PT  - JOURNAL ARTICLE
AU  - Alvarado, Gabriela
AU  - McBain, Ryan
AU  - Chen, Peggy
AU  - Estrada-Darley, Ingrid
AU  - Engel, Charles
AU  - Malika, Nipher
AU  - Machtinger, Edward
AU  - McCaw, Brigid
AU  - Thyne, Shannon
AU  - Thompson, Nina
AU  - Shekarchi, Amy
AU  - Lightfoot, Marguerita
AU  - Kuo, Anda
AU  - Benedict, Darcy
AU  - Gantz, Lisa
AU  - Perry, Raymond
AU  - Kannan, Indu
AU  - Yap, Nancy
AU  - Eberhart, Nicole
TI  - Clinician and Staff Perspectives on Implementing Adverse Childhood Experience (ACE) Screening in Los Angeles County Pediatric Clinics
AID  - 10.1370/afm.3014
DP  - 2023 Sep 01
TA  - The Annals of Family Medicine
PG  - 416--423
VI  - 21
IP  - 5
4099  - http://www.annfammed.org/content/21/5/416.short
4100  - http://www.annfammed.org/content/21/5/416.full
SO  - Ann Fam Med2023 Sep 01; 21
AB  - PURPOSE To understand clinician and clinical staff perspectives on the implementation of routine Adverse Childhood Experience (ACE) screening in pediatric primary care.METHODS We conducted a qualitative evaluation in 5 clinics in Los Angeles County, California, using 2 rounds of focus group discussions: during an early phase of the initiative, and 7 months later. In the first round, we conducted 14 focus group discussions with 67 participants. In the second round, we conducted 12 focus group discussions with 58 participants. Participants comprised clinic staff involved in ACE screening, including frontline staff that administer the screening, medical clinicians that use screening to counsel patients and make referrals, and psychosocial support staff who may receive referrals.RESULTS Themes were grouped into 3 categories: (1) screening acceptability and perceived utility, (2) implementation and quality improvement, and (3) effects of screening on patients and clinicians. Regarding screening acceptability and perceived utility, clinicians generally considered ACE screening to be acceptable and useful. In terms of implementation and quality improvement, significant barriers included: insufficient time for screening and response, insufficient training, and lack of clarity about referral networks and resources that could be offered to patients. Lastly, regarding effects of screening, clinicians expressed that ACE screening helped elicit important patient information and build trust with patients. Further, no adverse events were reported from screening.CONCLUSIONS Clinic staff felt ACE screening was feasible, acceptable, and beneficial within pediatric care settings to improve trauma-informed care and that ACE screening could be strengthened by addressing time constraints and limited referral resources.