ACEs and SR are correlated.

Childhood trauma shapes current life stressors.

“They all work so hand in hand with each other. It's impossible to take one out from the other.” – primary care clinician

“The ACEs questionnaire, the original adult 10 question questionnaires, is just not, in and by itself, as useful as when we combine it with more social determinants of health questions. And even just the PEARLS tool that we use for kids is so much more helpful, because it has these additional categories that are really crucial for us to know about.” – clinic leader and primary care clinician

“I believe it's absolutely necessary to have both. If you're opening a wound and not addressing it… It's not trauma informed, it's not patient-centered. And I believe it defeats the purpose of the conversation… As we look at social determinants of health, these are things that people live, experience, work. All these conditions impacted their family from their childhood, impacted their teenage selves or adult selves, the kids that they're raising and the families that they're starting. If we're talking about ending cycles of ACEs, it means giving them support.” – ACEs navigator

ACEs and SR screening can have positive impact on patient-clinician relationships.

Screening may elicit trust and open communication.

“I think it opens so many beautiful doors. I've never ever felt it hindered my connection with my patients… I would say 90% of the time it leads to an opening and… a deeper connection with the patient.” – primary care clinician

“I feel that it does open things up, it does open a gateway to be able to interact and understand your patients more and see where they're coming from, as well as for the patient, who realizes that the provider does care.” – medical assistant

“I could see it definitely being triggering for some people… it perhaps creates a barrier between the provider and the patient. But I think at the end of the day, opening the dialogue and also, it does create a sense of trust if asked appropriately. And then with some sensitivity, knowing that they can trust their primary care provider.” – patient

ACEs screening can trigger emotional responses from patients – Addition of SR screening could overwhelm patients.

“What I'm afraid would happen is that people would start to deny their economic needs that we could help with… Because they're like, ‘Every time you ask me these questions, it re-traumatizes me. I don't want to talk about this anymore.’ They're like, ‘No, I'm fine. I have enough food.’ ‘No, I'm fine. I don't need transportation.’” – primary care clinician

“I feel like the ACEs is very personal and if you ask those personal questions, sometimes it brings up bad memories. They tend to get emotional, it just brings up their past… And then if you turn around and you're like, ‘Okay, well are you homeless? Are you, this?’ And then it's kind of like, ‘No, I don't want to talk about it.’ So like, ‘I'm done with the conversation, I don't want to talk about anything else.’ So I feel like one thing at a time, instead of bombarding them with 20 million questions, I think would be better.” – medical assistant

“It would feel like… a job interview instead of a doctor's appointment.” – patient