Implementing Pediatric Adverse Childhood Experiences Screening in an FQHC

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Adverse Childhood Experiences (ACEs) are traumatic life events in childhood that hold long-lasting physical and mental health impacts for patients with scores ≥4  of the 10 factors that measure abuse, neglect, and household dysfunction. In a 2012 study, 12% of a comparable low-income Federally Qualified Health Center (FQHC) pediatric population scored ≥4 on their ACE questionnaire. This score is significantly correlated with learning and behavior problems and the potential risk for obesity and cardiovascular diseases. AltaMed serves a similar population, and 64% of our patients are at or below the 200% of the Federal Poverty Level.    The screening tool used at AltaMed’s four pilot sites was the Pediatric ACEs and Related Life-Events Screener (PEARLS). A screener is considered positive if 4 or more experiences apply or if the patient scores between 1-3 and has an ACE-Associated Health Condition (AAHC). Between June 2021 and February 2022, over 1,500 pediatric patients were screened with 7.9% positive scores. By introducing ACE screenings at primary care clinics, early intervention through referrals to social services and resiliency programs can potentially mitigate the long-term health outcomes of pediatric patients.


  • Mary Valencia, Health Educator, AltaMed Health Services
  • Norma Perez, MD, FAAP, Pediatrician and Program Director, AltaMed Health Services
  • Ariami Garcia, BS, Project Intern, AltaMed Health Services