Article Figures & Data
Figures
- Figure 1.
Typical ACE screening clinic workflow.
ACE = adverse childhood experience.
Tables
Domain Sample Questions Overall screening process and experience How is ACE screening going?
What aspects of the screening process are working best?
What aspects of the screening process are more challenging?Training and supervision How prepared were you for your role in ACE screening and response? Acceptability and equity How comfortable is the screening process for you?
In what ways were you mindful of your patients’ background (racial/ethnic/cultural/religious) when talking about ACEs?Experiences with patients How do you address ACEs during the visit?
Have you noticed any issues with patients when completing the screener?Resources and referrals When and how do you offer resources and referrals to patients? Effects on staff How has the ACE screening and response affected you? ACE = adverse childhood experience.
Study Characteristic Round 1 (Aug-Dec 2020) Round 2 (Jul-Oct 2021) Implementation phase Early implementation Later implementation Number of FGDs 14 12 Number of clinics included 5 5 Number of frontline staff 30 29 Number of medical clinicians 29 22 Number of psychosocial support staff 8 7 Total number of participants 67 58 FGD = focus group discussion.
Theme Round 1 Round 2 Theme 1. Clinicians, frontline staff, and psychosocial support staff generally felt comfortable administering and discussing the ACE screener. ✓ ✓ Theme 2. Clinicians were concerned about conducting screenings when there were insufficient resources to help patients. ✓ ✓ Theme 3. At certain clinics serving patients with a high prevalence of adversity, some clinicians, frontline staff, and psychosocial support staff did not see strong added value of ACE screening. ✓ ✓ Theme 4. Clinicians and frontline staff shared concern about “triggering” patients, though they weren’t aware of any specific instances of this occurring. ✓ ✓ Theme 5. Clinicians felt patients and caregivers have been receptive and open to the ACE screening, with a few exceptions. ✓ ✓ Theme 6. Medical professionals perceived that many patients and caregivers appeared to find value in ACE screening—including a sense of relief and validation. ✓ ✓ Theme 7. Many patients and caregivers did not complete the open-ended question on strengths, but clinicians perceived this question as important. ✓ ✓ Theme 8. Both clinicians and frontline staff offered more specific observations on patient/caregiver challenges, confusion, hesitancy, and discomfort related to ACE screening. ✓ ✓ ACE = adverse childhood experience.
Theme Round 1 Round 2 Theme 1. Clinicians, frontline staff, and psychosocial support staff faced logistical challenges and workflow issues with ACE screening. ✓ ✓ Theme 2. For some frontline staff, ACE screening was viewed as a “black box” about which they knew little and were only peripherally involved. ✓ ✓ Theme 3. Clinicians and frontline staff faced challenges in describing the purpose of ACE screening to patients and reviewing screening results with patients. ✓ ✓ Theme 4. Clinicians were sometimes unsure how to respond to ACE screening results and wanted additional tools or support in this area; they developed opinions on areas for more training and ongoing support. ✓ ✓ Theme 5. Clinicians and psychosocial support staff needed more resources and support for referrals. ✓ ✓ Theme 6. There were additional challenges regarding ACE screening for certain populations. ✓ ✓ Theme 7. Clinics had increasingly established effective ACE screening and response workflows. ✗ ✓ Theme 8. Clinicians and frontline staff formulated suggestions to improve ACE screening implementation, quality, and acceptability. ✗ ✓ ACE = adverse childhood experience.
Theme Round 1 Round 2 Theme 1. Clinicians and frontline staff thought the ACE screening helped elicit important information and build trust with patients. ✓ ✓ Theme 2. Many clinicians were unsure if patients were connecting with existing resources after receiving referrals. ✓ ✓ Theme 3. Clinicians, frontline staff, and psychosocial support staff expressed concerns about the burden of completing ACE screening for caregivers of young and/or multiple children. ✓ ✓ Theme 4. Although most clinicians felt ACE screening had not changed patient care, some expressed that screening gave them peace of mind that important information was not being overlooked. ✓ ✓ Theme 5. ACE screening and review can take an emotional toll on clinicians. ✓ ✗ Theme 6. Success of the referral process has varied significantly. ✗ ✓ ACE = adverse childhood experience.
SUPPLEMENTAL MATERIALS IN PDF FILE BELOW
- Eberhart_Supp_App.pdf -
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- Eberhart_Supp_App.pdf -
