Abstract
Background & Objective
Adverse childhood experiences (ACEs) are associated with poor health outcomes over
the life course. Interest in ACEs screening is growing, but standard ACEs screening
workflows have yet to be established. We aimed to describe common workflow processes
and variation among pediatricians who have successfully implemented ACEs screening
and response protocols.
Methods
We conducted semi-structured interviews with members of the American Academy of Pediatrics
who practiced in clinical pediatric settings that implemented standardized ACEs screening
(n = 18 physicians). Interviews were coded and analyzed using thematic content analysis
and clinical processes were examined for differences across ACEs screening workflow
processes.
Results
ACEs screening workflows varied considerably, hinging primarily on determination of
a positive screen, the type of interventions recommended in response, and protocolization
of the workflow. We identified 5 major theme domains related to ACEs screening workflows:
1) degree of protocolization of the workflow, 2) screening tool(s) used, 3) timing
of screening, 4) clinic staff involvement, and 5) interventions recommended and/or
initiated by the physician. Common workflow processes were identified and grouped
based on determination of and thresholds for response to a positive screen. Clinicians
used symptoms, ACE score, or a combination of the 2 as criteria for deciding when
to intervene and to what degree, though protocolization of this approach varied.
Conclusions
ACEs screening workflow variability was largely driven by clinical feasibility and
availability of ACEs intervention resources. This variability demonstrates that a
one-size-fits-all standardized screening protocol may not be universally feasible
or appropriate across practices.
Keywords
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Article Info
Publication History
Published online: April 21, 2022
Accepted:
March 31,
2022
Received:
October 23,
2021
Publication stage
In Press Journal Pre-ProofFootnotes
The authors have no conflicts of interest to disclose.
Principal Investigator: Adam Schickedanz.
IRB#: 19-002044.
Identification
Copyright
Copyright © 2022 by Academic Pediatric Association
