Lessons Learned from a Quality Improvement Initiative: Adverse Childhood Experiences Screening in a Pediatric Clinic

Crenshaw, Molly M.; Owens, Caitlyn R.; Dow-Smith, Carrie; Olm-Shipman, Casey; Monroe, Rasheeda

doi:10.1097/pq9.0000000000000482

Cited by 4 publications

(3 citation statements)

References 25 publications

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“…19 With 46.5% of previously unconnected patients receiving new referrals to behavioral health resources, we achieved a higher connection rate than those reported in similar trauma screening studies. [20][21][22][23]…”

Section: Discussionmentioning

confidence: 99%

“…There are significant differences between our approach and results compared with other trauma screeners and workflows published in the literature. [19][20][21][22][23][24] Our model asks about recent trauma in the past year and is linked to a PTSD symptomology screener when trauma is identified. Other screening models, such as the Whole Child Assessment, CYW-ACEQ, the Juvenile Victimization Questionnaire, and the SEEK, utilize a longer screening method with multiple categories of adversity and do not screen for PTSD symptomology.…”

Section: Screening and Referral Approachmentioning

confidence: 99%

“…27 The identification of PTSD symptomology is 1 potential reason for our higher referral rates when compared with other studies in primary care settings. [20][21][22][23] Advantages of the other trauma screening tools over our model are their ability to measure cumulative adversity, ask about specific trauma categories, and identify social drivers of health.…”

Section: Screening and Referral Approachmentioning

confidence: 99%

See 2 more Smart Citations

Pediatric Trauma and Posttraumatic Symptom Screening at Well-child Visits

DiGiovanni

Frances

Brown

et al. 2023

Pediatric Quality &Amp; Safety

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Introduction: Adverse childhood experiences (ACEs), including abuse or neglect, parental substance abuse, mental illness, or separation, are public health crises that require identification and response. We aimed to increase annual rates of trauma screening during well-child visits from 0% to 70%, post-traumatic stress disorder (PTSD) symptom screening for children with identified trauma from 0% to 30%, and connection to behavioral health for children with symptoms from 0% to 60%. Methods: Our interdisciplinary behavioral and medical health team implemented 3 plan-do-study-act cycles to improve screening and response to pediatric traumatic experiences. Automated reports and chart reviews measured progress toward goals as we changed screening methods and provider training. Results: During plan-do-study-act cycle 1, a chart review of patients with positive trauma screenings identified various trauma types. During cycle 2, a comparison of screening methods demonstrated that written screening identified trauma among more children than verbal screening (8.3% versus 1.7%). During cycle 3, practices completed trauma screenings at 25,287 (89.8%) well-child visits. Among screenings, 2,441 (9.7%) identified trauma. The abbreviated Post Traumatic Stress Disorder Reaction Index was conducted at 907 (37.2%) encounters and identified 520 children (57.3%) with PTSD symptoms. Among a sample of 250, 26.4% were referred to behavioral health, 43.2% were already connected, and 30.4% had no connection. Conclusions: It is feasible to screen and respond to trauma during well-child visits. Screening method and training implementation changes can improve screening and response to pediatric trauma and PTSD. Further work is needed to increase rates of PTSD symptomology screening and connection to behavioral health.

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