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Reply to "Integrating ACE Screening and Intervention into Primary Care"

Marcus,

A colleague and I have been screening for ACEs in our internal medicine practice for a year. There's more written on addressing ACEs in a pediatric setting, such as the Center for Youth Wellness mentioned above, with very little in the literature for adult patient settings. We use the traditional ACE Questionnaire, though look at it more as a conversation starter as to how one's childhood was. We feel it has been very successful doing such screening, and the patient response has been overwhelmingly positive, with essentially no negatives. A few caveats are that I've yet to find a way to do the screening and follow up discussion without taking a longer than scheduled visit (I typically go 45-50 min, while the slots are 30 min); it's hard for me not to stop talking, as it's typically such a powerful educational opportunity, and the patients are almost always into it (if they aren't I keep the discussion short). Another very important point is that screening needs be done in a trauma informed way, with the patient feeling it's a safe environment. If I sense someone is in a anxious state, I won't screen. That being said, there are several studies looking at medical assistants, or other non-clinical staff, giving out questionnaires to parents of pediatric patients, and the results show the high majority of parents appreciate the screening. I'm not sure how well this translates to adult patients.

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