Adverse Childhood Experiences (ACE) Screening in a Midwest Suburban Pediatric Primary Care Setting: A Quality Improvement Project
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Authors
Menninga, Jodi
Issue Date
2024-05-11
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Manuscript
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Keywords
Adverse Childhood Experience (ACE) , ACE Screening , ACE Screening Process , Quality Improvement
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Abstract
Abstract
Background: Adverse Childhood Experiences (ACEs) are traumatic events which occur in childhood before the age of 18. ACEs adversely impact psychosocial development and health outcomes across the lifespan, contributing to higher rates of mental health disorder, substance use, suicidality, unemployment, homelessness, and death. Strategies which reduce the significance and occurrence of ACE are achievable with the assistance of ACE screening process, making pediatric primary care and ideal setting for use.
Objectives: The purpose of this quality improvement (QI) project was to implement an ACE screening process for pediatric primary care providers not currently screening for ACEs.
Methods: A process for ACE screening was developed utilizing the Advancing Research & Clinical Practice through Close Collaboration (ARCC) model. Prior to implementation staff received education and procedural instruction. Patients 13 years or older, scheduled for a well-care visit, and able to self-report were eligible to participate in ACE screening, using the CWY ACE-Q Teen SR tool. A toolkit providing scripts, interpretation guidelines, local referral resources, and patient educational handouts was made available to reduce common barriers identified with ACE screening efforts.
Results: Fifty-one out of 68 eligible participants were invited to complete ACE screening (75%), of which, 23 chose to participate (45%). Fifty-six percent of patients reported at least 1 ACE, 35% reported 2 ACEs, and 13% had a score 4. Limited provider engagement resulted in near absent data collection, and no indication of offered intervention.
Conclusion: A process for ACE screening, while feasible and supportive for implementation, does not in itself ensure change related to ACE identification, interventional strategies, or outcomes. ACE reducing efforts require knowledge, beliefs, and the participation of all stake holders, be that patient, family member, or healthcare provider.
Keywords: Adverse Childhood Experience, ACE, ACE Screening, ACE Screening Process
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Publisher
Creighton University
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Copyright is retained by the Author. A non-exclusive distribution right is granted to Creighton University