Implementing the ACE Screening Tool to Improve Access to Trauma-Focused Care for Individuals with a Substance Use Disorder

Background: Research has shown that individuals with substance use disorders (SUDs) have high rates of childhood trauma. Individuals who experience high levels of childhood trauma are 4-12 times more likely to have a SUD. Trauma-informed care supports SUD treatment interventions by identifying root problems and core issues driving substance abuse behaviors. Concurrent treatment of trauma and substance abuse supports recovery, sobriety, and positive health outcomes. Low-income and homeless populations utilizing the services of community resource centers often have high rates of SUDs. An identified potential barrier within community resource centers is the lack of a standardized trauma screening tool. Implementing a trauma screening tool could help increase trauma focus care for individuals with SUDs. Methods: A pre-implementation questionnaire assessed the clinical staff's prior trauma screening practices and their knowledge of the impact of trauma and SUD. An educational seminar and pamphlet on childhood trauma, SUD, and the Adverse Childhood Experience (ACE) screening tool were given to facility managers and disseminated to clinical sites. A modified ACE screening tool was implemented following education into the client intake documentation process. Following implementation, a post-implementation questionnaire was sent to clinical staff to re-evaluate their understanding of the presented education materials and determine their thoughts on the ACE screening tool's usability, feasibility, and sustainability. Results: Out of 41 clinical staff who completed the pre-implementation questionnaire, 44% (n = 18) were satisfied with their current trauma screening process, and 83% (n=34) agreed that the ACE screening tool would be effective for their client population. The ACE screening was completed by 277 individuals. 159 reported no history of SUD and had a mean ACE score of 4.07, while 118 reported a history of SUD and had a mean ACE score of 6.8. Out of 23 clinical staff who completed the post-implementation questionnaire, 53% (n=12) were satisfied with the ACE screening tool and 56% (n=13) found the ACE screening feasible and easy to use. However, education was not as effective as desired regarding clinical staff knowledge of childhood trauma and SUD. Conclusions: The ACE screening tool was successfully implemented into the client intake documentation process at Switchpoint Community Resource Centers across Utah. Overall, clinical staff were satisfied with the ACE screening tool's effectiveness, ease of use, and feasibility and found it beneficial for their clientele population. The results from this project support the literature and prior studies' findings that individuals with high rates of childhood trauma are at higher risk of developing SUD later in life. Future quality improvement projects are needed to address individual facility's team member's frustrations and barriers with the ACE screening tool and implement evidence-based trauma-focused treatments specific to the facility's population needs.