ACE Overviews
Trauma-Informed Care
Clinician
Non-Clinician
Scripting and Screening tools for ACE - for Clinical and Non-Clinical Staff
Self-Care for Staff | Addressing Vicarious Trauma

Patient and Family Materials
Workflows
Policies and Procedures
Billing and Reimbursement
Quality Improvement

The Health Improvement Partnership of Santa Cruz (HIP) has created a curated list of resources to support primary care practices that are implementing, adopting or sustaining an ACE screening program that provides a trauma-informed care approach. We do not want to replicate other sources such as the comprehensive resources on the ACEs Aware website. Rather, we are responding to a need to manage the sheer volume of information and resources related to ACE screening, treatment and healing.

Please contact Laura Wishart at lwishart@hipscc.org to provide feedback, alert us to other high-value resources, or to submit a resource created by you or your organization.

Resources by Type

Resources for Adverse Childhood Experiences (ACE) Screenings

How childhood trauma affects health across a lifetime. Motivating 15-minute TED talk by Dr. Nadine Burke Harris, making the case that everyone needs to know about and understand the impacts of ACE. Great for all staff to hear!

ACEs Aware Trauma-Informed Network of Care Roadmap - Draft for Public Comment. ACEs Aware. This is a comprehensive 93-page guide or roadmap for implementing and fully adopting ACE screening in California. This is a must-have resource! As of April 2, 2021 - The public comments have been gathered and are being incorporated into the Roadmap. The team making the updates is in the process of evaluating the evidence behind some of the recommendations, although not much is expected to change. The final version is expected to be released later in April 2021.

California's Mandated Reporting Requirements and ACE Screening. ACEs Aware. It is possible that responses to an ACE screening can reveal child abuse and/or neglect. In this instance, it may indicate the need for a mandated report to Child Protective Services (CPS).

The Science of ACEs and Toxic Stress. ACEs Aware. Explains the impact of ACE and toxic stress on health.

The Science of ACEs and Toxic Stress (Part 2). ACEs Aware. Explores the impacts of ACEs on lifelong health and stress-mitigation strategies.

The Science of ACEs and Toxic Stress (Part 3). ACEs Aware. Demonstrates how providers can develop their treatment and follow up plans in response to ACEs and toxic stress.

The Science of ACEs and Toxic Stress. ACEs Aware. Explains impact of ACE and toxic stress on health.

ACE Overviews

“Trauma-informed care recognizes and responds to the signs, symptoms, and potential consequences of trauma to support the health needs of patients who have experienced ACEs and other risk factors for toxic stress.” ACEs Aware Trauma-Informed Network of Care Roadmap - Draft for Public Comment p. 14

Fostering Resilience and Recovery: A Change Package for Advancing Trauma-Informed Primary Care. National Council for Behavioral Health. While long at 80 pages, this is an excellent guidance document with helpful checklists and change concepts for organizations seeking to implement a trauma-informed approach to patient care.

Trauma-Informed Care Overview. ACEs Aware. Reviews information on the framework and principles of trauma-informed care - succinct five-page fact sheet

Trauma-Informed Care Champions: From Treaters to Healers. Trauma-Informed Care Implementation Resource Center. Series of videos to help build awareness and generate buy-in toward becoming a trauma-informed organization.

Trauma-Informed Care

Becoming ACEs Aware in California Training. ACEs Aware. Certified two-hour case-based training for providers to learn about ACE and evidence-based care to effectively intervene on toxic stress - must have NPI number to access and take the training.

About the CDC-Kaiser ACE Study Centers for Disease Control and Prevention. Detailed information about the original ACE Study conducted at Kaiser Permanente from 1995 to 1997.

Rationale for ACEs Screening Center for Youth Wellness. Explains how screening can improve clinical decision-making and prevent negative health outcomes. Short at three pages and includes some ACE screening statistics (prior to 2018).

Clinician

What is Toxic Stress? Center for Youth Wellness. Describes the differences among positive, tolerable and toxic stress responses; clarifies how toxic stress affects children’s bodies and provides short guidance on how adults can protect children from toxic stress. Short two-pager - good for non-clinical staff and possibly for patients.

ACE Training for Non-Clinician Staff (Pilot). recorded byTrudy Bearden. This pilot training was filmed in April 2021 in response to supporting a clinic cohort in implementing ACE screening in their practices.

ACE Screening Sample Scripts for Pediatric Clinical Teams. ACEs Aware. This guide outlines best practices for introducing ACEs screening to your patients and conducting a successful screening.

Clinician and Non-Clinician

ACE Screening Implementation How-To Guide. ACEs Aware. This guide breaks down screening integration in four stages to help organizations.

ACE Screening, Clinical Assessment, and Treatment Planning for Toxic Stress. ACEs Aware. ACE Screenings are not a diagnosis, rather they are an indication to build trust and further investigate your patient's ACEs to develop a functional mutually agreed treatment plan. This guide provides strategies on making a clinical assessment and treatment plan.

Putting It All Together — Your ACE Screening & Clinical Response Approach. ACEs Aware. This guide supports clinic teams in identifying their approach and response to ACE screenings.

Conducting Sensitive Screenings. EM Consulting. Download this excellent resource that includes several scripting examples regardless of whether you’re doing a telehealth or in-person visit.

PEARLS Resilience De-Identified, Positive and Negative. EM Consulting. Excellent 11-min video of an MA conducting an ACE screening on a video visit, using “actors”.

Providing Anticipatory Guidance for ACEs Screening. Center for Youth Wellness. Scripting guidance and tips for introducing ACE screening to families - use for clinical and non-clinical staff.

