ACE Screening Implementation How-To Guide

Stage 1

Prepare the Foundation

Stage 2

Select Your Approach

Stage 3

Implement the Program

Stage 4

Build Sustainability

About the Guide

The ACE Screening Implementation How-To Guide was developed to facilitate the adoption of ACE screening and trauma-informed care into practice at the organizational level. It provides practical, step-by-step guidance, as well as resources and tools to help clinics move further along their ACE screening implementation journey.

The structure of the How-To Guide and the focus of the content was informed by:

  • Implementation science frameworks for the introduction, scaling, and sustaining of innovations in health care.
  • Quality improvement strategies, which facilitate monitoring and improving on new health care practices.
  • Adult learning principles, which inform how to engage adult learners.

The tips and tools in this guide were derived from various sources, including:

  • Research on ACE screening implementation, including literature review and interviews with clinicians and clinical leadership of practices where screening has been implemented or tried.
  • Lessons learned through learning collaboratives and pilot programs that focused on the implementation of ACE screening and trauma-informed care, including the California ACEs Learning and Quality Improvement Collaborative (CALQIC), National Pediatric Practice Community on ACEs (NPPC), Resilient Beginnings Network (RBN), and Trauma-Informed Primary Care: Fostering Resilience and Recovery.
  • Research, reports, and dissemination tools from other screening implementation initiatives, including those related to intimate-partner violence screening, maternal depression screening, developmental screening, HIV risk assessment, and social needs assessment.

Acknowledgements

This How-To Guide was also developed and informed by contributions from ACEs Aware Subcommittee members, as well as several other key advisors and contributors. Each individual brought an invaluable perspective that informed the structure and content of this guide.

Sara Marques and Jennifer Marshall – Health+ Studio

Tanya Schwartz, Mallika Mahalingam, and Jennifer Ryan – Aurrera Health Group

Rachel Gilgoff, MD – ACEs Aware

Dayna Long, MD – UCSF Benioff Children’s Hospital Oakland

Mikah Owen, MD, MPH – UC Davis Health

Eric Ball, MD, FAAP – American Academy of Pediatrics – Orange County, California

Marti Baum, MD – California Medical Association – Board of Trustees

Kim Bower, MD – Blue Shield of California Promise Health Plan

Michelle Cabrera – California Behavioral Health Directors Association

Yvonne Choong, MPP (Co-Chair) – California Medical Association

Jerri Davis, CHCP – California Academy of Family Physicians

Lishaun Francis, MPP – Children Now1

Carey Watson, MD, FACOG – Kaiser Permanente (The Permanente Medical Group)

Amber Kemp, MBA – California Association of Health Plans

Lisa James – Futures Without Violence

Stephen Lockhart, MD, PhD – Sutter Health

Brigid McCaw, MD, MPH, MS, FACP – CALQIC

Demetria Malloy, MD, MSHS (Co-Chair) – Anthem Blue Cross

Mike Witte, MD – California Primary Care Association

Leon Altamirano, PsyD – North County Health Services

Deirdre Bernard-Pearl, MD – Santa Rosa Community Clinics

Tanya Dansky, MD (Facilitator) – ACEs Aware Clinical Advisor

Ken Epstein, PhD – University of California, San Francisco

Liza Eshilian-Oates, MD – Kaiser Permanente Southern California

Mike Flaningam, MD – Sutter Medical Group, Sacramento

Rachel Gilgoff, MD, MPH, FAAP – Stanford University

Nancy Goler, MD – The Permanente Medical Group

Lisa Gutierrez Wang, PhD – Santa Cruz County

Simone Ippoliti, PNP – Bayview Family Health Center

Dayna Long, MD – UCSF Benioff Children’s Hospital Oakland

Chris Longhurst, MD – University of California, San Diego

Eddy Machtinger, MD – University of California, San Francisco Medical School

Brigid McCaw, MD, MS, MPH – Senior Clinical Advisor, CALQIC, University of California, San Francisco

Connie Mitchell, MD, MPH – California Department of Public Health

Matt Pantell, MD, MS – University of California, San Francisco

Adia Scrubb, MD, MPP – California Academy of Family Physicians

Shannon Thyne, MD – University of California, Los Angeles Children’s Hospital

Linda Zane, MSN-FNP – Hill Country Community Clinic

Gregory Aarons, PhD, Professor, Department of Psychiatry, University of California, San Diego; Faculty, University of California, San Diego/San Diego State University Joint Doctoral Program in Clinical Psychology; Director, Child and Adolescent Services Research Center; Co-Director, Center for Organizational Research on Implementation and Leadership; Principal Investigator, National Institute of Mental Health and the Centers for Disease Control and Prevention

Mercie DiGangi DO, FAAP – Southern California Permanente Medical Group (SCPMG)

Meredith Evans and Rocio Rosas – Peach Tree Clinic