Hi Kevin,
Thank you for your insightful feedback. As the science is emerging, providers are understanding now that many of the conditions in adulthood have their roots in childhood. The idea is that something can be done if things are caught early (primary and secondary prevention). Screening for ACEs differs from the conventional neglect and abuse screening in that it covers a broader range of adversities. Catching those early enough would allow providers to intervene not only with intervention, but also to prevent further exposure with anticipatory guidance. As adversities can occur as early as in-utero, caregivers are in the position of knowing and reporting for their children.
For your suggestion of starting small, I think it is a great idea. That is what the Center for Youth Wellness has just engaged in. The center started a project to select and train a number of sites to start implementing screening. Those sites will then recruit and train more sites and we get all pediatric primary care settings to screen.
I Like the COM-B analysis as well; though I might need to revise it.
Kadi