On June 16, 2020, $14.3 million in ACEs Aware grants was awarded to 100 organizations across California to augment the work of the state’s ACEs Aware initiative. A Dec. 9, 2020 report, Roadmap for Resilience: The California Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress, and Health, detailed how Adverse Childhood Experiences (ACEs) and toxic stress can impact learning and school success. Toxic stress can impede learning and affect relationships and other aspects of functioning in school by impairing the areas of the brain responsible for learning, memory, threat detection, emotional regulation, impulse control and executive functioning.
More than 20 ACEs Aware grantees were awarded funding to develop practice papers highlighting promising strategies and lessons learned, as well as new research around ACE screening and trauma-informed systems of care. The practice papers cover a broad range of topics, some of which apply to local educational agencies and the organizations they partner with. This CSBA series will highlight several of these reports.
Two were developed by the Philip R. Lee Institute for Health Policy Studies at the University of California, San Francisco. The first practice paper examines ACEs and ACE screening with adolescents through surveys with both adolescent health providers and adolescents themselves to understand their perspectives on this topic.
Approximately half of all adolescents ages 12-17 in the United States have experienced at least one adverse childhood experience, which can have profound detrimental effects, including increased risk for poorer physical health and learning and behavioral issues during childhood and adolescence, as well as depression, substance abuse, chronic illness and shorter lifespan.
Adolescence provides a key window of opportunity to ameliorate the short- and longer-term impacts of trauma and adversity, positively altering the life course trajectory, according to researchers, yet despite high prevalence rates of trauma and an increasing awareness of the importance of addressing ACEs, screening for ACEs in adolescent health care settings remains inconsistent.
This may be where schools can provide additional support. Two small focus groups of adolescents from across the state highlighted the importance of answering such personal questions in the presence of a trusted adult.
“All youth who had experienced any kind of psychosocial screening agreed that ‘time alone’ with a provider was important and an essential element for feeling comfortable in the visit,” the report states. “Some youth talked about preferring to be screened for ACEs in schools, as they had enough contact with school and school clinic personnel to know whom they would trust and whom they would seek out if they were having a problem, versus a primary care provider they saw once a year or less.”
Another primary concern about ACE screenings among adolescents was confidentiality.
Assurances of confidentiality are critical for increasing adolescents’ willingness to disclose information about their mental health, sexual health, substance use and comfort in seeking health care in the future. Teens are more willing to disclose sensitive information if screening occurs apart from their parents or guardians. However, researchers noted that in a recent study, only half of adolescents had time alone with primary care providers and discussed confidentiality with those providers.
A companion document to the report above, this practice paper examines ACEs and ACE screening with immigrant youth and offers recommendations for adolescent health providers to effectively implement ACE screening with this vulnerable student population.
Nearly 11 million immigrants reside in California — about 39 percent of whom were born in Asia and 50 in Latin America. Half of students statewide have at least one parent who is an immigrant to the U.S., and one in five children enrolled in California public schools is an English language learner. Compared with non-Hispanic white children, Latino children in the U.S. experience ACEs at higher rates (42 percent have experienced at least one ACE compared to 36 percent of their non-Hispanic white peers), according to the report.
The purpose of ACE screening in all populations is to open up a conversation about and assess for risk of toxic stress, but some researchers suggest that “traditional ACES screening may fail to capture the particular stresses of undocumented immigrants or children in mixed status families, and that deprivation of resources and threats or experiences of deportation should be integrated more fully into assessments of childhood adversity,” the report states.
At the same time, it’s important that those charged with screening immigrant youth for ACEs recognize that not all immigrants share the same life experiences regarding what motivated them or their families to leave their countries of origin, how they entered this country, their legal status, and the timing and political context of rejection or acceptance of immigrants and refugees — all of which “may place them at greater risk for ACEs, either before their arrival to this country, as part of their adjustments to their new country, or both.”
Once again, ACE screening in schools was found by those surveyed to be helpful in building trust in the process. One mental health clinician surveyed who worked in an unnamed school district talked about screening immigrant adolescents for ACEs, noting that in one school, students had more trust in the teachers and the principal. “I think having that trust that just exists within the school really helped me facilitate that screening,” the clinician said.