Trust shapes perspectives on addressing childhood adversity in school-based health centers

An exploratory qualitative study published in Pediatric Research examined barriers and facilitators to addressing adverse childhood experiences (ACEs) in school-based health centers. Researchers conducted semi-structured interviews with 10 adolescents aged 16–22 and 10 parents or caregivers of children aged 3–17. Participants were recruited from community advisory groups, primary care waiting rooms, and snowball sampling. Interviews took place from December 2024 to October 2025, with thematic analysis continuing until saturation.

Four themes emerged. Participants expected trust with the clinician addressing ACEs, described the school’s social environment as influencing comfort with the process, and identified relationships and circumstances outside school as shaping their perceptions. They also saw potential for addressing ACEs through school-based centers to benefit the wider school community. The study considered the full process, from initiating screening through subsequent response and intervention.

The findings may inform family-centered approaches that consider clinician relationships, school environments, and broader social contexts rather than screening alone. However, this small, purposively recruited qualitative sample assessed perspectives, not clinical effectiveness or health outcomes. Participants were not necessarily enrolled in the partnering Southern California school district. The authors also note that definitive evidence that routine ACEs screening improves outcomes remains lacking.