- Even as some clinicians urge widespread uptake of screening for adverse childhood experiences (ACEs), others urge caution and application of the principles of trauma-informed care.
- Asking about a child’s ACEs history should be done as part of a continuum of relevant care, not as a single action.
Why this matters
- 6% of people report exposure to at least 4 ACEs, and some clinicians have called for broader screening and preventive steps, including in a recent JAMA paper.
- Risks include revictimisation or fumbling follow-up care.
- As screening for ACEs gains more attention and resource infusions, care needs to be taken to have a safety net for children who screen positive.
- These authors call early adoption of these tools “premature.”
- Little evidence supports their incorporation into routine practice, these authors say.
- No rigorous evaluation or validation has been performed.
- For non-paediatric patients, the ACEs screen excludes any experiences beyond childhood and should not stand in for screening for these.
- Evidence is limited that screening will be preventive, they say.
- Potential harms include re-traumatisation, lack of follow-up, inappropriate care that is not trauma-informed.
- These authors say that being trauma-informed should precede ACE screening as routinely as handwashing precedes patient interaction.