How Can Healthcare Providers Prevent Adverse Childhood Experiences?

In their most recent published article, TXICFW’s Dr. Monica Faulkner and Dr. Beth Gerlach joined colleagues in exploring how healthcare providers can prevent adverse childhood experiences. Researchers examined knowledge of adverse childhood experiences (ACEs) and use of ACE-informed response strategies among healthcare professionals in Central Texas.

You can read the full article here. If you’re pressed for time but would like to learn more about this publication’s findings, read on for a brief synopsis.

What’s the problem?

More than 34 million children in the United States have experienced at least one adverse childhood experience (ACE), ranging from abuse and neglect to living with household members who have substance use disorders. As research continues to reveal the lifetime harmful effects of ACEs, the benefits of prevention and early intervention have come to the forefront. One suggested approach to prevention is universal ACE screenings in pediatric office visits. Although there are some concerns about using ACE as an individual screening tool, healthcare providers can play a critical role in identifying and responding to ACEs by implementing a broad range of ACE-formed strategies.

What makes this study different?

In this study, the research team sought to fill a gap in literature on healthcare providers’ knowledge of ACEs and use of ACE-informed response strategies. The study further explores the prevalence of screening and patient disclosures of ACEs, as well as the relationship between knowledge of ACEs and implementation of ACE-informed response strategies. 

How was this subject studied?

The research team created an online survey completed by 85 healthcare providers who were at least 18 years of age and provided care in a medical setting to children or women in Central Texas. A multidisciplinary group of professionals—including social workers, physicians, and public health practitioners—helped inform the creation of the survey, which included closed and open-ended questions covering the following topics:

  • Demographics
  • ACE knowledge and familiarity
  • Screening prevalence
  • Patient disclosure frequency by type of ACE
  • ACE-informed responses
  • Barriers to providing ACE-informed care

Researchers used two types of sampling to recruit survey respondents. After approaching local healthcare providers known to the research team and reaching out to physicians who provided email addresses to the Texas Medical Board, the research team asked providers who responded to the survey to forward the link to others. 

Results showed most respondents (43.5%) were not familiar with the ACE study, with 31.2% being moderately familiar and 8% very familiar with the ACE study. Despite these low levels of ACE knowledge, over half of respondents (59.6%) reported having attended training related to child trauma or toxic stress. Approximately one third of providers (28.4%) did not screen for any ACE items, but in contrast almost half (49.9%) screened for at least four ACE items—most frequently for mental illness and substance use disorders. Most healthcare providers in this study reported encountering patient disclosure of each of the ACE items at least occasionally.

Respondents most frequently reported using ACE-informed response strategies such as identifying family strengths and utilizing on-site resources. Less than 10% of respondents reported focusing on broader ACE-informed response strategies, such as creating an ACE-informed culture in their practice.

How can this study be applied to your work with children and families?

As the findings from this study demonstrated, familiarity with and knowledge of ACEs is associated with greater use of ACE-informed response strategies in healthcare practices. The low level of ACE familiarity and screenings among respondents in this study suggests a need for ACE-related training and education for healthcare providers and other community stakeholders. This training would better equip community partners to implement broader, community-level ACE-related interventions and practices to improve child wellbeing. 


Gerlach, B.; LaBrenz, C. A.; Barczyk, A. N.; Larkin, H.; Van Diest, H.; Morris, M.; & Faulkner, M. (2021). ACE-informed responses in Central Texas: Findings from a needs assessment.Social Work in Public Health. Advance online publication.