Complete the Pediatric ACEs and Related Life Events Screener for Juan Jr.

What plans would you make for working with this family based on the identified ACEs? 
How would you administer the ACEs assessment in this case or other cases involving young children?
Pediatric ACEs and Related Life Events Screener
CHILD
Many families experience stressful life events.
Over time these experiences can affect your
child’s health and wellbeing. We would like to ask
you questions about your child so we can help
them be as healthy as possible.
Pediatric ACEs and Related Life Events Screener (PEARLS)
CHILD – To be completed by: Caregiver
At any point in time since your child was born, has your child seen or been present when the
following experiences happened? Please include past and present experiences.
Please note, some questions have more than one part separated by “OR.” If any part of the
question is answered “Yes,” then the answer to the entire question is “Yes.”
PART 1:
Please check “Yes” where apply.
?
1. Has your child ever lived with a parent/caregiver who went to jail/prison?
2. Do you think your child ever felt unsupported, unloved and/or unprotected?
3. Has your child ever lived with a parent/caregiver who had mental health issues?
(for example, depression, schizophrenia, bipolar disorder, PTSD, or an anxiety disorder)
4. Has a parent/caregiver ever insulted, humiliated, or put down your child?
5. Has the child’s biological parent or any caregiver ever had, or currently has a problem with
too much alcohol, street drugs or prescription medications use?
6. Has your child ever lacked appropriate care by any caregiver?
(for example, not being protected from unsafe situations, or not cared for when sick or
injured even when the resources were available)
7. Has your child ever seen or heard a parent/caregiver being screamed at, sworn at, insulted
or humiliated by another adult?
Or has your child ever seen or heard a parent/caregiver being slapped, kicked, punched
beaten up or hurt with a weapon?
8. Has any adult in the household often or very often pushed, grabbed, slapped or thrown
something at your child?
Or has any adult in the household ever hit your child so hard that your child had marks or
was injured?
Or has any adult in the household ever threatened your child or acted in a way that made
your child afraid that they might be hurt?
9. Has your child ever experienced sexual abuse?
(for example, anyone touched your child or asked your child to touch that person in a way
that was unwanted, or made your child feel uncomfortable, or anyone ever attempted or
actually had oral, anal, or vaginal sex with your child)
10. Have there ever been significant changes in the relationship status of the child’s
caregiver(s)?
(for example, a parent/caregiver got a divorce or separated, or a romantic partner moved in
or out)
How many “Yes” did you answer in Part 1?:
Please continue to the other side for the rest of questionnaire
This tool was created in partnership with UCSF School of Medicine.
Child (Parent/Caregiver Report) – Identified
PART 2:
Please check “Yes” where apply.
?
1. Has your child ever seen, heard, or been a victim of violence in your neighborhood,
community or school?
(for example, targeted bullying, assault or other violent actions, war or terrorism)
2. Has your child experienced discrimination?
(for example, being hassled or made to feel inferior or excluded because of their race,
ethnicity, gender identity, sexual orientation, religion, learning differences, or disabilities)
3. Has your child ever had problems with housing?
(for example, being homeless, not having a stable place to live, moved more than two
times in a six-month period, faced eviction or foreclosure, or had to live with multiple
families or family members)
4. Have you ever worried that your child did not have enough food to eat or that the food for
your child would run out before you could buy more?
5. Has your child ever been separated from their parent or caregiver due to foster care, or
immigration?
6. Has your child ever lived with a parent/caregiver who had a serious physical illness
or disability?
7. Has your child ever lived with a parent or caregiver who died?
How many “Yes” did you answer in Part 2?:
This tool was created in partnership with UCSF School of Medicine.
Child (Parent/Caregiver Report) – Identified
Hernandez Family Episode 1
Hernandez Family Episode 1
Program Transcript
JUAN HERNANDEZ: But we didn’t do anything wrong. That woman, that social
worker, who came to our house, I told her, me and Elena, we decide what’s best
for our boys, not her. Telling us we punish to hard. She doesn’t know anything
about us.
ELENA HERNANDEZ: We give our sons a good life. We love them very much.
It’s not fair what she said about Juan and me. We’re good parents.
FEMALE SPEAKER: Mrs. Hernandez, I understand how difficult this is for you-JUAN HERNANDEZ: I don’t think you do. Everything that we do, we do for them,
everything. We work hard. We take care of them. And when they don’t follow the
rules, they get punished, strictly. The old fashioned way.
ELENA HERNANDEZ: Shh. Quiet. I told you.
JUAN HERNANDEZ: Sometimes I’m not strict enough with them. Look, I punish
my sons the way I see fit. That’s the only way they are going to learn. That’s how
we learned from our parents, right? Nobody took parenting classes. That’s
ridiculous.
FEMALE SPEAKER: I understand you’re angry. And you’re raising your children
the way you were brought up to do. But ACS has required that you do this.
JUAN HERNANDEZ: What if I don’t want to be required?
ELENA HERNANDEZ: I have a question.
FEMALE SPEAKER: Of course.
ELENA HERNANDEZ: If we go through with this, the things we talk about with
you, will it be private?
JUAN HERNANDEZ: But we have not agreed to do this.
ELENA HERNANDEZ: I don’t want to be here either. But I don’t want to loose our
children. Would it be private, what we talk about?
FEMALE SPEAKER: The information we share is between us. The only
exception to that is if one of you says you’re going to hurt yourself or hurt
someone else. In that case, I have to report it to the ACS worker. But everything
else is strictly confidential.
© 2013-2021 Walden University, LLC
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Hernandez Family Episode 1
So how do you think we can work together to make this a positive experience for
both of you?
JUAN HERNANDEZ: Parenting classes, really? What about the bills? I’m not
going to be able to work overtime.
ELENA HERNANDEZ: If we do what we’re supposed to do, would it be OK with
our family?
FEMALE SPEAKER: There are no guarantees. But here’s what I can say. We’ll
all work together to create a plan based on what the ACS worker has required
and recommended. Then it will be up to her what the outcome will be.
So shall we make a plan?
Hernandez Family Episode 1
Additional Content Attribution
MUSIC:
Music by Clean Cuts
Original Art and Photography Provided By:
Brian Kline and Nico Danks
© 2013-2021 Walden University, LLC
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