Universal ACEs Screening in an Integrated Internal Medicine-Pediatrics Clinic: a Quality Improvement Project

Background: Exposure to Adverse Childhood Experiences (ACEs) has been shown to have direct, dose-dependent, and inter-generational effects on long term health outcomes. Increasingly, health professionals are using screening tools to identify ACEs earlier in their patient populations with the hope of intervening to address these issues and build resilience. Most clinical efforts involving ACEs are seen in the pediatrics community; however, these issues remain vital throughout life. Objective: Through a quality improvement process, increase the frequency of screening for ACEs for patients of all ages, increase provider comfort level in addressing ACEs, and increase indicated social work or community resource referrals in our Internal Medicine-Pediatrics clinic. Methods: Providers were surveyed prior to intervention on ACEs knowledge and comfort level. During a 3 month time period a modified version of a validated screening tool was administered to patients of all ages at the beginning of every wellness visit. Surveys were reviewed by a provider and positive screens were addressed with the patient. Follow-up survey was given at conclusion of the visit to evaluate patient comfort level and satisfaction. Results: Pre-intervention surveys indicated providers have variable comfort levels in addressing ACEs or unmet social needs, and frequently do not ask about these issues during patient encounters. Initial intervention data showed positive screens in 47% of surveyed patients (age range 4 months to 40 years, n = 55) with 13% of these visits generating social work referrals. Outtake patient surveys regarding patient comfort level and satisfaction were overwhelmingly positive. Conclusion: We administered an ACEs screening program in a combined Internal Medicine-Pediatrics clinic. By screening patients of all ages, we are able to address needs across generations in an organized, systematic way. Our experience can serve as a model for similar efforts in other clinical settings.