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The Implementation of Screening for Adverse Childhood Experiences in Pediatric Primary Care
Mercie J DiGangi1, Sonya Negriff2
1Department of Pediatrics, Kaiser Permanente Southern California, Bellflower, CA.
Insights
Adverse Childhood Experiences (ACEs) screening is feasible in a large healthcare system. Data reveal an increasing trend of ACEs in children aged 3-13, emphasizing the need for early intervention.
Area of Science:
- Pediatric Health
- Public Health
- Healthcare System Implementation
Background:
- Adverse Childhood Experiences (ACEs) significantly impact child development and long-term health.
- Integrated healthcare systems offer a unique setting for universal screening and early intervention.
- Understanding screening rates and prevalence is crucial for effective public health strategies.
Purpose of the Study:
- To evaluate the implementation and effectiveness of ACEs screening in a large integrated healthcare system.
- To determine screening rates across different age groups (3, 5, 10, and 13-year-olds).
- To assess the prevalence of ACEs among children within the healthcare system.
Main Methods:
- Screening for ACEs was initiated in July 2018 at Kaiser Permanente Southern California.
- The screening program expanded from one medical center to multiple sites, including well-child visits for 3-, 5-, 10-, and 13-year-olds.
- Data were collected on the number of children screened and their ACEs scores.
Main Results:
- Screening rates varied by age: 53% for 3-year-olds, 53% for 5-year-olds, 37% for 10-year-olds, and 13% for 13-year-olds.
- Prevalence of ACEs (score ≥1) was 15% for 3-year-olds, 17.5% for 5-year-olds, 30.5% for 10-year-olds, and 33.8% for 13-year-olds.
- An increasing trend in ACEs prevalence was observed with age.
Conclusions:
- ACEs screening is a feasible intervention within a large integrated healthcare system.
- The rising prevalence of ACEs in children highlights a critical public health concern.
- Early education and intervention are essential to mitigate the lifelong effects of toxic stress associated with ACEs.
Objective:
To assess the implementation of screening, screening rates, and prevalence of adverse childhood experiences (ACEs) in a large integrated healthcare system.
Study Design:
Kaiser Permanente Southern California is a large integrated healthcare system with 15 medical centers/hospitals and 233 medical office buildings that serve approximately 1.5 million children. Screening for ACEs began in July 2018 at 1 medical center (Downey, Bellflower medical office) for 3- and 5-year-old well-child visits (yearly physical examination). It quickly expanded to 3 other medical centers (6 clinics in total) and now also includes the 10- and 13-year-old well-child visits.
Results:
Since July 2018 we have screened 3241 3-year-olds (53% of the target population), 2761 5-year-olds (53%), 545 10-year-olds (37%), and 509 13-year-olds (13%). Of the 3-year-olds who were screened, 15% had an ACEs score of 1 or higher. Of the 5-year-olds that were screened, 17.5% had an ACEs score of 1 or higher. Of the 10-year-olds, 30.5% had an ACEs score of 1 or higher and of the 13-year-olds, 33.8% had an ACEs score of 1 or higher.
Conclusions:
Although we have encountered some challenges, particularly with follow-up for those screening positive for ACEs, screening was feasible. The data show an increasing trend of ACEs in 3- to 13-year-old children, highlighting the need for early education about ACEs to mitigate the effects of toxic stress.
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