Available in French. The research evidence documenting the importance of these components in the evaluation of an MTBI is provided in the reference list. How is the ACE questionnaire and trauma informed care any different from what we are already doing? Wood A, Kroll L, Moore A, Harrington R. J Child Psychol Psychiatry. You must register to use it. CYW Adverse Childhood Experiences Questionnaire (ACE-Q) Child . Age range: 6-17 years. ACE Instructions The ACE is intended to provide an evidence-based clinical protocol to conduct an initial evaluation and diagnosis of patients (both children and adults) with known or suspected MTBI. 1995;36(2):327-34. Today’s Date: _____ Child’s Name: _____ Date of birth: _____ Your Name: _____ Relationship to Child: _____ Many children experience stressful life events that can affect their health and wellbeing. or Act in a way that made you afraid that you might be physically hurt? - A Pyschosocial Interview For Adolescents Interview S Adapted from Contemporary Pediatrics, , Getting into Adolescent Heads (July 1988), by John M. Goldenring, MD, MPH, & Eric Cohen, MD Background The major cause of morbidity and mortality in adolescents is unintentional injuries, including motor vehicle accidents, more than half related to drug or alcohol use. Adverse Childhood Experiences Questionnaire Adapted from BRFSS Screening Questionnaire (CDC) To be completed by Clinician with Parent/Guardian or Child/Youth Today’s Date:_____ Child’s Name:_____ Date of Birth:_____ Your Name:_____ Relationship to Child:_____ Stressful life events experienced by children and teens can have a profound affect on their physical and mental health. Parental ACEs screening tool Dr. R.J. Gilespie developed this tool to screen for parental ACEs in his practice, providing an opportunity to discuss how a parent’s ACE score can affect their parenting. The results from this questionnaire will assist your child’s doctor in assessing health and determining their guidance. Tags: Depression School-aged Adolescent CES-DC. Availability: Free. The ACE Questionnaire is free and is intended to be used solely for informational or educational purposes. Time required to complete: 5-10 minutes. The ACE International Questionnaire (ACE-IQ) is intended to measure ACEs in all countries, and the association between them and risk behaviours in later life. Yes No If yes enter 1 _____ 2. ACE-IQ is designed for administration to people aged 18 years and older. Properties of the mood and feelings questionnaire in adolescent psychiatric outpatients: a research note. Did a parent or other adult in the household often … Swear at you, insult you, put you down, or humiliate you? Completed by: Self-report. Adverse Childhood Experience (ACE) Questionnaire Finding your ACE Score ra hbr 10 24 06 While you were growing up, during your first 18 years of life: 1.