P3.279: Screening and Interventions for Adverse Childhood Experiences in the Primary Care Setting

Purpose/Objectives: Early adverse childhood experiences (ACEs) have been shown to be associated with poorer adult health outcomes and increased risky behaviors. ACEs include experiencing violence, abuse, neglect, or a family member attempt or death by suicide. Screening for ACEs in children within their primary care setting to allow for timely intervention to potentially mitigate the impact of the adverse experiences is a topic of research. The Trauma-Informed ACEs Screening & Intervention Evaluation (TASIE) Project ECHO was developed to demonstrate a model for integrating ACEs screening and strength-based, trauma-informed services into pediatric primary care practices.

Design/Methods: The Project was an initiative of the Center for Youth Wellness and the New Jersey Chapter, American Academy of Pediatrics with funding from Health Resources and Services Administration. Primary care practices applied to participate in the TASIE Project ECHO with a total of 3 cohorts. The Pediatrician Champion from practices attended an orientation workshop, a 2-hour ACEs training workshop, and eight monthly sessions, which fostered peer-to-peer learning. At NMCSD, the project was implemented through the pediatric residency continuity clinic curriculum with education on ACEs, screening tools, and the seven pillars of wellness. Quality Improvement PDSA cycles were used throughout the study period to evaluate our practice performance and make adjustments. Education on ACEs and the Seven Pillars of Wellness were hung in all exam rooms. The PEARLS tool (Pediatric ACEs and Related Life Events Screener) was incorporated into the 9 month and 3 year well visit screening and dot phrases for documentation in the medical record were developed. Several military-unique stressor questions were incorporated into the tool. The medical records for all 9 month and 3 year well visits were reviewed to access our screening rate.

Results: In reviewing our run chart of the rate of ACEs screening, it is clear that incorporating ACEs screening into a pediatric clinic is feasible. We did have a dip in our screening rate which was associated with periods when we experienced a decrease in our clinic support staff. Having appropriate staffing in the clinic and educating the entire team is critical with any QI project. Overall, parents were willing to complete the screening and understand more about ACEs and the seven pillars of wellness.

Conclusion/Discussion: At NMCSD we continue to include ACEs screening at our 9 month and 3 year well checks as the providers recognize the importance of this screening. Our HealthySteps providers and Social Worker are available to meet with families who request support, or the providers feel need extra support. We are investigating potentially expanding the screening to include other age groups or new enrollees to the clinic.

Of note, funding was provided to the department for participating. This funding is being used to support further resident education.