Promising Practices for Implementing Adverse Childhood Experiences and Resilience Screening in Obstetric Care.

Abstract

Introduction: Adverse childhood experiences (ACEs) and resilience screening have the potential to improve health outcomes for pregnant women and their children. However, in the prenatal setting, guidance is lacking regarding both implementation of this screening as well as recommended follow up for patients. Methods: This is a summary of two pilots examining the feasibility and acceptability of ACEs and resilience screening during prenatal care in five medical centers in Kaiser Permanente Northern California (KPNC). Data includes qualitative and quantitative patient and clinician surveys as well as commentary on the challenges faced. Results: Patient and clinician survey data supports the feasibility and acceptability of ACEs and resilience screening in prenatal care. Trauma informed education for clinicians and staff regarding ACEs and resilience, scripts, workflows, and algorithms for follow up were essential. Most patients with ACEs don't desire mental health follow up but were satisfied with apps, books, and online resources. Conclusions: This commentary offers a practical model for obstetric practices to implement ACEs and resilience screening. This promising practice is feasible, valued by both clinicians and patients and does not necessarily require additional high-intensity referrals.