Implementing Standardized Screening for Adverse Childhood Experiences in a Pediatric Resident Continuity Clinic
Sarah M Marsicek1, John M Morrison1, Neha Manikonda1
1Office of Medical Education, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.
Insights
Screening for adverse childhood experiences (ACEs) in pediatric clinics increased from 0% to 60% in one year. This standardized tool successfully identified children at high risk, though provider comfort levels did not significantly change.
Area of Science:
- Pediatrics
- Child Mental Health
- Public Health
Background:
- Childhood adversity, or adverse childhood experiences (ACEs), is linked to poor mental health and chronic medical conditions in children and adults.
- Recognizing ACEs and implementing interventions can enhance children's resilience.
- A standardized screening tool was implemented to assess patient exposure to adversity.
Purpose of the Study:
- To increase the screening rate for ACEs from 0% to 80% in children during annual well-child visits within one year.
- To evaluate the effectiveness of a standardized ACEs screening tool in a general pediatrics clinic.
Main Methods:
- A standardized ACEs screening tool was implemented in a general pediatrics clinic.
- Educational lectures, simulation, and process changes were utilized to promote screening.
- Surveys were administered to resident physicians and faculty regarding their experiences with ACEs screening.
Main Results:
- Over one year, 1,206 patients were screened for ACEs, increasing screening rates from 0% to 60%.
- Provider comfort in discussing abuse and familiarity with resources for children exposed to ACEs remained unchanged.
- The study demonstrated successful implementation of ACEs screening in a resident-led clinic.
Conclusions:
- A standardized ACEs screening tool can be effectively implemented in a resident-led pediatric clinic.
- This approach successfully identifies children with high-risk ACE scores.
- Further education and implementation may enhance provider comfort with ACEs screening.
Introduction:
Exposure to adversity in childhood has been shown to impact the development of children and increase their risk of poor early childhood mental health and chronic medical conditions in young children, and developing chronic diseases, mental health disorders, and substance abuse disorders as adults. The recognition of adverse childhood experiences (ACEs) and provision of behavioral-based interventions can help children build resilience. We implemented a screening method to help providers better assess patients' exposure to adversity. Our goal was to increase the screening for ACEs utilizing a standardized ACEs screening tool from 0% to 80% of children presenting for annual well-child visits within 1 year.
Methods:
We implemented a screening tool to determine a child's exposure to ACEs within our general pediatrics clinic. A variety of interventions, including resident, faculty, and staff-focused educational lectures, simulation, and process changes were performed to increase screening. Also, we surveyed resident physicians and faculty about their experiences with ACEs screening.
Results:
Over 1 year, we screened 1,206 patients for exposure to ACEs and increased screening from 0% to 60%. Provider comfort with discussing abuse with patients and familiarity with resources for children exposed to ACEs did not change significantly.
Conclusions:
Patients can successfully be screened in a resident-led, general pediatric clinic using a standardized ACEs screening tool. Such an approach can successfully identify patients with high-risk ACE scores. Additionally, education on and implementation of the tool may improve provider comfort with screening for ACEs.
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