Overcoming Barriers to ACE Screening in Primary Care

Background: Adverse childhood experiences (ACEs) are strongly linked with risk factors for the leading causes of death in adults, and recent evidence suggests that ACEs among college students are correlated with worse depression, substance use, diet, and sleep, and increased suicidal ideation. Local Problem: In the State of Utah, 63% of adults have experienced at least one ACE, yet several barriers exist that prevent primary care providers from implementing ACE screening into their practice. This project aimed to set the foundation to address this clinical gap at a primary care student health clinic. Methods: Pre- and post-intervention questionnaires assessed baseline provider knowledge, perceptions, and behaviors towards ACE screening at 2 time points over 5 weeks. Feasibility, usability, and satisfaction were assessed with post-intervention questionnaire. A provider checklist was utilized to track ACE screenings and ACE interventions in lieu of a chart review to protect patient privacy. Interventions: An ACE educational intervention PowerPoint presentation was developed and presented to providers and staff during a 1-hour staff meeting. The focus of the educational intervention was to increase provider knowledge about ACEs, ACE screening, and ACE interventions available in primary care. An ACE screening and interventions protocol was implemented for five weeks. Results: Descriptive statistics and simple averages from pre- and post-intervention questionnaire results demonstrated improvement in the measures of provider ACE knowledge, provider screening frequency, and provider confidence in conducting ACE screening and interventions. Conclusion: This project demonstrated provider readiness to incorporate ACE screening into primary care when supported by ACE education, screening protocol, and patients and provider resources.