A National Trauma-Informed Adverse Childhood Experience Screening and Intervention Evaluation Project

Adverse childhood experiences (ACEs) are traumatic childhood events that can disrupt neurologic, endocrine, and immune regulation and increase the risk for poor health outcomes. This Trauma-Informed ACE Screening and Intervention Evaluation (TASIE) Quality Improvement (QI) Project, ECHO, evaluated (1) pediatric provider knowledge of ACEs, toxic stress, and trauma-informed care principles, (2) implementation of ACE screening and clinical response in practice, and (3) patient and provider perspectives around benefits and challenges of ACE screening.

From November 2021 to May 2024, three cohorts, totaling 46 pediatric practices across the U.S., participated in the TASIE Project, which included 2 h ACE training, eight monthly 75 min ECHO sessions, and monthly QI coaching. A mixed-methods approach was used to evaluate monthly data, while patient and provider surveys and provider focus groups were used to evaluate the program.

All 46 participating practices implemented ACE screening by the project's conclusion. Of the patients eligible for ACE screening, over half were screened for ACEs during the program. Providers increased comfort with discussing ACEs and screening questions. During the first month, the practices were reported to have provided education to 56% of patients, and by the end of the project, this rate increased to 79% of patients. Overall, 97% of caregivers and 92% of adolescents screened agreed or somewhat agreed that it is important for providers to know about ACEs and toxic stress so they can offer better care. By the end of the project, for each cohort, providers reported that they were able to screen effectively and efficiently in routine practice and were more familiar with local resources.