Theses and Dissertations at Montana State University (MSU)
Permanent URI for this collectionhttps://scholarworks.montana.edu/handle/1/733
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Item Implement ACE screening tool in a psychiatric outpatient clinic: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2022) Herron, Michelle Marie; Chairperson, Graduate Committee: Susan LuparellAdverse childhood experiences (ACEs) can decrease some of the identified leading causes of death in adults. These leading causes of death include heart disease, cancer, respiratory diseases, diabetes, and suicide. Adverse childhood experiences cause toxic stress, and the long-term effects of which follow people their entire lives. Screening of ACEs can identify ACEs early and allow for early prevention, referrals for additional services and supports to reduce long term health effects. Despite recommendations, psychiatric providers do not consistently screen for ACEs, ultimately missing opportunities to prevent ACEs with early intervention in childhood for those with higher risk or occurrence of ACEs. This quality improvement project took place a pediatric psychiatric outpatient clinic. This project focused on incorporating recommendations from studies completed by Centers for Disease Control and Prevention and Kaiser Permanente focusing on identifying high ACE scores and offering preventative supports. Lewin's three step change theory was used to guide this quality improvement project. The project was conducted for six weeks, collecting data on an excel spreadsheet identifying patients with high ACE scores for psychiatric providers. At the end of the quality improvement project, minimal data was able to be collected due to the barriers of the pandemic. The quality improvement project sought to identify patients with high ACE scores in order to offer additional preventative interventions, supports and referrals to decrease long term health issues. ACEs are a critical public health issue due to the profound negative and lasting effects on the health and wellness of a child later in life. Psychiatric pediatric outpatient clinics are settings in which ACEs can be identified and implementing interventions and supports can help children build resilience and decrease the effects of the adverse experiences and improve patient outcomes.Item Turning straw into gold, ACE screening for adult agricultural workers in primary care: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2022) Conner, Jeanne Randale; Co-chairs, Graduate Committee: Yoshiko Yamashita Colclough and Susan LuparellHistory of adverse childhood experiences (ACEs) is common among adults and associated with nine of the ten leading causes of death in the United States. ACEs screening, coupled with patient education and support from behavioral health promotes resilience and healing from trauma. ACEs screening was not a routine component of the annual assessment visit at the primary care clinic, a federally qualified health center serving agricultural workers and their families. The purpose of this project was to implement ACEs screening as a routine part of the annual assessment visit for adult agricultural workers, coupled with education and, for patients at increased risk, prompt referral to behavioral health. Prior to implementation, training was provided to clinical staff to prepare them for ACEs screening. During the ten-week data collection period, 75% of annual assessment visits included ACEs screening with documentation in the patient's medical history. 17% of the patients screened were determined to be at increased risk due to ACEs, and 57% of patients referred to behavioral health secondary to ACEs screening completed a visit with a behavioral health provider within two weeks of screening. Recommendations to increase ACEs screening and behavioral health referrals in this primary care clinic include adding ACEs screening to the organization's At-a-Glance Checklist for chart preparation, adding ACE score documentation to peer review chart audit, and identifying ACE-specific diagnoses to list in the medical history to facilitate data extraction and meaningful use for population health.