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I'm a pediatric neurologist at University of Alabama at Birmingham and Children's of Alabama.  

ACEs in the Peds ED:  I've discussed ACE screening with some of my Peds ED colleagues (and there's interest) but that's as far as we've gotten....

 ACE screening elsewhere:  Is anyone doing ACEs in sub-specialty pediatrics?  I am looking for help on "best practices" in this setting.  

Over the past few months I have been informally asking an unscientific sample of my parents in Peds Neurology clinic to fill out ACE and resilience questions about themselves; I have not yet started using ACEs questionnaires for children and teens.  

I use the questions from ACEstoohigh site (https://acestoohigh.com/got-your-ace-score/ )  which I either print out or help them find link on their cell phones.  I also print out or help them link to ACEs101 (https://acestoohigh.com/aces-101).  It seems like my families hang on to information better if they put it on their phones than if they are given printed handouts!    

I instruct parents that they can tell me the number of ACEs if they chose to but don't need to tell me the specific ones.  I tell them I am mostly interested in their honest feedback on how they feel about the questions and whether they would find it intrusive if we included those questions for the parents and patients along with our standard intake form.  

The first parent I surveyed had "all but 3" ACEs and said she thought it was important that we ask these questions.  Most of the 15-20 other caregivers (mostly moms) I have surveyed since then have told me they are glad someone knows about stressors they have had in their lives.   Several parents said they would be more comfortable answering on a touch screen rather than being questioned directly or filling out a paper form. Only one mom to date has told me she thought we shouldn't ask these questions, in part because she worried it could result in "labeling" or "judgement" by medical staff.

Questions:  In a place where a child may have clinical encounters in lots of different settings,
1.  Should we be screening for ACEs in a tertiary care setting?  
1a.  If so, where? (ED? Inpatient services? Outpatient neuro clinic? Behavioral health? GI clinic? Every clinic?) 

2.  Who gets screened? (patient only? or include only parents or grandparents or whoever the caregiver is?)  
2a.  If we ask parents, grandparents, etc about their own ACEs, how do we avoid repeat screening?

3.  How often do we screen children and teens for ACEs?  And how do we ensure screening "often enough" at the right times without over doing it?

4.  Should patient/parental ACEs be part of the electronic medical record?(perhaps in protected field to limit access)? 

5.  And as a research question, what is best way to assess epigenetic changes to see whether they correlate with ACEs?

 

Jayne Ness posted:

I'm a pediatric neurologist at University of Alabama at Birmingham and Children's of Alabama.  

ACEs in the Peds ED:  I've discussed ACE screening with some of my Peds ED colleagues (and there's interest) but that's as far as we've gotten....

 ACE screening elsewhere:  Is anyone doing ACEs in sub-specialty pediatrics?  I am looking for help on "best practices" in this setting.  

Over the past few months I have been informally asking an unscientific sample of my parents in Peds Neurology clinic to fill out ACE and resilience questions about themselves; I have not yet started using ACEs questionnaires for children and teens.  

I use the questions from ACEstoohigh site (https://acestoohigh.com/got-your-ace-score/ )  which I either print out or help them find link on their cell phones.  I also print out or help them link to ACEs101 (https://acestoohigh.com/aces-101).  It seems like my families hang on to information better if they put it on their phones than if they are given printed handouts!    

I instruct parents that they can tell me the number of ACEs if they chose to but don't need to tell me the specific ones.  I tell them I am mostly interested in their honest feedback on how they feel about the questions and whether they would find it intrusive if we included those questions for the parents and patients along with our standard intake form.  

The first parent I surveyed had "all but 3" ACEs and said she thought it was important that we ask these questions.  Most of the 15-20 other caregivers (mostly moms) I have surveyed since then have told me they are glad someone knows about stressors they have had in their lives.   Several parents said they would be more comfortable answering on a touch screen rather than being questioned directly or filling out a paper form. Only one mom to date has told me she thought we shouldn't ask these questions, in part because she worried it could result in "labeling" or "judgement" by medical staff.

Questions:  In a place where a child may have clinical encounters in lots of different settings,
1.  Should we be screening for ACEs in a tertiary care setting?  
1a.  If so, where? (ED? Inpatient services? Outpatient neuro clinic? Behavioral health? GI clinic? Every clinic?) 

2.  Who gets screened? (patient only? or include only parents or grandparents or whoever the caregiver is?)  
2a.  If we ask parents, grandparents, etc about their own ACEs, how do we avoid repeat screening?

3.  How often do we screen children and teens for ACEs?  And how do we ensure screening "often enough" at the right times without over doing it?

4.  Should patient/parental ACEs be part of the electronic medical record?(perhaps in protected field to limit access)? 

5.  And as a research question, what is best way to assess epigenetic changes to see whether they correlate with ACEs?

 

I’m kind of bad here because I didn’t read your entire reply but this area of somatic complaints and concerns over behavioral problems like ADHD - is really where I started asking the ACE questions mixed in with a bunch of other psychosocial questions - and the ACEs were always very high.   I’ve been doing this since at least 2004. 

 

Rahil Briggs is awesome in this area as is NBHarris and they have a webinar coming up in a few days on integrating this into care. For Neurology - chronic headaches, GI (functional abdominal pain) and definitely psychiatry/behavioral pediatrics this information is essential. 

https://www.chcs.org/resource/...d2d3c31993-152144421

 

Last edited by Former Member

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