Integrating ACEs Prevention into Medical Practice: A Needs Assessment of Prenatal and Pediatric Care

Background and Purpose: Research on Adverse Childhood Experiences (ACEs) has provided strong evidence for the negative effects of trauma on the developing brain and health across the lifespan. Advances in biology, psychology and human development have shown that reducing the exposure to trauma in prenatal and early childhood is crucial for protecting children from the long-term harm of accumulated adversity.  Thus, early interventions that limit exposure to adversity and build safe, stable and nurturing environments can have a substantial effect on children’s long-term well-being.  One area of increasing attention is universal ACE screening by healthcare providers serving expectant parents, children, and families.  Healthcare providers could serve as a front line in intervening to change the long-term health trajectories of vulnerable children.

 

Methods: The objectives of this study included assessing the knowledge, comfort, and capacity of healthcare providers regarding ACEs and ACE-informed care.  The study was a mixed methods needs assessment of healthcare providers in Central Texas.  An online survey was developed by an interdisciplinary team to assess health care professionals’ familiarity with ACEs research, experience with adversities disclosed by patients, and barriers providers face when screening for and discussing ACEs with their patients.  In addition to the online survey, a semi-structured interview protocol was developed to gather in depth information from key informants in the healthcare field.  Descriptive and bivariate statistics were used to analyze the survey data, and qualitative thematic analysis was conducted to examine themes that emerged from the interviews with key informants. 

 

Results: A total of 122 surveys and seven in-depth interviews were completed by healthcare providers. Over half of the participants reported no prior familiarity with the ACEs study.  While some providers do screen for some adversities, 70% responded that they do not screen for ACEs.  However, only 2% felt there was no clinical utility for screening for ACEs in their practice.  Most providers did report experience with patient disclosure of adversities in their current household, most commonly mental illness, drug or alcohol abuse, and divorce.  The most frequent barriers were lack of available time to spend with each patient (68%), lack of ACE knowledge and training (65%), hesitation in adding another screening tool (35%), and uncertainty of how to handle a positive ACE or trauma screen (33%).

 

Conclusion and Implications:  While some healthcare providers are familiar with ACEs, we found that the majority of providers serving children and families lack the knowledge, comfort and capacity to screen for ACEs in their current practice.  Despite this, the American Academy of Pediatrics (AAP) has strongly encouraged physicians to screen for ACEs as part of their routine practice.  This demonstrates an opportunity for social workers with expertise in trauma and ACEs to partner with healthcare providers to offer support, training and technical assistance in implementing ACEs screening and brief intervention in their settings.