105. ADVERSE CHILDHOOD EXPERIENCES SCREENING IN RESIDENT CONTINUITY CLINIC

Abstract

Background Adverse Childhood Experiences (ACEs) are traumatic events that occur prior to age 18. Exposure to ACEs has been associated with negative health outcomes including developmental delay and mental health conditions. ACEs are common and there are ∼17,000 children in our county with exposure to 2+ ACEs. Studies show early resource utilization and promoting resilience can combat the effects of ACEs, however many individuals are not using resources. Aim Statement his project is aimed at improving screening and recognition of ACEs to allow for referrals to resources in order to decrease effects from ACEs. Our goal is to screen 75% of children ages 0-5 for ACEs during well visits. For those who screen positive (score of 4+), our goal is to refer to resources 75% of the time. The project also focuses on improving provider knowledge of ACEs with a goal of 75% of residents reporting feeling at least “somewhat comfortable” with ACEs screening. This project takes place at Myers Park Pediatrics in the Resident Continuity Clinic and involves children ages 0-5 years. The project was initiated in March 2018 and is ongoing. Interventions Visual prompts were placed on workstations to help registration staff and providers remember which visits the screening was scheduled to take place. Scoring instructions were placed on the form. After initial data showed many screens were left incomplete, scoring instructions were taken off the form to encourage more families to complete the form without fear of a SW consult which was originally listed on the form. Provider education including resilience screening and lectures were provided to increase knowledge about ACEs and allow providers to understand the importance of screening. A cover sheet was also placed on the screening form and was edited to provide families more information on why screening was being performed. Measures Outcome measures included % of children ages 0-5 that are screened for ACEs and % of children ages 0-5 with positive screens that are referred with the goal for both being 75%. Process measures included % of residents trained in ACEs screening, % of front desk staff trained in distributing ACEs forms, % of forms distributed to families, and % of forms completed by families. Balancing measures included 75% of front desk staff will report no change in work flow due to handing out screening and 75% of residents will report that ACEs screening is helping them learn about ACEs and how to manage them. Results The average % of screening for all patients in the targeted population was 57%. At times the percentage of screens was above the goal, however was not sustained. Results demonstrated random variation despite multiple interventions. Only 4 patients had ACEs scores of 4+, however all were referred to resources which was above our goal of 75%. Only 10% of residents initially reported feeling at least “somewhat comfortable” with ACEs screening, however after initiation of the project and further education, 85% of residents reported feeling at least “somewhat comfortable”, with a goal of 75%. Eighty-six percent of residents reported that they learned from ACEs screening. When assessing balancing measure, 88% of registration staff reported no change in overall work flow. Conclusions and Next Steps ACEs are common and can have many negative health outcomes. Early intervention with resources can promote resilience and prevent negative outcomes. We have been successful in implementing screening in a local clinic, but have not met sustainability. We have been able to educate providers and ensure that there is no negative impact on clinic work flow. We continue to make changes to improve screening and identification of those affected by ACEs to refer them to resources. We have also been chosen to participate in a Pediatric Integrated Care Collaborative which will provide improved education for our providers and more resources to our patients related to ACEs.