89. BEYOND SCREENING: USING ADVERSE CHILDHOOD EXPERIENCE (ACE) SCREENING TO PILOT A WELLNESS PROGRAM

Abstract

Background The AAP recommends ACE screening, but effective implementation and support for patients with high ACE scores is challenging. Many providers are hesitant to screen without intervention support. The second-year resident class worked sequentially to implement ACE screening and use the momentum from screening to pilot an integrated wellness program. Aim Statement 1. Screen for ACE in >80% of patients at annual preventative care visits by December 2019 2. Determine resources needed by patients with high ACE scores 3. Implement an integrated wellness program for patients with high ACE scores. Interventions Interventions addressed barriers for our primary drivers: medical assistants (MA), providers, and families. A MA champion taught best screening strategies and communicated updates. Providers received educational sessions and progress updates via email and monthly meetings. EHR was modified to simplify documentation. Intake forms were streamlined to combat form fatigue. Residents created a QI sign out to update the next resident team and share successes. The wellness nurse developed a menu of services including information about toxic stress and a strength's-based wellness assessment. Integrative techniques were provided to improve resilience, develop strengths, and connect patients to mental health services. Measures Monthly ACE screening rates were determined by measuring the number of screens compared to preventative care visits. Patients with a score of 3 with symptoms or 4-10 were referred to a wellness team. Secondary measures were ACE team referrals, wellness assessments, counseling sessions, integrative interventions, and resources provided. Results ACE screening improved from 2 to 89% in 18 months. During the first 5 months of the wellness program, there were 161 referrals, 80 full wellness assessments, 136 integrative appointments, and 92 in-office counseling sessions. Community resources (food, housing) were provided 617 times, and 2230 pieces of written education were distributed by the wellness team. Conclusions and Next Steps Interventions have shown a sustained increase in ACE screening rates. After establishing the wellness program, there was a marked increase in the number of screens, referrals and wellness appointments. The addition of dedicated staff allowed for better care coordination and resource distribution. Next steps are to decrease no show rates for wellness appointments and to monitor resilience scores and patient surveys for ongoing improvements to the program.