Alex, age 16, is a high school sophomore who is physically healthy. He plays intramural sports and recently joined a service club. Alex comes to the clinic alone for his annual physical and is also concerned about acne. The medical assistant hands Alex the Pediatric ACEs and Related Life Event Screener (PEARLS) questionnaire to complete. Alex is unsettled by the questionnaire and returns it to the Medical Assistant with a zero score.
What Alex Is Thinking as the ACEs Screening Is Introduced
- I am here for a physical and have to get to my job. What do these questions have to do with my health? I don’t have time for this.
- I am embarrassed by what happened to me. It’s in the past, and I have moved on. I don’t want to get emotional here; no one here really knows me.
- I bet they don’t give this to everyone like the medical assistant said.
- I wonder who sees the answers. I don’t want everyone in the office or my parents to know my answers to this questionnaire.
- Recognize approaches to inquiring about and validating adversity, distress and strengths in ways that support healing
- Identify words and practices within the TRIADS framework that resonate with your own approach to health care
- Practice applying the TRIADS framework
Watch & Learn
Maria, the medical assistant, answers Alex’s questions about the confidentiality of the screening and who else has access to his responses.
Dr. Anda Kuo, a pediatrician, tells Alex that she appreciates how the PEARLS screener asks about strengths – that is, what helps teenagers thrive.
In a follow-up visit, Dr. Anda Kuo realizes that Alex now wants to revisit some of the questions asked in the PEARLS screener.
Finding Your Own Words
Below are some commonly asked questions and an example response. The aim is to help you find your own words when communicating with your patients about the ACEs screening.
Why are you asking me these questions?
What I really like about the [PEARLS] screener is how it highlights strengths and what helps our patients cope well and really thrive. So that’s also part of the screener that you may have seen.
By asking everybody, it allows us to open the door for our patients to bring topics up that they may not have connected with things that are happening health-wise for them. What the screeners allow us to do is open that conversation, help us realize that there are other factors that might be impacting our health and how we’re feeling.”
I haven’t had these traumatic experiences…
I see that none of those experiences seem to have impacted you, but maybe take some time to think about it if you want. We can always talk about them later.”
How do you use the information from this screener?
For me, [the screener] validates some of the things that my patients are carrying around with them that might be impacting everything from acne to headaches to anxiety and depression. I could be prescribing medications and talking about depression in a different way when there might be some experience they’ve had that is directly impacting that acne, the headache, or the depression.”
I was thinking about those questions you asked me during the last visit…
I noticed that you have some questions about the screeners. Sometimes, when patients are curious like that it’s because they want to talk more about something. I’m just checking to see if there’s something about the screeners that you want to talk about. If not, you don’t have to.”
You’re doing awesome. We’re here to help make sure you can keep on the path that you have in front of you. If it works for you, I would like to touch base with you in two months or so by telephone.”
Now that you’ve reviewed the scenario above, reflect on the questions here, either on your own or in a group setting:
- How do you think that went?
- What do you think went well and what could have been improved?
- What language could you see yourself using when conducting an ACEs screening?
- How might this scenario be different if it were in person rather than telehealth?
After you’ve had a chance to reflect on your own, view a conversation between the health care team and Dr. Alicia Lieberman, Professor of Psychiatry at UCSF and Director of the Child Trauma Research Program.
Dr. Alicia Lieberman and medical assistant Maria talk about Maria’s role as the clinic’s “first point of contact” to build trust with patients who may feel vulnerable after completing an ACEs screening.
Dr. Anda Kuo reviews how to normalize experiences noted in an ACEs screening by using accessible language (e.g., difficult experiences) and relatable conditions (e.g., depression, headaches).
Dr. Anda Kuo and Dr. Alicia Lieberman discuss how a relational approach to care means being supportive, respectful, and dignifying what the patient expresses.
Now You Try It
Note: This is intended for all members of the health care team. Remember that we’re all learning and that there are no mistakes.
- Find the words and the body language from the Watch and Learn section that feel comfortable for you and that you can envision using in your conversations with patients.
- Jot down some of the suggestions from the Reflective Practice section that were most helpful to you.
- Now take a moment and visualize yourself running through this scenario with a patient.
- On your own or with another person, practice using the words and the body language that convey the message that you want. Alternatively, you can record a voice memo or video on your phone so that you can play it back to review. You may also get feedback from a trusted colleague or friend.
- In a group setting, pair-share or self-reflection, consider these questions:
- What came easy to you? What would take some work?
- What do you think you are doing well?
- What do you need some practice with?