Adverse Childhood Experiences (ACEs) Screening Implementation in Integrated Primary Care: A Mixed-Methods Pilot Study
Author
Capiaghi, Alexander
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This item will be available on: 2024-07-01
Abstract
For over two decades, adverse childhood experiences (ACEs) have been identified as a significant risk factor for multiple chronic physical and mental health conditions. Accordingly, ACEs are now highlighted as a public health concern requiring screening and intervention efforts in pediatric and family medicine settings. The benefits of ACEs screening in healthcare settings include the identification of clinically relevant social risk factors, such as history of trauma exposure and other chronic stressors. However, various patient, provider, and healthcare organizational factors create barriers to the uptake of routine ACEs screening practices, and few models of ACEs screening implementation are described in the extant literature.
In the current study, we piloted an educational intervention to increase routine ACEs screening by primary care providers at a university-affiliated integrated primary care clinic. Intervention methods focused on the use of behavioral health consultants to complete ACEs education sessions with primary care providers within a Primary Care Behavioral Health (PCBH) model. Emphasis was placed on the targeted reduction of providers’ self-reported barriers to completing routine ACEs screening with their adult primary care patients. Using a rapid-cycle quality improvement approach, we also incorporated provider feedback into study materials and processes, while addressing relevant environmental/organizational barriers to screening over a 12-month study period.
The results of this study suggest that primary care providers view it as appropriate to complete ACEs screening with their adult primary care patients; however, they consistently report time constraints as a barrier to ACEs screening. Our findings also suggest that providers are comfortable with patient-initiated discussions of ACEs and trauma history, but relatively less comfortable with provider-initiated screenings. Providers endorsed mixed responses about the clinical utility of ACEs screening. Preliminary data reflect that didactic educational interventions are helpful for reducing primary care providers’ self-reported barriers to ACEs screening. Our results also suggest that increasing providers’ knowledge of ACEs, comfort with ACEs screening, and confidence with incorporating ACEs screening results into treatment planning may offset other screening barriers related to time constraints during patient encounters and perceptions that ACEs-related health concerns do not benefit from medical interventions.
Due to the low observed changes in primary care providers’ ACEs screening frequency throughout our 12-month study period, we review appropriate recommendations from the implementation science literature to help guide future ACEs and trauma screening efforts in healthcare settings. We emphasize the need for flexibility for implementation strategies in the primary care setting, as well as the importance of data collection systems that allow for rapid and continuous data monitoring to measure progress towards organizational screening goals. We also highlight the need for improved clinical guidelines to inform ACEs screening, prevention, and intervention practices in healthcare settings, as providers will likely continue to question the clinical utility of ACEs screening without clearer recommendations for patient care.
Date
2023-08-07
Citation:
APA:
Capiaghi, Alexander.
(August 2023).
Adverse Childhood Experiences (ACEs) Screening Implementation in Integrated Primary Care: A Mixed-Methods Pilot Study
(Doctoral Dissertation, East Carolina University). Retrieved from the Scholarship.
(http://hdl.handle.net/10342/13149.)
MLA:
Capiaghi, Alexander.
Adverse Childhood Experiences (ACEs) Screening Implementation in Integrated Primary Care: A Mixed-Methods Pilot Study.
Doctoral Dissertation. East Carolina University,
August 2023. The Scholarship.
http://hdl.handle.net/10342/13149.
April 28, 2024.
Chicago:
Capiaghi, Alexander,
“Adverse Childhood Experiences (ACEs) Screening Implementation in Integrated Primary Care: A Mixed-Methods Pilot Study”
(Doctoral Dissertation., East Carolina University,
August 2023).
AMA:
Capiaghi, Alexander.
Adverse Childhood Experiences (ACEs) Screening Implementation in Integrated Primary Care: A Mixed-Methods Pilot Study
[Doctoral Dissertation]. Greenville, NC: East Carolina University;
August 2023.
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Publisher
East Carolina University