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Adverse Childhood Experiences (ACE)

The Adverse Childhood Experiences (ACE) Questionnaire is a 10-item clinical screening tool for adults that counts the categories of adversity a patient experienced before the age of 18. The tool guides therapists through the questionnaire, calculates the ACE score automatically, assesses the patient's risk for toxic stress using the ACEs Aware clinical algorithm, and stores screenings per patient.

What you can do

  • Administer the ACE Questionnaire for Adults directly within the platform.
  • Automatically calculate the patient's ACE score (0-10) in real-time.
  • View the toxic stress risk level and its recommended clinical response, based on the ACE score and the patient's ACE-associated health conditions.
  • See which categories of adversity (abuse, neglect, household challenges) the patient endorsed.
  • Record the patient's own view of how these experiences affected their health.
  • Save screenings against a specific patient and review them later.

Getting Started

To use the tool, navigate to Features > Tools > ACE Questionnaire.

Starting a Questionnaire

  1. Select a Patient: Search for and select the patient you want to screen. Like other assessment tools, the ACE Questionnaire is linked to a specific patient to enable history tracking.
  2. Click Begin Questionnaire.

Administration Note: Offer the questionnaire in a private setting. ACE screening is recommended once per adult lifetime.

Questionnaire Panel

The questionnaire panel allows you to record the patient's answers, assess ACE-associated health conditions, review the risk level, and save the result.

Screening Alerts

Alerts appear at the top of the panel when a screening needs a second look:

  • Under 18: The questionnaire is validated for adults aged 18 and over. If the patient's date of birth shows they are younger, a warning suggests using a pediatric screener such as PEARLS instead.
  • Previous screening: If the patient already has a saved ACE screening, an alert shows its date, as ACE screening is recommended once per adult lifetime.

Score Entry

  • For each of the 10 questions, record whether the patient experienced it before their 18th birthday:
    • Yes (1 point)
    • No (0 points)
  • Questions can be left unanswered if the patient prefers not to respond.
  • The Total row shows the ACE score out of 10, along with how many questions have been answered.
  • Click Save to store the screening against the selected patient.

Items and Categories

Each question is tagged with the category of adversity it belongs to:

  1. Physical neglect (Neglect)
  2. Loss of a parent through divorce, abandonment, death, or other reason (Household Challenges)
  3. Household mental illness (Household Challenges)
  4. Household substance use (Household Challenges)
  5. Violence between parents or adults in the home (Household Challenges)
  6. Household member incarcerated (Household Challenges)
  7. Emotional abuse (Abuse)
  8. Physical abuse (Abuse)
  9. Emotional neglect (Neglect)
  10. Sexual abuse (Abuse)

The Categories panel shows how many questions the patient endorsed in each category (e.g., Abuse 1 / 3, Neglect 0 / 2, Household Challenges 2 / 5).

Health Impact

Below the questions, record whether the patient believes these experiences have affected their health: Not much, Some, or A lot. This answer is saved with the screening to support the conversation with the patient; it does not change the ACE score or the risk level.

ACE-Associated Health Conditions

Check Patient has at least one ACE-associated health condition if it applies. Combined with the ACE score, this determines the toxic stress risk level.

Expand the reference list for the conditions associated with ACEs in adults:

  • Cardiovascular disease, tachycardia, stroke
  • Chronic obstructive pulmonary disease, asthma
  • Diabetes, obesity
  • Hepatitis or jaundice, kidney disease
  • Cancer
  • Arthritis, headaches, chronic pain, fibromyalgia, unexplained somatic symptoms
  • Skeletal fracture, physical disability requiring assistive equipment
  • Memory impairment, including dementias
  • Depression, anxiety, post-traumatic stress disorder, sleep disturbance, suicidal ideation or attempts
  • Alcohol, tobacco, cannabis, or illicit drug use
  • Teen pregnancy, sexually transmitted infections
  • Violence victimization or perpetration

Toxic Stress Risk

The right-hand panel shows the patient's risk for toxic stress, based on the ACE score and ACE-associated health conditions:

  • Low risk: Score of 0, or 1-3 without ACE-associated health conditions.
  • Intermediate risk: Score of 1-3 with ACE-associated health conditions.
  • High risk: Score of 4 or more, with or without ACE-associated health conditions.
  • Unknown risk: Screening incomplete.

The relevant risk level for the current answers is highlighted automatically, along with its recommended clinical response (for example, education about toxic stress and resilience, assessing protective factors, or jointly formulating a treatment plan). An incomplete screening still shows Intermediate or High risk as soon as the answered questions are enough to reach that level.

Note: The ACE score indicates risk at the population level. It is not a diagnosis and does not predict individual outcomes.

Patient History

The tool keeps a patient's past ACE screenings so they can be reviewed at any time.

Past Screenings

  • A list of all previous ACE screenings for the selected patient is shown, ordered from most recent to oldest, with the date and ACE score of each.
  • Click on any entry to load that screening and review its answers, health impact, and health conditions.
  • While viewing a historical record, the answers are read-only. Click New Questionnaire to start a fresh screening for the same patient.

Because ACE screening is recommended once per adult lifetime, the tool does not chart scores over time like the other assessments.

Session Management

  • Patient-linked: Every ACE screening is associated with a patient, so earlier screenings are flagged before a new one is administered.
  • Edit Patient: Use the (edit) button next to the patient's name to switch to a different patient before saving.
  • History Navigation: Switch freely between past screenings and a new questionnaire without losing saved data.