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Screening for Adverse Childhood Experiences (ACEs) in an Integrated Pediatric Care Model

         The Center for Youth Wellness (CYW) is a clinical research center located in Bayview Hunters Point, that was created in response to the medical understanding that early adverse traumas can harm the developing brain and bodies of our children. They operate on the mission to improve the health of children and adolescents exposed to adverse childhood experiences (ACEs). The CYW has collaborated with the Bayview Child Health Center (BCHW) to develop tools and methodologies for early detection and interventions. Together they created the BCHC-CYW Integrated Pediatric Care Model, which is aimed to address the medical and behavioral health needs of children exposed to ACEs.

         As many of you may know scientific research suggests a strong, dose-response association between ACEs and negative health outcomes. Also in children ACEs have been correlated with poor general health, illness requiring a doctor, fair or poor dental health, lifetime asthma, attention deficit hyperactive disorder, autism, being overweight or obese, and learning difficulties (Purewal et al., 2016). Physiological stress response at an early age also plays an important role in negative long-term health outcomes. This stress response refers to the physiological and behavioral response to selective pressures from the physical and social environments disrupting the self regulating property (homeostasis)  to maintain internal stability (Purewal et al., 2016).  Toxic stress is an intense, frequent, sustained activation of the body’s stress response, which can cause chronic dysregulation of the neuro-endocrine-immune (NEI)  network making it difficult for the body to return homeostasis. If toxic stress occurs during important stages of childhood development this could permanently change a child’s physiology and increase vulnerability to developmental, biological, psychiatric, psychological, and behavioral outcomes in adulthood.

         Screening children for ACEs will promote health development and is a critical investment in preventing poor health outcomes over the span of one's life.  The American Academy of Pediatrics now recognizes importance of identifying child maltreatment to better support positive child development. The AAP called on pediatricians to “actively screen for precipitants of toxic stress that are common in their particular practices”(Purewal et al., 2016). Interacting with families early and at regular intervals could enhance the opportunity for a provider to develop a trusting relationship  with a patient and help them come up with a treatment plan if toxic stress is indicated. Early childhood is a crucial time for the developing brain and is a particularly vulnerable time to the effects of ACEs, which is why early intervention and treatment should be utilized.

         A questionnaire similar to the ACE’s questionnaire created by Felitti and Anda has been adapted for screening and here is the breakdown of their questionnaire and model of care for reference.

I hope this was a valuable resource to you all and demonstrates the importance of early screening and trauma informed care!


Purewal, S. K., Bucci, M., Gutierrez Wang, L., Koita, K., Silverio Marques, S., Oh, D., & Burke Harris, N.   (2016). Screening for Adverse Childhood Experiences (ACEs) in an Integrated Pediatric Care Model. Zero To Three36(3), 10-17.


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