Trauma-informed care is crucial when screening for adverse childhood experiences

  • Racine N & al.
  • JAMA Pediatr
  • 4 Nov 2019

  • International Clinical Digest
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Takeaway

  • 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.

Key comments

  • 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.

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