Implementing Adverse Childhood Experiences Screening Tool in Outpatient Mental Health Clinic

Abstract

Problem: Adverse Childhood Experiences (ACEs) have negative outcomes regardless of background. Exposure to ACEs is linked to premature deaths, high-risk behaviors, cancer, mental health problems, and heart diseases. It is estimated that 50 to 60% of American children below 18 have at least one ACE, with 25% having three or more. This community mental health clinic does not screen for ACEs. Baseline data showed that many children were exposed to divorce, substance abuse, domestic violence, sexual abuse, incarceration, and separation of parents or guardians. Its lack of specialized trauma care increases ACE-related poor outcomes. Implementing ACEs screening will promote early detection and prompt referral. Purpose: This Quality Improvement (Q.I.) project implemented the Center for Youth Wellness Adverse Childhood Experiences Questionnaires (CYW ACE-Q) in a mental health clinic for patients ages 10-18 and evaluated its effectiveness in early detecting high-risk patients and referrals. Methods: ACEs screening forms are completed with other new intake forms during the initial psychiatric evaluation. Providers review completed forms, and referrals are made based on the ACE scores. Staff education was done before the commencement of implementation. A weekly chart audit was used to retrieve screening information. Therapy placement is confirmed at the two-week follow-up. Results: 326 children were seen during the 14-week implementation, and 88% (n=269) met eligibility. Of all eligible patients, 88% had ACE scores ≥4 and received referrals for therapy. Of which 83% secured placement on two weeks follow-ups. Of all patients seen, 9.3% refused screening. Conclusions: CYW ACE-Q effectively identifies at-risk patients, supporting evidence that children with more than four ACEs often have mental, emotional, and/or behavioral issues. Screening questions were sensitive; aggregate screen scoring mitigated this barrier. Keywords: Adverse childhood experience screening (ACEs), Center for Youth Wellness Adverse Childhood Experiences Questionnaires (CYW ACE-Q).