Debate: Is ACE screening doing more harm than good? A consideration of screening versus child health surveillance.

The ACEs questionnaire has been used in population epidemiology for decades and is now recommended, by some authors, for screening purposes. However, screening programmes bring both harms and benefits and are different from population epidemiology and clinical enquiry. In this paper, I use a modern modification of Wilson and Jungner's screening programme criteria to consider whether a screening programme for ACEs would be advisable. I conclude that a screening programme for ACEs would not be appropriate and might be harmful. However, routine child health surveillance, with close collaboration across agencies including health, education and social work, is essential to ensure that ACEs, and potential harms arising from ACEs, are avoided wherever possible. A composite case example from Scotland, a country with a well-developed child health surveillance system, is provided to illustrate how such a system can support children who have experienced ACEs and their families.