Screening patients in the HUB clinic presents a unique subset of barriers for staff. Below are patterns identified by HUB staff and corresponding solutions:

BARRIER: Some caregiver responses (for patients ages 0-11) do not always match what providers have on record for patient experiences.
SOLUTION: In these cases, we advise providers to chart caregiver responses but to also leave comments that are consistent with existing patient history.

BARRIER: Some caregiver do not have a complete knowledge of history due to the movement of children in foster care.
SOLUTION: HUB clinics have opted to only screen patients 0-11 who are in-home and 12 and older patients who have the ability to complete screen by themselves.

BARRIER: Asking sensitive questions to a group of individuals who have already been through a lot.
SOLUTION: While there is no conclusive solution to avoiding potential re-traumatization, it is important to let the patients guide the conversation and reinforce the ideas of readiness to speak and their right to decline.

BARRIER: Rapport with ancillary staff might not be as established as rapport with provider.
SOLUTION: In these cases, if it is established in workflow for ancillary staff to facilitate the ACEs screen and the patient or caregiver is not comfortable offer the option/ask if they would like to wait to complete the screen with their provider (who they might closer to).