Communicating About ACEs. Center for Youth Wellness. Scripting guidance and tips to build trust with families when screening for ACE - use for clinical and non-clinical staff.

Conducting Sensitive Screenings. EM Consulting. Download this excellent resource that includes several scripting examples. We encourage your teams to roleplay conducting screenings as part of your practice’s implementation and onboarding procedures.

PEARLS Resilience De-Identified, Positive and Negative. EM Consulting. Excellent 11-min video of an MA conducting an ACE screening on a video visit, using “actors”.

ACEs Screening Tools. Screening Tools. Tools for conducting ACE screening for children and adults- use is for clinical and non-clinical staff. Screening tools are available in 17 languages.

Screening tools for Children and Adolescent Screening

Child (Parent-Caregiver Report) – De-Identified. Center for Youth Wellness, UCSF Benioff Children’s Hospital
Child (Parent-Caregiver Report) – Identified. Center for Youth Wellness, UCSF Benioff Children’s Hospital
Child (Parent-Caregiver Report) – Part 1 De-Identified, Part 2 Identified. Center for Youth Wellness, UCSF Benioff Children’s Hospital
Teen (Parent-Caregiver Report) – De-Identified. Center for Youth Wellness, UCSF Benioff Children’s Hospital
Teen (Parent-Caregiver Report) – Identified. Center for Youth Wellness, UCSF Benioff Children’s Hospital
Teen (Parent-Caregiver Report) – Part 1 De-Identified, Part 2 Identified. Center for Youth Wellness, UCSF Benioff Children’s Hospital
Teen (Self-Report) – De-Identified. Center for Youth Wellness, UCSF Benioff Children’s Hospital
Teen (Self-Report) – Identified. Center for Youth Wellness, UCSF Benioff Children’s Hospital
Teen (Self-Report) – Part 1 De-Identified, Part 2 Identified. Center for Youth Wellness, UCSF Benioff Children’s Hospital

Screening Tools for Adult Screening

Adverse Childhood Experience Questionnaire for Adults - Identified. California Surgeon General’s Clinical Advisory Committee.
Adverse Childhood Experience Questionnaire for Adults - De-identified. California Surgeon General’s Clinical Advisory Committee.

Scripting and Screening tools for ACE - for Clinical and Non-Clinical Staff

Staff involved in ACE screening and treatment of toxic stress may be triggered or experience vicarious trauma. Systems need to be in place to support staff if either of these occur.

The Journey Toward a Healing Organization. Center for Care Innovations. 10 Steps to transform a workplace into a healing organization.

Self-Care for Staff | Addressing Vicarious Trauma

Parenting with ACEs Explains how a parents’ ACE can increase risk for ACE in their child.

What are ACEs and Why Do They Matter? Center for Youth Wellness. Potential parent two-page handout but only if high literacy - provides high-level overview of ACE.

To Lower Toxic Stress at Home Things families can do to improve their health and well-being.

Supportive Relationships

The Benefit of Supportive Relationships. Center for Youth Wellness. Explains the importance of maintaining supportive relationships and tips to do so.

Quality Sleep

Good Sleep Habits. Center for Youth Wellness. Tips to help children get a good night’s sleep.

Balanced Nutrition

Tips for Good Nutrition. Center for Youth Wellness. Tips to improve healthy routines and nutritional food consumption.

Physical Activity

Promoting Exercise. Center for Youth Wellness. Ideas to encourage children to get enough exercise.

Mindfulness Practices

Using Mindfulness. Center for Youth Wellness. Introduction to mindfulness as a tool to reduce toxic stress.

Access to Nature

Santa Cruz County

Mental Health Care

Improving Mental Health. Center for Youth Wellness. When to seek professional support in protecting your child from the effects of toxic stress.

ACEs Aware Self-Care Tool for Adults. ACEs Aware. Self-guided checklist for adults to set goals that help decrease stress and improve health.

ACEs Aware Self-Care Tool for Pediatrics. ACEs Aware. Self-guided checklist for families to set goals that help decrease stress and improve health.

Patient and Family Materials

ACE Screening Clinical Workflows, Risk Assessment Algorithm, and Associated Health Conditions: For Pediatrics and Adults. ACEs Aware. Template workflows, risk algorithms, and list of health conditions.

ACEs Screening Implementation Plan Template, Sample Workflow and Starter PDSA HIP. These three resources were created during a pilot program with three health care organizations. The implementation plan is modifiable for months and includes most of the actions required to implement ACEs screening. The sample workflow is just one example of how the screening workflow may be executed. The starter PDSA is for organizations or teams that want to have an organized plan for piloting screening with one care team. The starter PDSA form includes relevant prompts and space for the Do, Study and Act portions of the pilot (or test of change).

To download and adapt: Press on the three dots in the upper right hand corner and select Download. This will then become editable using Microsoft PowerPoint.

Workflows

ACEs Screening Policy and Procedure DRAFT. HIP. This resource was created at the request of the three health care organizations that participated in a pilot program. It can be downloaded as a modifiable Word document from Google docs.

Policies & Procedures

Reminders for ACEs and Childhood Developmental Screening Billing Medi-Cal publication aggregating communications about ACE screenings and summarizing billing guidelines.

Medi-Cal Certification and Payment Alliance network providers will need to complete ACEs training and attestation of completion to receive payment. This link explains how Medi-Cal providers can receive payment for screening for ACEs. ACE screenings will need to be billed for on a separate claim from the well-visit or sick visit to receive payment. Contact your Provider Relations Representative with any questions.

Billing and Reimbursement

Screening for Adverse Childhood Experiences (ACEs) in Pediatric Practices. Center for Community Health and Evaluation. Insights based on learning from evaluations of two programs.