Center for Youth Wellness

History & Vision

The Center for Youth Wellness (CYW) was founded in San Francisco’s Bayview Hunter’s Point neighborhood in 2012 by pediatrician Dr. Nadine Burke Harris. Through her practice at the Bayview Child Health Center (BCHC), Dr. Burke Harris realized that children sent to her for evaluation of Attention Deficit Hyperactivity Disorder (ADHD) had been misdiagnosed and were instead showing symptoms of exposure to highly traumatic experiences. After learning of the science on Adverse Childhood Experiences (ACEs), she founded CYW to focus on deepening understanding on the bio-psycho-developmental harms of early adversity on children and to transform the way society responds to young people exposed to significant ACEs and toxic stress.

CYW is working to push forward and amplify a national conversation about childhood adversity and its implications across the life-course to help practitioners, providers, and policymakers better understand and address the impact of ACEs and toxic stress on the children and families they serve.

Our Screening Protocol

Our experience and the emerging research in this field has shown that if we can identify and assess risk early on, we have a better chance of offering interventions that improve health and behavioral outcomes across a lifetime, so in partnership with our primary pediatric partner BCHC, every young person we see is screened for ACEs.

BCHC and CYW have developed three screening instruments (Caregiver report for child 0-11, Caregiver report for teen 12-19, Teen self-report) that seek to identify young people who have been exposed to ACEs. The CYW/BCHC screening protocol is as follows:

  1. Staff identify the appropriate version of the ACE-Q (parent/caregiver report or teen-self report) to administer to the patient when they check in for well-visit appointment, starting at the age of 9 months.
  2. A trained medical assistant presents the ACE-Q as part of a packet of routine assessments and describes its purpose, explaining that the information is gathered from all patients to help keep them healthy. The caregiver or teenager completes the ACE-Q in the waiting room, indicating whether they had been exposed to a list of 17 (or, for teens, 19) adverse experiences. The results are tallied and form a number that indicates a total of how many types of adversity a child has experienced.
  3. In the ensuing medical visit, the primary care physician reviews the ACE-Q with the child and/or parent/caregiver, explains the impact of normal and toxic stress on health and development and asks whether the child is experiencing any symptoms that may be related to toxic stress. If a child’s ACE-Q score is 0, or 1 to 3 with no related symptoms, the clinician will provide anticipatory guidance, explaining the concepts of ACEs and toxic stress, strategies for avoiding exposure to ACEs, managing stress and forging consistent, supportive relationships. If the ACE-Q score is 1 to 3 with symptoms, or 4 or higher with or without symptoms, the clinician will recommend integrated care.
  4. If a child is referred for integrated care, a multidisciplinary clinical team will provide support to the patient and family. Care coordinators will educate the family about the impact of ACEs, interact with other providers and collaborate with other members of the BCHC-CYW clinical team, arranging for home visits, psychotherapy, psychiatry, wellness nursing, biofeedback and other services from CYW or external providers.

For more information about the CYW – BCHC screening protocol, go to www.centerforyouthwellness.org and download our ACE-Q User Guide.