Screening for Adverse Childhood Experiences in Pediatric Primary Care

Abstract

Problem & Purpose: Pediatric mental illness is a growing epidemic in the United States, yet the average time from onset of symptoms to treatment is eight to ten years. Screening children for Adverse Childhood Experiences (ACEs) is associated with early identification of mental illness risk and improved outcomes. The purpose of this quality improvement project was to implement an ACEs Screening Program for adolescents in a pediatric primary care practice and evaluate the program’s effectiveness in early risk-identification and referral to mental health services. Methods: Patients ages 8-18 years were screened for ACEs using the Center for Youth Wellness Adverse Childhood Experiences Questionnaires (CYW ACE-Q) during routine pediatric well visits and consults. Patients and/or caregivers self-completed the pen/paper CYW ACE-Q screening tools and pediatricians then analyzed and discussed the results with the patients and/or caregivers. Patients with positive screens were referred to mental health services if not already under care, and appointments were confirmed by the office practice nurses. Statistical Process Control procedures were utilized to demonstrate change over time with screening and referral. Results: Over 70% of all eligible patients and caregivers during the 13-week implementation period were screened for ACEs (n=232). Of those, 14% (n=32) screened positive, and four were referred for mental health services. Phone-call follow-up to referred patients found one patient obtained an appointment with a mental health professional. Eighty-eight percent of stakeholders strongly agreed that the screening program was feasible for well visits and consults. Conclusions: An ACEs Screening Program using the CYW ACE-Q tools is an effective and feasible strategy for primary care practices to identify children at higher risk for mental illness and facilitate earlier referral to mental health services. This increase in early identification and referral of higher-risk children can play a key role in decreasing the burden of pediatric mental illness and its associated complications in the United States.