Abstract Background & Objective

Adverse childhood experiences (ACEs) are associated with poor health outcomes over the life course.1,2 Interest in ACEs screening is growing, but there is little information on clinical workflows to guide implementation practices. We describe models and variation in ACEs screening workflows from pediatricians who have successfully incorporated ACEs screening into their practices.

Methods

We conducted semi-structured interviews with pediatrician members of the American Academy of Pediatrics who practiced in clinical settings that had conducted standardized ACEs screening (n=18 pediatricians from 17 practices). Interview transcripts were coded and analyzed using thematic content analysis and diagrams were constructed for each physician’s ACEs screening process workflow.

Results

Workflow processes varied considerably across participants. Workflows were categorized based on whether or not and to what degree there was protocolization of the response to identified ACEs. Providers used the presence of symptoms, ACE score, or a combination of the two as criteria for deciding when to intervene and to what degree. Key workflow implementation factors were identified that often hinged on feasibility, provider beliefs surrounding categorization of patient risk, availability of support staff, and/or access to services for ACEs intervention or response.

Conclusion

Physicians’ ACEs screening workflow variability was largely driven by clinical feasibility and availability of intervention referral resources. Better guidance and identification of evidence-based best practices are needed to reduce this variation and improve the consistency of ACEs interventions that screening and response implementation might be built upon.