Despite evidence that over 40% of youth in the United States have one or more adverse childhood experiences (ACEs), and that ACEs have cumulative, pernicious effects on lifelong health, few primary care clinicians routinely ask about ACEs. Lack of standardized and accurate clinical assessments for ACEs, combined with no point-of-care biomarkers of the "toxic stress" caused by ACEs, hampers prevention of the health consequences of ACEs. Thus, there is no consensus regarding how to identify, screen, and track ACEs, and whether early identification of toxic stress can prevent disease. In this review, we aim to clarify why, for whom, when, and how to identify ACEs in pediatric clinical care. To do so, we examine the evidence for such identification; describe the efficacy and accuracy of potential screening instruments; discuss current trends in, and potential barriers to, the identification of ACEs and the prevention of downstream effects; and recommend next steps for research, practice, and policy.

Objective This study examined risk, vulnerability, and protective processes of parental expressed emotion for children's peer relationships in families living in emergency shelters with high rates of exposure to parental violence (EPV). Parental criticism and negativity were hypothesized to exacerbate the association between EPV and poorer peer relations, while parental warmth was expected to buffer this association. Method Participants included 138 homeless parents (M = 30.77 years, SD = 6.33, range = 20.51-57.32 years; 64% African-American, 12% Caucasian, 24% other) and their 4-6-year-old children (43.5% male; M = 4.83, SD = .58, range = 4.83-6.92 years; 67% African-American, 2% Caucasian, 31% other). Families were assessed during the summer at three urban shelters, with parents completing the Five-Minute Speech Sample (FMSS), later scored for criticism, negativity, and warmth, and interview items about EPV. Teachers were subsequently contacted in the fall about children's classroom behavior, and they provided ratings of peer relations. Demographic factors, parental internalizing symptoms, and observed parental harshness were examined as covariates. Results Regression analyses indicated an interaction of EPV and warmth, consistent with a moderating effect of expressed emotion for EPV and peer relations, although no interactions were found for criticism or negativity. Observed harshness also directly predicted worse peer relations. Conclusions Parental warmth may be protective for positive peer relations among impoverished families with high levels of EPV. The FMSS is discussed as an efficient tool with potential for both basic clinical research and preventative interventions designed to target or assess change in parental expressed emotion.

Pediatric settings are increasingly called upon to implement early childhood developmental and behavioral health screening as an early identification and health promotion strategy. Understanding the dynamic barriers and facilitators of implementation at various stages will help implementers plan for and address these factors in support of high quality implementation. Our research supported this goal by analyzing longitudinal, qualitative data. There were 128 semistructured interviews conducted with pediatric clinic and implementation providers across four years. Interviews were transcribed, coded, and synthesized using rigorous qualitative methods. Results were produced using an iterative process to summarize, analyze, and consolidate themes about screening implementation over time. Barriers and facilitators of implementation included characteristics of screening implementation as well as contextual characteristics of the pediatric primary care setting. Some implementation themes were stable over time whereas others demonstrated shifts. Results are discussed in terms of lessons learned for successfully integrating this critical preventive practice within pediatric clinics.

Research Findings The transition to kindergarten has important ramifications for future achievement and psychosocial outcomes. Research suggests that physical aggression may be related to difficulty during school transitions, yet no studies to date have examined the role of relational aggression in these transitions. This paper examined how engagement in preschool physical and relational aggression predicted psychosocial adjustment during the kindergarten school year. Observations and teacher reports of aggression were collected in preschool, and kindergarten teachers reported on student-teacher relationship quality, child internalizing problems, and peer acceptance in kindergarten. Results suggested that preschool physical aggression predicted reduced peer acceptance and increased conflict with the kindergarten teacher. High levels of relational aggression, when not combined with physical aggression, were related to more positive transitions to kindergarten in the domains assessed. Practice or Policy These data lend support to the need for interventions among physically aggressive preschoolers to target not only concurrent behavior but also future aggression and adjustment in kindergarten. Thus, educators should work to encourage social influence in more prosocial ways amongst aggressive preschoolers.

Academic Health Centers (AHCs) across the nation are experiencing a reawakening to the importance of Diversity, Equity, and Inclusion (DEI). Such work impacts both employees and patients served by healthcare institutions. Yet, for departments without previously existing formal channels for this work, it is not always apparent where to begin. The current manuscript details a process for creating a committee as a vehicle for championing DEI efforts at the department level within an AHC. The authors present a six-step model for forming a DEI Committee and progress monitoring measures to remain accountable to identified objectives. In each step, the authors provide examples of their work with the goal for readers to tailor and apply each step to their own departments' DEI efforts. The current paper also identifies lessons learned with regard to barriers and facilitators of department-level DEI work. Reflections and next steps for DEI work beyond the proposed model are also discussed.