Lessons Learned from a Quality Improvement Initiative: Adverse Childhood Experiences Screening in a Pediatric Clinic

Area of Science:

• Pediatric Health
• Public Health
• Quality Improvement Science

Background:

• Adverse Childhood Experiences (ACEs) screening is recommended by the American Academy of Pediatrics due to significant downstream health risks.
• Despite recommendations, widespread adoption of ACEs screening practices remains limited.
• Pediatric clinics face challenges in integrating new screening protocols.

Purpose of the Study:

• To implement and assess the feasibility of Adverse Childhood Experiences (ACEs) screening in a busy pediatric clinic.
• To evaluate the process of screening infants and their caregivers for ACEs.
• To measure key process and balancing metrics associated with ACEs screening implementation.

Main Methods:

• Quality improvement methodologies, including Plan-Do-Study-Act cycles, were employed.
• Screening was conducted for 1-month-old infants and their accompanying caregiver(s).
• Process measures included screening completion rates and time; balancing measures included referral numbers and caregiver reception.

Main Results:

• A screening completion rate of ≥ 80% was maintained for infants and caregivers over 10 weeks.
• 23% of caregivers reported an ACEs score of ≥ 4, with 6% referred for resources.
• The average time to discuss the screen was 86.78 seconds, with high caregiver acceptance (2% refusal).

Conclusions:

• Implementing ACEs screening for a specific age group and their caregivers is feasible using quality improvement methods.
• The study demonstrates a successful model for integrating ACEs screening into routine pediatric care.
• Findings support the expansion of ACEs screening initiatives in diverse pediatric populations.