in Vermont, we are working with our legislature. Elizabeth Prewit did two (?) pieces about the Vermont activity, which I'm sure you can find on the ACEs Connection website. I took issue with them on prescisely this issue - the screening. The ACE study is an incredibly valuable study. It is a watershed moment in the childhood trauma world. It did not, however, develop screening tools, and it is not "trauma informed." The ten-item ACE questionnaire is not a validated screen - it came out of the ACE study. It is an event-based questionairre that trauma experts have great concern about - asking questions about events is often triggering for trauma survivors. I am well aware that for the ACE study someone carried a cell phone 24/7 in case anyone who went through the much more intensive questioning for the study needed support afterwards. No one ever called that cell phone, and therefore, the presumption is that no one was triggered. This is an impossible assertion to make - we cannot draw conclusions from data that does not exist. Trauma experts say that it is very likely that many people were triggered, and the significant drop in primary care visits that the ACE study documented in the year following the study may well have been, at least in part, due to triggered patients not wanting to go back to the place that triggered them.
It is important to note that this may not have been conscious on the part of the patients. They may just have avoided the practice and not, themselves, known why. It is also important to note that a trauma survivor who is triggered may not themselves be aware that they were triggered - the response ( which may be severe dissociation, with a range of consequences, for the trauma survivor him/herself, and for that person's family and friends, perhaps also for coworkers) may not really "kick-in" until a week or two later (or longer?). That same person may well avoid the place that triggered them, but never realize, in any conscious way, that they were triggered or who triggered them. So to say that the fact that no one called the 24 hour hotline number means no one was harmed by the event-based questions is double-jeopardy. No data does not provide us a conclusion in any situation, and then when we're in the world of childhood trauma and it's attendant psychological ramifications, the ACE study is well out of it's depth.
This is all to say that any screen must be validated. It should be a symptom-based screen if non-trauma-trained professionals are administering it.
In Vermont we are looking at the 4 question PTSD screen for adults, and for children using a question that was suggested in a recent JAMA article: "Since the last time I saw you, has anything really scary or upsetting happened to you?"
We have a workgroup focused on this issue that is working with representatives from two primary care practices.
Addressing childhood trauma, with adults and with children, is of critical importance, and it is the ACE study that made that clear. It is imperative, however, that any work to address childhood trauma relies on the experts in childhood trauma - those psychiatrists and psychologists who have made early toxic stress, it's prevention, intervention and treatment, their focus. MDs are experts in their fields, but unless they're MDs in psychiartry who have focused on childhood trauma, it is as irresponsible to rely on them for addressing this as it would be to ask a cardiologist to advise on treatment for an endrocrine disorder.
You might check out the National Child Traumatic Stress Network and SAMHSA for resources for screening for trauma. Both have compiled screens and the research behind them that would be very helpful.