Screening Tools

Several versions are available for different patient populations

female doctor smiling at young patient held by smiling father

Select the appropriate screening tool

Screening for ACEs helps primary care clinicians assess risk for toxic stress and guide effective responses. To receive Medi-Cal payment for conducting ACE screenings, clinical team members in California must use the following screening tools for children, adolescents, and adults.

The tools are available in 17 languages and in de-identified and identified formats so providers can choose the approach that works best for them and their patients:

  • De-Identified Screening: Respondents count the number of ACE categories on the screening tool and indicate only the total score — without identifying which ACE(s) they or their child experienced.
  • Identified Screening: Respondents count the number of ACE categories on the screening tool and indicate which ACE(s) they or their child have experienced.

Pilots of the pediatric ACE screening tool in a large pediatric setting indicate that randomization via the de-identified (as opposed to the identified) format may facilitate higher rates of disclosure and greater patient comfort with the screening experience.

For Children and Adolescents
The Pediatric ACEs and Related Life-events Screener (PEARLS) is used to screen children and adolescents ages 0-19 for ACEs. PEARLS was developed by the Bay Area Research Consortium on Toxic Stress and Health (BARC), a partnership between the Center for Youth Wellness, the University of California, San Francisco (UCSF), and UCSF Benioff Children’s Hospital Oakland. The PEARLS tool includes a screening for ACEs (Part 1) as well as a screen for additional adversities (Part 2). There are three versions of the tool available, based on age and reporter:

  • PEARLS child tool, for ages 0-11, to be completed by a parent/caregiver.
  • PEARLS adolescent tool, for ages 12-19, to be completed by a parent/caregiver.
  • PEARLS for adolescent self-report tool, for ages 12-19, to be completed by the adolescent.

For Adults
The ACE questionnaire for adults is adapted from the work of Kaiser Permanente and the Centers for Disease Control and Prevention. The adult screening tool was compiled by the Office of the California Surgeon General and Department of Health Care Services in consultation with the California Surgeon General’s Clinical Advisory Subcommittee. If an alternative version of the ACE questionnaire for adults is used, it must contain questions on the 10 original categories of ACEs to qualify for Medi-Cal payment. For 18 and 19 year olds, either tool may be used.