Understanding and addressing Adverse Childhood Experiences (ACEs) is an important component of promoting health and resilience. On September 12, 2023, Pathways to Resilience brought together experts Laurie Crawford from the Virginia Department of Social Services Office of Trauma and Resilience Policy, Antoinette Medina from the California Rural Indian Health Board’s Rural Epidemiology Center, and Mikah Owen from the UCLA-UCSF ACEs Aware Family Resilience Network. The speakers reflected on different approaches to and best practices for screening for adversity across different settings and populations.

Many Approaches, One Goal

Screening can help identify individuals at risk of experiencing the negative impacts of adversity and toxic stress and connect them to community resources and supports. However, screening is just the beginning. For example, Dr. Owens noted that he leverages screening as an entry point to conversations about the effects of adversity and various behavioral concerns or challenges. He shared that many of his patients have found relief and validation through the process of sharing about their past experiences and reflecting on their potential impacts. In Virginia, Laurie Crawford is implementing a screening process across various system entry points to meet children and families where they are being served and make personalized warm handoffs to community-based services. While the implementation and delivery of screening programs can vary across sectors and populations, the common thread is the goal of connecting children, families, and individuals to relevant supports and services to address potential negative outcomes associated with adversity, promote healing, and build resilience.

“The trauma exists whether or not we are screening for it… youth are impacted by it whether or not we ask about it.” – Dr. Mikah Owen, UCLA-UCSF ACEs Aware Family Resilience Network 

There Is No One-Size-Fits-All Approach

Much like the variety of screening and implementation approaches, there are many screening tools available to providers that vary by populations and settings. The California Rural Indian Health Board (CRIHB), for example, is in the final stages of developing a tool for use with Native American communities in California. The development of the Tribal Adverse Childhood Experience Tool (TACE) is a groundbreaking step towards screening that reflects Indigenous experiences, values, and resilience. Based on the expanded ACEs screening tool, TACE was developed with support from the Centers for Disease Control and Prevention and extensive community input. It incorporates key cultural elements and protective factors and aims to equip providers and communities with a culturally specific resource to screen for adversity among Native Americans. Antoinette Medina highlighted the importance of a screening approach that reflects culturally specific experiences and addresses additional adversities, such as the impact of colonialism and separation from ancestral homelands in American Indian and Alaska Native communities.

Virginia’s Department of Social Services has also introduced a new screening tool. Developed with support from the United States Department of Justice Office of Justice Programs and Office for Victims of Crime’s Linking Systems of Care project, the strengths-based tool is employed across systems entry points to identify adversity, potential symptoms or reactions to adversity, and protective factors and sources of support. Over 2,200 youth have been screened in the first year of implementation, with trends emerging related to the prevalence of community violence and exposure to weapons. Using this information, providers can identify opportunities to connect youth to services and identify gaps in existing support systems.

Moving Forward Through Connection and Care

To screen for adversity without appropriate follow up can be harmful and potentially re-traumatizing. When screening, providers collect deeply personal information creating a responsibility to act. Universal ACEs screening has been a topic of significant controversy in recent years, in part because of the risk if evidence-based interventions are not available following screening. While there is no single screening tool that meets all needs, there are best practices regarding post-screening activities. This may include providing basic education about trauma and toxic stress, discussing strategies for mitigating toxic stress symptoms, validating the individual’s experience, and connecting the individual to appropriate resources and services. These strategies, sometimes referred to as universal precautions, can be used with individuals regardless of their level of exposure to adversity.

Additionally, organizations may consider developing a network of care in their community to connect individuals with local resources to mitigate impacts of trauma and toxic stress.

How to Get Started with Screening

For organizations interested in starting screening initiatives, there are two concrete steps you can take to get started:

Assess organizational readiness. Do you have a leadership champion for the initiative? Do frontline staff have the capacity to implement a new protocol? Is your organization prepared to deliver a screening in a culturally-responsive manner that avoids re-traumatization?

Develop a Network of Care. Trauma-responsive, healing-centered networks of care are groups of cross-sector organizations that collaborate and coordinate to connect children, families, and individuals to services and supports to prevent, treat, and heal from the harmful consequences of trauma and toxic stress. Networks of care vary across communities and may include culturally relevant, community-based organizations, health care providers, educators, and government agencies. Are community resources available to support referrals and connection to services? Form multidisciplinary workgroups and identify leadership to champion the initiative. Include community members and individuals with lived experience to inform the process as you plan.

Through thoughtful, culturally responsive, and community-informed implementation of screening processes, providers can pave the way for improved well-being for individuals and communities.

Pathways to Resilience thanks Antoinette, Laurie, and Mikah for their time and support of this Learning Network session. You can find resources from the speakers in our Pathways Resource Library.

Interested in developing a screening process for your organization? Pathways to Resilience supports organizations with needs assessments and organizational assessments, workforce development and education, and screening implementation processes and procedures. Learn more here.

Watch the full Pathways Learning Network session below. Pathways to Resilience will continue to amplify strategies for promoting healing and resilience across sectors and states.