkage to resources are critical for young families given the importance of parent-child relationships and child development. endobj <> Trauma by Numbers: Warnings Against the Use of ACE Scores in Trauma-Informed Schools The cultivation of supportive, protective conditions by parents and other adults, by children themselves, and by their broader communities provides an ambitious but essential public health agenda. 25 26 Clinicians perceived ACE screenings to help develop a deeper clinician-patient relationship, highlight the mind and body connection, and foster integrated care.25 In the study by Gillespie and Folger,12 clinicians felt ACE screenings fostered a trusting relationship, increased their empathy toward patients, and led to better communication. Private outpatient pediatric office group found it feasible to screen for ACE. , 8600 Rockville Pike 26 This review also provides evidence that implementing screening is possible in a variety of health care settings including pediatric care, prenatal care, adult primary care, home visits, and schools.7 C. Buss et al., Intergenerational Transmission of Maternal Childhood Maltreatment Exposure: Implications for Fetal Brain Development,, 12. 
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application/pdf Research findings support the need for clinician and staff education to successfully incorporate ACE screenings. 11 0 obj Alex Winninghoff Policymakers should review initiatives regarding school safety and security to ensure they are consistent with trauma-informed principles. . and transmitted securely. It is well-documented that high ACEs impact overall health, yet, to date, ACE screenings have not widely been incorporated in routine primary care over possible concerns of patient discomfort. 
