Evaluation of an Adverse Childhood Experiences Screening Program for Pregnant Patients in Rural Missouri

Adverse Childhood Experiences (ACEs) are defined as exposure to traumatic conditions from birth until age 18 years. Exposure to ACEs is associated with poor health outcomes and increased risks of chronic conditions such as obesity, heart disease, diabetes, stroke, and cancer. Pregnant women who have experienced ACEs have increased rates of depression, anxiety, post-traumatic stress symptoms, substance abuse and suicidality. The high prevalence of ACEs justifies screening, early support and interventions. This Quality Improvement Project was an evaluation of an existing ACEs screening program initiated in 2019 at an Obstetrics and Gynecology clinic in Northeast Missouri. It was aimed at screening ACEs in pregnant patients at their prenatal visit, so that timely referrals and resources can be provided to patients with high ACEs scores. The effectiveness of this program was evaluated by screening charts of all the eligible patients January 2021 to March 2021 (Timepoint 1, T1) and January 2022 to March 2022 (Timepoint 2, T2). Of the 144 patients, 50 participants (34.7%) had an ACE score of three or above. There was no statistically significant difference in the ACE scores between T1 and T2 (p = .21). Although not statistically significant, there was a small to moderate increase in Community Health Worker (CHW) referrals for ACE scores of four or higher. There was a moderate, statistically significant increase in the number of patients who kept their appointment from T1 to T2, c² (4) = 9.74, p = .05, ϕ = 0.26). There was a 300% increase in referrals provided to pregnant patients with ACE scores of four or higher from T1 to T2. These changes could stem from the fact that every three months, providers are now prompted about ACEs, screening, documentation, and Trauma Informed Care (TIC). This has ensured that providers have ACEs and TIC awareness thereby facilitating timely referrals of patients to appropriate resources.