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November 4, 2019

Trauma-Informed Care as a Universal Precaution: Beyond the Adverse Childhood Experiences Questionnaire

Author Affiliations
  • 1Department of Psychology, University of Calgary, Calgary, Alberta, Canada
  • 2Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada
  • 3Riley Park Maternity Clinic, Calgary, Alberta, Canada
  • 4Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
JAMA Pediatr. 2020;174(1):5-6. doi:10.1001/jamapediatrics.2019.3866

Experiences of childhood adversity are common, with more than 50% of adults reporting having experienced at least 1 adversity as children and more than 6% exposed to 4 or more adverse childhood experiences (ACEs).1 There is currently a controversial debate in the medical field as to whether the ACEs questionnaire, which asks about abuse, neglect, and household dysfunction before age 18 years, should be administered as routine practice by pediatricians. While some argue that identifying and addressing ACEs can lead to support that may promote resilience and help decrease the well-established health burden of ACEs,2 others caution against its limited evidence and effectiveness as a universal “screening tool” as well as its potential harms in terms of revictimization and increased patient stigma.3,4 Although research on the potential benefits and consequences of universal screening for ACEs is in its infancy, the ACEs questionnaire has been rapidly adopted into pediatric care settings across North America. For example, $45 million has recently been allocated to state funding in California to increase ACEs screening and trauma-related training in pediatric care settings. Moreover, there are now 27 states that have statutes and resolutions associated with ACEs and trauma-informed approaches to care.

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