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A Qualitative Study of Pediatricians’ Adverse Childhood Experiences Screening Workflows

  • Julia Reading
    Correspondence
    Address correspondence to Julia Reading, MD, UCLA Mattel Children's Hospital, University of California Los Angeles, 757 Westwood Plaza, Room 5215G, Los Angeles, CA 90095
    Affiliations
    Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles (J Reading and A Schickedanz), Westwood, Calif
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  • Denise Nunez
    Affiliations
    California Chapter-2 of the American Academy of Pediatrics Adverse Childhood Experiences Committee (D Nunez, T Torices, and A Schickedanz), Pasadena, Calif

    Department of Medicine, Division of Preventive Medicine and Medicine-Pediatrics, University of California, Los Angeles (D Nunez), Santa Monica, Calif
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  • Tomás Torices
    Affiliations
    California Chapter-2 of the American Academy of Pediatrics Adverse Childhood Experiences Committee (D Nunez, T Torices, and A Schickedanz), Pasadena, Calif
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  • Adam Schickedanz
    Affiliations
    Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles (J Reading and A Schickedanz), Westwood, Calif

    California Chapter-2 of the American Academy of Pediatrics Adverse Childhood Experiences Committee (D Nunez, T Torices, and A Schickedanz), Pasadena, Calif
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Published:April 21, 2022DOI:https://doi.org/10.1016/j.acap.2022.03.021

      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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