Other Titles
Rising Star Poster/Presentation - Rapid Presentation Round
Abstract
Introduction: Adverse childhood experiences (ACEs) are potentially traumatic events that occur in childhood including abuse, neglect, and household dysfunction. They are highly prevalent among children, especially those that are racially, ethnically, or socioeconomically disadvantaged. ACEs are negatively associated with unfavorable health outcomes in children including behavioral problems, cognitive delays, and poor physical health. Various governing bodies recommend routine screening for ACEs in pediatric primary care, but some studies report screening rates as low as 4%.
Aims: The aim of this quality improvement doctor of nursing practice (DNP) project was to implement an evidence-based ACE screening protocol and referral to behavioral health services workflow, measure compliance of ACE screening, and evaluate project outcomes for sustainment recommendations.
Theoretical Framework: Implementation of ACE screening into the routine of well child visits at a federally qualified health center was guided by the Kotter change model. Components of the model that were essential to project success included stakeholder support, a multidisciplinary team, clear project aims and communication, and identification of implementation barriers.
Methods: The ACE screening process was implemented at well child visits with referrals for positive screens to co-located behavioral health services at the project site for children 12 years and older and referrals to behavioral health services within an external community program for children younger than 12 years old. Data analysis included descriptive statistics of the number of ACE screenings completed during the project timeframe and the number of referrals made following positive screens. Interview questions were sent to project site staff to analyze acceptability and sustainability of the ACE screening process.
Results: ACE screenings were completed at a screening rate of 96%. While fewer than 25% of positive screens were referred to behavioral health services, it was found that more than 50% of children with positive screens were receiving behavioral health services in other settings. Project site staff found the process to be both acceptable and sustainable beyond the project timeframe.
Conclusions: The implementation of an evidence-based ACE screening and referral protocol into the routine of well child visits at a federally qualified health center has been successful in increasing the number of pediatric patients screened for ACEs and referred to behavioral health services.
Notes
References:
DiGangi, M. J., & Negriff, S. (2020). The implementation of screening for adverse childhood experiences in pediatric primary care. The Journal of Pediatrics, 222. 174-179. https://doi.org/10.1016/j.jpeds.2020.03.057
Kia-Keating, M., Barnett, M. L., Liu, S. R., Sims, G. M., & Ruth, A. B. (2019). Trauma-responsive care in a pediatric setting: Feasibility and acceptability of adverse childhood experiences (ACEs) screening. American Journal of Community Psychology, 64(3-4). 286-297. https://doi.org//10.1002/ajcp.12366
Liu, S. R., Grimes, K. E., Creedon, T. B., Pathak, P. R., DiBona, L. A., & Hagan, G. N. (2021). Pediatric ACES assessment within a collaborative practice model: Implications for health equity. American Journal of Orthopsychiatry, 91(3). 386-397. https://doi.org/10.1037/ort0000536
Marie-Mitchell, A. & Kostolansky, R. (2019). A systematic review of trials to improve child outcomes associated with adverse childhood experiences. American Journal of Preventative Medicine, 56(5). 756-764. https://doi.org/10.1016/j.amepre.2018.11.030
Negriff, S., DiGangi, M. J., Sidell, M., Liu, J., & Coleman, K. J. (2022). Assessment of screening for adverse childhood experiences and receipt of behavioral health services among children and adolescents. JAMA Network Open, 5(12). https://doi.org/10.1001/jamanetworkopen.2022.47421
Sigma Membership
Beta Sigma
Type
Poster
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Translational Research/Evidence-based Practice
Keywords:
Adverse Childhood Experiences, ACEs, Health Outcomes, Health Screening, Primary Health Care, Pediatrics
Recommended Citation
Waite, Megan Nicole, "Implementation of Adverse Childhood Experiences Screening in Pediatric Primary Care" (2026). Creating Healthy Work Environments (CHWE). 2.
https://www.sigmarepository.org/chwe/2024/posters_2024/2
Conference Name
Creating Healthy Work Environments
Conference Host
Sigma Theta Tau International
Conference Location
Washington, DC, USA
Conference Year
2024
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-02-16
Implementation of Adverse Childhood Experiences Screening in Pediatric Primary Care
Washington, DC, USA
Introduction: Adverse childhood experiences (ACEs) are potentially traumatic events that occur in childhood including abuse, neglect, and household dysfunction. They are highly prevalent among children, especially those that are racially, ethnically, or socioeconomically disadvantaged. ACEs are negatively associated with unfavorable health outcomes in children including behavioral problems, cognitive delays, and poor physical health. Various governing bodies recommend routine screening for ACEs in pediatric primary care, but some studies report screening rates as low as 4%.
Aims: The aim of this quality improvement doctor of nursing practice (DNP) project was to implement an evidence-based ACE screening protocol and referral to behavioral health services workflow, measure compliance of ACE screening, and evaluate project outcomes for sustainment recommendations.
Theoretical Framework: Implementation of ACE screening into the routine of well child visits at a federally qualified health center was guided by the Kotter change model. Components of the model that were essential to project success included stakeholder support, a multidisciplinary team, clear project aims and communication, and identification of implementation barriers.
Methods: The ACE screening process was implemented at well child visits with referrals for positive screens to co-located behavioral health services at the project site for children 12 years and older and referrals to behavioral health services within an external community program for children younger than 12 years old. Data analysis included descriptive statistics of the number of ACE screenings completed during the project timeframe and the number of referrals made following positive screens. Interview questions were sent to project site staff to analyze acceptability and sustainability of the ACE screening process.
Results: ACE screenings were completed at a screening rate of 96%. While fewer than 25% of positive screens were referred to behavioral health services, it was found that more than 50% of children with positive screens were receiving behavioral health services in other settings. Project site staff found the process to be both acceptable and sustainable beyond the project timeframe.
Conclusions: The implementation of an evidence-based ACE screening and referral protocol into the routine of well child visits at a federally qualified health center has been successful in increasing the number of pediatric patients screened for ACEs and referred to behavioral health services.
Description
This presentation will discuss a quality improvement project that was led by a doctor of nursing practice student to implement an evidence-based adverse childhood experiences screening and referral to behavioral health services workflow in a federally qualified health center that provides care to underserved pediatric patients.