When does screening commence?

Patients can be screened by self-report on paper or verbally with a screener
Paper screens can be distributed at check-in or when the patient is roomed

Note: Although face-to-face screening opens the opportunity for ACEs screen to be easily handed off to patients, a solid introduction is a vital to increase patients’ agreeability to complete the screen. Please refer to the introduction for telehealth screening or provide an introduction that includes the following components:

• Connecting the screen to the visit.
• Being clear about the context/nature of questions.
• Giving confidentiality disclosure.
• Emphasizing that the patient/caregiver are not required to answer any questions if they are not ready.

Privacy when screening adolescents and adults

• If screening with paper tools, hand the patient responsible for answering the questions the screening tool and state clearly that they should be the one to complete the answers. It is best to provide these forms to the patient confidentially when possible.
• If screening verbally, kindly ask adolescent caregiver(s) or other adults present with the patient to leave the room.

“It is the clinic’s policy that patients 12 years and older answer the screening questions in privacy with the provider. Can you please wait in the hallway while we go over these questions with [patient’s name]?”

Patient/caregiver hesitancy See the Hesitancy Response chart in the Appendix.

During screening

• Provide a private space for patient/caregiver to complete screens, whether verbally or on paper
• Allow patient/caregiver adequate time to complete the screens.
• If the patient/caregiver appears to need extra support while completing a paper screen, clinic staff may assist patient/caregiver by reading questions aloud to the patient/caregiver.

After screening

• Ask people how they are feeling/doing after the screen (this will help follow-up/identify distress)
• Thank the patient/caregiver for their time.
• Notify patient/caregiver that their provider will review results.
• Enter the results into the appropriate ad hoc forms prior to the provider seeing the patient. LA County DHS: See job aids and screening tool chart.
• Providers should be notified of any positive screening results prior to seeing the patient
• Scan any paper versions of the screening tools into the patient’s electronic medical record per your facility’s guidelines.

General screeners

• Document into ORCHID screening results as appropriate. This includes calculating and documenting the ACEs Risk Score. LA County DHS: See charting job aids.
• Do not interpret screening results for the patient/caregiver.
• Do let patients know that their provider will review the details of the patient’s results.
• Support patients who have experienced adversity/toxic stress. See Adversity Response table for General Screeners in the Appendix.
• Offer general resource/health education material from pre-approved list.
• Share responses with providers.

Providers and designated staff

• Review screener’s risk assessments and adjust scoring as needed. For ACEs Risk Score, utilize the risk stratification chart to determine appropriate risk stratification.
• Disclose and discuss risk score with the patient/caregiver. See Adversity Response table for Providers and Designated Staff in the Appendix.
• Treat and provide referrals as appropriate.