News Release

Screening for adverse childhood experience can improve trauma-informed care, though time constraints and limited referral resources present challenges

Clinician and staff perspectives on implementing Adverse Childhood Experience (ACE) screening in Los Angeles County Pediatric Clinics

Peer-Reviewed Publication

American Academy of Family Physicians

Screening for Adverse Childhood Experience Can Improve Trauma-Informed Care, Though Time Constraints and Limited Referral Resources Present Challenges

Researchers conducted a qualitative evaluation in five clinics in Los Angeles County to understand physician and clinical staff perspectives on the implementation of routine Adverse Childhood Experience (ACE) screening in pediatric primary care. The researchers employed focus group discussions with 125 clinic staff involved in ACE screening, including frontline staff who administer the screening; medical doctors who use screening to counsel patients and make referrals; and psychosocial support staff who may receive referrals. Clinical staff generally considered ACE screening to be acceptable and useful. Staff said that ACE screening helped elicit important patient information and build trust with patients. Further, no adverse events were reported from screening. However, regarding implementation and quality improvement, significant barriers included insufficient time for screening and response, insufficient training, and lack of clarity about referral networks and resources that could be offered to patients. Clinic staff felt ACE screening could improve trauma-informed care and could be strengthened by addressing time constraints and limited referral resources.

What We Know: Many children experience adverse childhood experiences, which may include abuse, neglect, violence in the home, or separation from a parent. While stress is a natural response to such occurrences, ACEs can trigger toxic stress, which has health ramifications for children later in life. This includes decreased physical and mental health in childhood and adulthood, as well as developmental delays, depression, asthma, obesity, smoking, cancers, and heart disease. Clinicians are increasingly interested in using routine screening for ACEs in pediatric/primary care settings to mitigate physical and mental health effects of ACEs in children and adults.

What This Study Adds: Researchers found that clinicians and frontline staff felt

comfortable administering and discussing ACE screening. Despite some challenges in using the screening within the clinic workflow, screenings worked effectively and staff were able to offer suggestions on how to improve implementation, quality, and acceptability. Staff also reported that ACE screenings helped them elicit important information and build trust with patients, along with giving them a structured way to ask questions that often go unasked. This contributed to a holistic approach to providing care. However, some staff reported frustration at not being able to provide resources to families with children experiencing ACEs. They also cited the burden of increased paperwork due to using ACE screening and recommended that providing emotional support to those who experienced the emotional burden of using the screening tool could help mitigate staff burnout.

 Clinician and Staff Perspectives on Implementing Adverse Childhood Experience (ACE) Screening in Los Angeles County Pediatric Clinics

Nicole Eberhart, PhD, et al
RAND Corporation, Santa Monica, California

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