Implementation of Adverse Childhood Experiences Screening in Pediatric Primary Care

Background: Adverse childhood experiences (ACEs) are potentially traumatic events that occur in childhood including abuse, neglect, and household dysfunction. They are highly prevalent among children, especially those that are racially, ethnically, or socioeconomically disadvantaged. ACEs are negatively associated with unfavorable health outcomes including behavioral problems, cognitive delays, and poor physical health.

Local problem: It is recommended that primary care providers screen for ACEs but the majority of providers do not. Additional information is needed to recommend an evidence-based approach to the implementation of ACE screening in pediatric primary care.

Methods: An evidence-based ACE screening and referral to behavioral health services workflow was implemented during well child visits at a federally qualified health center (FQHC) that provides primary care to underserved pediatric patients.

Interventions: Data analysis included the number of ACE screenings completed out of the eligible well child visits and the number of referrals made as a result of positive screens. Interviews were held with project site staff to analyze acceptability, feasibility, and sustainability of ACE screening implementation.

Results: ACE screenings were completed at a rate of 96%. While fewer than 25% of positive screens were referred to behavioral health services, it was found that more than 50% of children with positive ACE screens were receiving behavioral health services in other settings.

Conclusions: The implementation of an evidence-based ACE screening and referral protocol at a FQHC has been successful in increasing the number of patients screened for ACEs and referred to behavioral health services.