Results of a Pilot Program Using Aces Assessments in Obstetric and Well-Child Health Care

Background and Purpose: Preventing Adverse Childhood Experiences (ACES) in early childhood has the potential to improve local, state, and national population health, in part because of the link between ACES and chronic diseases. Increasingly, family physicians and pediatricians are called upon to lead “invigorated science-based efforts” that will reduce children’s exposure to toxic stress in order to promote their long-term health and development. However, there are no tested models of integrating ACES assessment and intervention into health care settings for families with young children. This study presents preliminary results from a pilot program, Score, Connect, and Nurture (SCAN), that aims to reduce the intergenerational transmission of ACES by intervening with families receiving obstetric and well-child health care. SCAN’s goals are to increase parents’ receipt of evidence-based parenting programs, strengthen patient-provider relationships, integrate ACES dialogue into routine medical care, and increase children’s receipt of preventive health care. Research questions are: (1) to what degree do families receiving well-child and perinatal health care report ACES and resiliency? (2) what is the relationship between SCAN services and outcomes, including well-child health care receipt and decreased Emergency Department (ED) use? and (3) what do physicians report about program utility, ACES knowledge before and after SCAN, and effects on patient-provider relationships?

Methods: The study uses mixed methods, including data from 263 families and 24 medical residents and physician faculty practicing in an urban family medicine clinic that is designated a patient centered medical home (PCMH). All patients involved in SCAN over a 6-month period were included. Patients are 60% Latina, average 28 years of age (range 14-60), and mostly Medicaid-insured. Measures include the 10-item ACES questionnaire, Connor-Davidson Resiliency Scale, pre and post administrative data of ED use and well-child visits, and a project-specific survey of physician knowledge. Descriptive and bivariate analyses using means, proportions, and t-tests were used to investigate the study questions.

Results: Parents reported 2.65 ACES on average and 33% reported 4 or more ACES, a rate that is more than double the rate found in the original ACES study (16%). Resilience averaged 77.8 on the 100-point scale, with 5% reporting very low levels of resiliency (<50). Administrative data on available records showed a reduction in ED visits of 29% and reduced “no shows” to scheduled health care visits after the SCAN intervention (p<.05) among patients with higher numbers of scheduled appointments. Physicians reported significantly increased knowledge, confidence, and documentation concerning ACES over time (p<.05 for each), and 50% reported talking with 5 to 12 patients about ACES. 

Conclusions: The study demonstrates preliminary positive outcomes of the SCAN intervention, including reaching a patient population that has high ACES occurrence and corresponding health risk. Intervening in health care to educate parents and physicians about ACES has the potential to influence child outcomes over time due to increased receipt of preventive health care among families, and addressing social determinants of health, such as ACES, in the patient-provider relationship. Increased visit compliance and decreased ER use also have the potential for health care cost savings.