Adverse Childhood Screening Among Adult Primary Care Patients
Creators: name: Aponté, Elizabeth 
Publisher: name: University of Massachusetts Amherst
Year: 2017

Abstract
Background: The prevalence of adverse childhood experiences (ACE) in the United States is estimated to be 60 percent of the population. A growing body of evidence unequivocally states the significant impacts of childhood adversity on chronic negative health outcomes and that the cumulative effects of adverse childhood experiences have profound public health and societal implications. Despite this overwhelming evidence, research suggests that a lack of effective ACE screening persists in the primary care setting. Purpose: The purpose of this project was to effectively translate the evidence of ACEs’ negative influence on overall health into a clinical practice, and to ultimately eliminate the gap between evidence-based ACE research and clinical practice. Methods: A screening intervention intended to assess for childhood adversity and the presence of chronic diseases was implemented among adult patients within the primary care setting. The selected clinical site of implementation was a nurse practitioner owned and operated primary care office that serves a large rural community. Adult patients with histories of gastrointestinal complaints, chronic pain, substance abuse, anxiety, depression, or a poorly managed chronic health condition were screened for ACEs. Adult patients who reside in high-risk settings or had high health care utilization were also screened. Additionally, a post-screening form was completed by the nurse practitioner student to collect information about screening process including patient responses, provider preparedness and comfort level, and patient-specific follow-up recommendations. Descriptive statistics were used to calculate total adults screened, prevalence of ACEs, and patient and provider responses to the screening intervention. Results: Of the convenience sample, 82% reported ACE. Despite the notably high ACE prevalence, only 24% of patients were receiving psychological counseling. Chronic diseases were found to be associated with higher ACE scores. Moreover, significant reports of additional chronic health problems were found which expanded upon those originally hypothesized. Additionally, the average ACE screening time was 8.5 minutes. An increase in provider comfort and knowledge had a strong positive correlation with decreased ACE screening time. Furthermore, providers that were more secure in knowledge and ability to screen for ACE were more comfortable with screening for ACE. Conclusions: The large volume of individuals with poorly managed chronic illnesses seen in the primary care setting affords a rich opportunity for identifying ACE. Furthermore, ACE is associated with significant chronic diseases often unrecognized by patients and providers. Evaluation of this ACE screening intervention suggests that ACE screening is feasible in the primary care setting, allowing for purposeful interventions to improve patient outcomes. Moreover, increasing knowledge and comfort in screening for ACE can help providers and patients improve well being and management of chronic disease.
Keywords: abuse, childhood, primary care, review, evidenced based practice, family history, screening, advanced practice nurse, child maltreatment, child trauma, child misfortune, adverse childhood experiences