Pediatric ACES assessment within a collaborative practice model: Implications for health equity

Am J Orthopsychiatry. 2021;91(3):386-397. doi: 10.1037/ort0000536. Epub 2021 Apr 1.


It is now well understood that exposure to Adverse Childhood Experiences (ACEs) is negatively linked to health and well-being across the lifespan. In an effort to disrupt ACEs exposure and its effects, there is a nationwide movement to screen for ACEs in primary care, despite a lack of well-established guidelines for assessing and responding to risk within routine care. Additionally, developing culturally responsive models of ACEs assessment is imperative, particularly because racial and ethnic minority populations face disproportionate risk of exposure to ACEs and disparities in quality of health care. Using mixed methods, we explored the feasibility, acceptability, and utility of conducting ACEs routine inquiry with an ethnically and economically diverse pediatric population through a unique collaborative practice model (CPM) consisting of an integrated, multidisciplinary team within primary care. In the CPM study, 163 children from a safety-net health system were enrolled; of those, an ACEs questionnaire was collected from 158 (97%) study participants as part of their mental health evaluation. The sample was highly ACEs exposed, with 40% of children and 56% of teens having scores of four or more. There were significant associations between level of ACEs exposure and degree of mental health impairment in both children and teens. Providers viewed the ACEs assessment process as feasible, acceptable, and to have utility for the care of the study's diverse pediatric population. Findings highlight benefits, challenges, cultural considerations and recommendations for promoting health equity through a primary-care integrated ACEs assessment model. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

MeSH terms

  • Adolescent
  • Adverse Childhood Experiences*
  • Child
  • Ethnicity
  • Health Equity*
  • Humans
  • Minority Groups