351 - Screening for Adverse Childhood Experiences (ACEs) in Community Clinics

Poster Number: 351
Publication Number: 351.345

Amal M. Algahmi, Authority Health Pediatric Residency Program, Dearborn, MI, United States; Ashwin K. Shankar, Authority Health Pediatric Residency Program, Detroit, MI, United States; Anthony A. Adetomiwa, Authority Health, Farmington Hills, MI, United States; Juan S. Arana, Authority Health, Detroit, MI, United States; Khyrista Jones, Authority Health GME Consortium, Royal Oak, MI, United States; Stephanie A. Taing, Authority Health GME, Detroit, MI, United States; Zahra Jiwani, Authority Health, Detroit, MI, United States; John Anderson, Authority Health, Ferndale, MI, United States; Allison Tripi, Authority Health, BRIGHTON, MI, United States; Jasmine T. Gray, Authority Health, Detroit, MI, United States; Lisa M. Randon, Detroit Community Health Connection, Inc., Detroit, MI, United States; Jonathan Heckman, Western Wayne Family Health Center, Birmingham, MI, United States; Carolyn Custer, Authority Health, Detroit, MI, United States; Chaya Pitman-Hunt, Central Michigan University College of Medicine, Canton, MI, United States

Background: Adverse childhood experiences (ACEs) are preventable, potentially traumatic events that occur during childhood. ACEs include all forms of abuse and neglect, household dysfunction, and societal challenges. Repeated exposure without a protective safeguard leads to constant activation of the stress response and toxic stress levels. Immediate effects include behavioral problems, poor academic performance, and depression, while long term this leads to increased risk of poor health outcomes in adulthood. Baseline data from selected resident continuity clinics in the metropolitan Detroit, MI area indicated that screening for ACEs was not a routine part of annual well visits.

Objective: We aimed to screen for ACEs during well visits for children 6 to 11 years of age. Our goal was to reach an initial screening rate of 25%, and increase in a stepwise manner to a rate of 75% within one year of project initiation.

Design/Methods: The Model for Improvement was utilized in this longitudinal quality improvement (QI) project. Planning took place in the fall of 2019; screening began in March 2020. The screening tool consisted of the Center for Youth Wellness ACE Questionnaire (CYW ACE-Q) and the Pediatric Symptom Checklist (PSC or PSC-17). Screening sites included two federally qualified health centers (FQHCs) and one established community pediatric clinic, all of which serve as resident continuity clinic sites. Five Plan-Do-Study-Act (PDSA) cycles were conducted, which included evaluating the screening tool, educating physicians and staff, and addressing data collection challenges.

Results: We achieved our goal of screening for ACEs during at least 75% of well visits for children 6 to 11 years of age. Screening rates by clinic and PDSA cycle are presented in Table 1 and Figure 1. Cumulative screening data by clinic over the entire study period, as well as the distribution of ACE scores by category, are shown in Table 3. Altogether, 36.7% of patients reported experiencing at least 1 ACE. Approximately 25% of families wanted to discuss the screen with the physician. When referrals to behavioral health (BH) services were documented, 27% of patients received a referral.Conclusion(s): Despite the challenges of the COVID-19 pandemic, and with commitment from community stakeholders, we demonstrated that screening for ACEs in the outpatient setting is achievable. Our goal is to establish screening for ACEs and intervening as a routine part of all well visits regardless of age. Future directions include tracking the effects of BH referrals, and research on the correlation of ACE scores with PSC scores and childhood diseases.
CV Algahmi, Amal - Sept 2021.pdf
Figure 1: Run Chart of ACE Screening Rates at All Clinic Sites