Learn about the C.A.R.E. method of asking about ACEs
This quick guide accompanies our video. Also see the infographic.
Health care professionals who are convinced that asking about ACEs could be helpful for their patients may be hesitant to ask because they are not confident about how to ask without needlessly upsetting their patients.
That is why we developed the C.A.R.E. method to be quick, easy top remember, and respectful.
We start with the idea that choosing the right words is not essential. Patients say that what is essential is that they want to be asked in a situation that feels safe, and to be believed if they choose to share their experience.
The name of the C.A.R.E. method can help you remember four easy steps.
C is for CONSENT. A simple question to get consent would be “Some difficult childhood and young adult experiences, that are pretty common, can affect your health even later in life. I would like to ask you some questions about things that may have happened when you were younger. Is that okay?”
If you are talking about a clinical condition that suggests a higher likelihood of ACEs, you could use that for context. You could say: “Since we are talking about chronic pain (or addiction, or depression, or whatever the topic is), I would like to ask about some childhood and young adult experiences that are very common in this situation. Is that okay?”
If the patient indicates that it is okay to go on, then you can ask.
A is for ASKING. We find it helpful when asking about ACEs to not try to be too precise. It is often better to give a little list of examples that conveys the general idea. The list conveys permission to describe other things that are similar.
You might say: “When you were growing up or as a young adult, did you have experiences that were frightening, or that made you feel unsafe? Was it common for you to feel unprotected or unloved? For example, were you hit, or touched in a way that you didn’t want, or bullied?”
The most important part of asking is not the words you choose, it is listening to your patient’s response. If they start to tell you something in the middle of your list, stop and listen. If they tell you they don’t want to talk about it, acknowledge that and move on. Listening well and following your patient’s cues are the most important parts of asking.
If your patient doesn’t want to talk about it, or doesn’t have anything to report, then you are done. If they have something to tell you, move on to reflecting and engaging.
R is for REFLECTION. To reflect on what has been said, you validate what your patient has told you and indicate that you are willing to think and talk about it together.
You can say: “Thank you for sharing that. Sometimes experiences like that can affect you even later in life because these experiences have an impact on your brain and how your brain responds to every day stress. I wonder if you draw any connection between those events and your current situation.”
Again, listen to how they respond.
E is for ENGAGING. In this step you defer to your patient about next steps.
You can say: “Are you comfortable sharing more with me? Is this something you have shared with others?” Or “Is it something you would like to talk more about at another time?”
And again, listen to what they say and follow their lead. Many people are content to have told you something relevant and don’t feel the need to talk more, If they do want to talk about it, you may need to schedule another time for that.
This quick guide accompanies our video. Also see the infographic.
Health care professionals who are convinced that asking about ACEs could be helpful for their patients may be hesitant to ask because they are not confident about how to ask without needlessly upsetting their patients.
That is why we developed the C.A.R.E. method to be quick, easy top remember, and respectful.
We start with the idea that choosing the right words is not essential. Patients say that what is essential is that they want to be asked in a situation that feels safe, and to be believed if they choose to share their experience.
The name of the C.A.R.E. method can help you remember four easy steps.
C is for CONSENT. A simple question to get consent would be “Some difficult childhood and young adult experiences, that are pretty common, can affect your health even later in life. I would like to ask you some questions about things that may have happened when you were younger. Is that okay?”
If you are talking about a clinical condition that suggests a higher likelihood of ACEs, you could use that for context. You could say: “Since we are talking about chronic pain (or addiction, or depression, or whatever the topic is), I would like to ask about some childhood and young adult experiences that are very common in this situation. Is that okay?”
If the patient indicates that it is okay to go on, then you can ask.
A is for ASKING. We find it helpful when asking about ACEs to not try to be too precise. It is often better to give a little list of examples that conveys the general idea. The list conveys permission to describe other things that are similar.
You might say: “When you were growing up or as a young adult, did you have experiences that were frightening, or that made you feel unsafe? Was it common for you to feel unprotected or unloved? For example, were you hit, or touched in a way that you didn’t want, or bullied?”
The most important part of asking is not the words you choose, it is listening to your patient’s response. If they start to tell you something in the middle of your list, stop and listen. If they tell you they don’t want to talk about it, acknowledge that and move on. Listening well and following your patient’s cues are the most important parts of asking.
If your patient doesn’t want to talk about it, or doesn’t have anything to report, then you are done. If they have something to tell you, move on to reflecting and engaging.
R is for REFLECTION. To reflect on what has been said, you validate what your patient has told you and indicate that you are willing to think and talk about it together.
You can say: “Thank you for sharing that. Sometimes experiences like that can affect you even later in life because these experiences have an impact on your brain and how your brain responds to every day stress. I wonder if you draw any connection between those events and your current situation.”
Again, listen to how they respond.
E is for ENGAGING. In this step you defer to your patient about next steps.
You can say: “Are you comfortable sharing more with me? Is this something you have shared with others?” Or “Is it something you would like to talk more about at another time?”
And again, listen to what they say and follow their lead. Many people are content to have told you something relevant and don’t feel the need to talk more, If they do want to talk about it, you may need to schedule another time for that.