Uplifted Youth

Patient disclosure of adverse experiences is a common part of primary care visits, whether using a formal ACEs tool, an interview style approach, or simply bringing trauma-informed practices to your SBHC. This section provides ways to respond to youth when adversity is disclosed with a focus on building on strengths and resilience as a way to mitigate the adverse impact of toxic stress and to inform health care plans to maximize healthy outcomes. These strategies are meant for universal use with patients to increase resilience and empowerment and improve overall health outcomes. Individuals in need of behavioral health services can benefit from the approaches described below and should also be referred to an appropriate behavioral health professional.

Learn how to respond to youth who report with high amounts of adverse experiences, those who do not report any, and those somewhere in between. 

Apply the HEAR acronym to help you pull together trauma-informed responses that utilize healing centered and HOPE frameworks to build resilience.

Practice your responses as a team or on your own by reading case examples. Check out our scripts for language to apply to your own work. 

Tiered Response to ACEs

Responding to ACEs effectively results from advance planning, on-going staff training and support, and organizational buy-in to trauma-informed and healing centered engagement frameworks alongside an established workflow for a tiered response to patients. 

There are many models and programs working to respond to ACEs in primary care settings, such as the Center for Child Wellbeing and Trauma,  Pediatric Integrated Post-Trauma Services (PIPs) Child Traumatic Care Process Model (CPM), University of Utah, the Center for Youth Wellness, and the ACES AWARE project.

Key considerations when responding include:

  • A workflow that includes multiple SBHC team members, internal and external referral processes and promotes connections to resources and referrals that foster resilience, agency, and hope in addition to addressing clinical needs.

  • A tiered response that allows the SBHC to respond to all patients in the context of an individual assessment inclusive of a conversation with the patient about the ACEs screening/disclosure, additional screenings, and physical health. 

    • Understand the difference between an adverse childhood experience and a traumatic response 

      • An individual with an ACEs score of 2 may report more trauma than someone with an ACEs score of 7, make sure to talk to individuals about how ACEs impacts them. If trauma screening is warranted, make appropriate referrals.

    • Remember that not all individuals who experience ACEs present with symptoms of trauma, and may not have any behavioral needs to address at present; however, they are still at higher risk for other health concerns and will benefit from education and brief interventions from primary care staff and possible referral to other supports and resources. 

      • Check out this list of symptomology known to be link to long-term exposure to toxic stress: ​

  • Communication of mandated reporting parameters clearly to patients prior to screening and during the patient visit and check for understanding

    • Follow existing SBHC policies in instances when maltreatment is disclosed or suspected.

  • HOPE and Healing Centered Engagement frameworks in clinical practice to promote resilience. The purpose is to foster agency and hope to build resilience while validating a patient's experiences impact on their health. 

    • Ongoing training on trauma-informed and Healing Centered Engagement frameworks and understanding how to apply strategies for building resilience across the SBHC staff are a critical part of responding to ACEs.

    • Organization level adoption of trauma-informed and healing centered engagement practices supporting all SBHC staff, patients, and partners model and extend the work being done in the exam room.

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Responding to Resilience Screening Questions

Many Colorado SBHCs are administering four resilience questions, either independently or asked automatically after the ACEs screening questions on the Apex ACEs screening tools. These questions are all self-report/narrative and provide insight to strengths and supports present in the patient's life. There are many ways to bring attention to these assets during the visit, such as: 

  • A comment reinforcing a strength, compliment the youth on self-insight, bring curiosity to learn more about positive supports, etc. Check out these Talking Points for ideas. 

  • Look for connections between responses to the 4 building blocks of HOPE and enhance the five Healing Centered Engagement principles of CARMA.

  • Apply motivational interviewing skills to facilitate conversations to build on identified areas of resilience and apply them as motivation to support areas that are challenges for the youth.

  • Connect the youth to resources that come out of discussing these questions that will continue to foster resilience and build agency and hope.

HEAR the Youth in Front of You

H.E.A.R. stands for Honor. Educate. Advocate. Resource.

Primary care staff are trusted adults who strive to create safe spaces for their patients. As such, the primary care team often encounters patient disclosures of exposure to adverse experiences, through screenings and/or during a patient’s visit. These encounters present opportunities to address the patient’s present and future health while building resilience through HOPE and Healing Centered Engagement frameworks and fostering the provider-patient relationship. For more information from the American Academy of Pediatrics, see AAP article on The Medical Home Approach to Identifying and Responding to Exposure to Trauma.  

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Click on the Table for a full size pdf of the document. For more details on the H.E.A.R. response and suggested applications for each component, review this in-depth document. Both documents can also be found in the Resource section of the toolkit. 

Scenarios and Scripts

This section is intended to illustrate how the information provided for responding to ACEs might look in practice.


Case Examples

Read through each scenario and accompanying response or pull out the patient descriptions and work as a team or on your own to develop your own response. After each scenario, you are prompted to think through the questions in the document.

  • Consider taking time to apply these questions to real case examples at your SBHC and talk through them as a full staff. 

Talking points

This one-pager provides ideas for how to respond to youth using the concepts of CARMA and highlighting building blocks of HOPE while practicing H.E.A.R. to foster resilience building in your patients. A simple sentence goes a long way!

Other helpful handouts (see Resources page for more)

School Children