ACE questionnaire implementation: creating a trauma-informed approach in an integrated community health setting

Abstract

Adverse childhood experiences (ACEs) are potentially traumatic events that occur in childhood (0-17 years) and can have a significant impact on adult high-risk behavior and chronic diseases such as heart disease, cancer, diabetes, and mental health disorders. Despite ACE screening being the recommended practice, primary care and community health providers do not consistently screen for ACEs. Screening for ACEs in these settings offers an opportunity for recognition, early intervention, and prevention of poor long-term health outcomes. This quality improvement project aimed to implement ACE screenings in a community health setting in southwestern Montana. Screening and identification of ACEs facilitated early interventions such as referrals to psychotherapy and would ultimately aid in the prevention of long-term negative health outcomes. The DNP student and lead behavioral health consultant (BHC) used the Plan Do Study Act (PDSA) framework to guide implementation. Data collection included ACEs administered, returned, scores, and referrals made. Data collection occurred over a six-week period. The Identified Adult ACE Questionnaire was included in new patient assessment packets and administered to all new behavioral health patients. Of the 18 patients who returned an ACE questionnaire, 14 (78%) completed a follow-up visit with a behavioral health consultant. The average ACE score was 3.83. Fifteen patients (83%) received referral resources for psychotherapy. Nine patients (50%) screened as "high risk" for poor long-term health outcomes. Implementing ACE screenings in a community health setting allows providers to screen high-risk patients and intervene with evidence-based practices to promote health and limit long-term negative health outcomes. ACEs, if recognized, can be mitigated through early intervention and trauma-informed care.