Responding to Adverse Childhood Experiences in the Primary Care Setting

Date of Publication


Project Team

Carol Buck-Rolland, Ed.D, APRN, Kimberly Pierce, PA-C


Purpose. The impact of Adverse Childhood Experiences (ACEs) on lifelong health outcomes is well documented. The effects of ACEs can be mitigated using therapeutic and mindfulness strategies which build resilience. Many health care providers are reluctant to screen patients for ACEs, citing barriers such as time, lack of familiarity, concern for patient emotional stability, and lack of knowledge about resources for patients with high scores. This project was designed to address these barriers, develop a resource list for resiliency strategies, and create a sustainable screening model.

Methods. A rural Federally Qualified Health Center (FQHC) was chosen as the implementation site. FQHC staff and community members were educated about ACEs and resiliency using the documentary Resilience. Providers participated in an additional training module regarding the ACEs screening tool and local resources for resiliency. Posters were displayed in the waiting room and exam rooms encouraging patients to ask about ACEs screening. Providers completed pre- and post-implementation surveys assessing knowledge and willingness to participate in screening program.

Results. A total of 210 ACEs screenings were completed and documented in the EHR. No significant shift in provider attitudes or beliefs about ACEs screenings occurred during implementation. All providers who completed post-implementation surveys indicated interest in continued use of ACEs screenings with their patients. Feedback from providers and patients was overwhelmingly positive regarding the integration of ACEs screening and education into primary health care.

Conclusions. ACEs screening can be successfully integrated into a primary care setting. Community education, and flexibility in design and delivery of ACEs screening are essential to building support and gaining trust from staff members and patients.

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