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Painful Questions: What Happens When Doctors Uncover Adverse Childhood Experiences?

This excellent article [https://www.calhealthreport.or...ildhood-experiences/] by Karen de Sa and Nadra Nittle reviews arguments for and against universal pediatric screening for ACEs in California. The title question identifies a central issue -- what happens when screening identifies ACEs -- and the article examines potential challenges in answering that question. It also highlights Dr. Nadine Burke Harris' concern that if we know ACEs science, it is irresponsible not to take action. She indicates that she has not heard alternative proposals for action from critics of ACE screening that might achieve her important goal of reducing toxic stress. Those alternatives exist, however.

Surgeon General Harris misses the potential to make pediatric developmental screening universal in California. The 2017-18 National Survey of Children's Health reveals that in California only 25.9% of parents reported a developmental screening (Did the child receive a developmental screening using a parent-completed screening tool in the past 12 months, age 9-35 months?). This is well below the national average of 33.4% and neighboring Oregon's rate of 55.6%. The American Association of Pediatrics  recommends universal developmental screening which can identify health and behavioral issues related to toxic stress [https://www.aappublications.or.../developmental121619 ].  Developmental screening gets directly at health and behavioral issues that are both over- and under-predicted by ACE scores.

The original goal of ACE data was to help identify populations at risk of later health problems and thus to guide public health efforts and policy to diminish the likelihood of adversity. Policy initiatives that improve supports for families along with community resilience building promise to buttress primary prevention of childhood toxic stress. 

Thus, there are very real alternatives to ACE screening that have great promise for achieving Surgeon General Harris' goal.

 

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