Routine screening of ACEs: Should we or shouldn’t we?

Deciding whether to screen for adverse childhood experiences (ACEs), like screening for any risk factor or health condition, should be informed by a systematic approach. The following questions, derived from key principles of health screening, are used to systematically evaluate the recommendation for ACEs screening: (1) Does an evidence-based intervention exist that will improve outcomes for high-risk groups identified through screening? (2) Is this evidence-based intervention available for those screening positive? (3) Is the screening approach accurate? (4) What are the potential harms associated with screening? (5) Are there positive findings from experimental trials using proposed screening approaches? (6) Have other critical domains been considered? Substantial gaps are identified in attempting to answer each of these questions when applied to ACEs screening. With the current state of knowledge, it cannot be assumed that potential gains from implementing ACEs screening outweigh potential harms.