Clinician Perspectives on Screening for Adverse Childhood Experiences in School-Based Health Centers: A Qualitative...

Adverse childhood experiences (ACEs) are associated with poor health and educational outcomes on a population level. School-based health centers (SBHCs) may be uniquely positioned to support youth with ACEs, but little is known about ACEs screening and response in that setting. In this qualitative study, we characterized barriers and facilitators to addressing ACEs in SBHCs from the perspectives of SBHC clinicians.

We conducted semistructured interviews with clinicians affiliated with a large public school district in Southern California that had implemented ACEs screening in its SBHCs. Interviews explored attitudes toward and experiences with ACEs screening in SBHCs, as well as differences between screening in SBHCs and other settings. We used a thematic analysis approach, continuing until thematic saturation was reached.

The sample included 10 SBHC clinicians. Six major themes emerged. Three themes were considered opportunities: 1) SBHCs serve as a bridge to care and resources for youth with ACEs, 2) SBHC clinicians are versatile in their approach to addressing ACEs, and 3) structural elements of SBHCs facilitate ACEs screening and response. The remaining 3 were considered challenges: 1) SBHCs have limited capacity for follow-up for youth with ACEs, 2) providers experience challenges with obtaining accurate ACEs screening results, and 3) responding to ACEs screening is complex.

SBHCs have the potential to support identification and response among youth with ACEs, though challenges remain. Policy and practice recommendations may consider how SBHCs can be leveraged as a unique context to support vulnerable populations at risk of toxic stress.