Implement ACE screening tool in a psychiatric outpatient clinic: a quality improvement project

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Montana State University - Bozeman, College of Nursing


Adverse 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.



Adverse childhood experiences (ACE)


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