Screening for Adverse Childhood Experiences in the Fort Worth Pediatric Mobile Clinic - A Quality Improvement Initiative

Purpose: Adverse Childhood Experiences, or ACEs, are stressful or traumatic events that can disrupt childhood cognitive, social, and emotional development and can increase the likelihood of adopting health-risk behaviors. ACEs have also shown strong correlations to the development of disease, disability, and asocial problems later in life. Low socioeconomic status, health disparities, low health literacy, and poor access to healthcare are factors that play an important role in poor health. Along with ACEs, prolonged adversity can cause a Toxic Stress Response, which can play an important role in negative health outcomes and poor well-being long-term. The Pediatric Mobile Clinic, or PMC, sees patients without insurance or who are on Medicaid. The goal of this project is to screen the patients of the PMC for ACEs and early symptoms associated with ACEs, determine if the patient population at the PMC has a higher prevalence, and develop an intervention about ACEs and poor health outcomes. Methods: Data was collected from 43 patients at the UNTHSC Pediatric Mobile Clinic. Patients were asked to complete two surveys about themselves regarding ACEs, life stressors, and associated symptoms. The surveys used were adapted from the Center for Youth Wellness ACE-Questionnaires. Data was interpreted by following the CYW ACE-Q Scoring Guidelines and the patients would be categorized as either a “refer to treatment” or not. Data was assessed using Microsoft Excel for the prevalence of ACEs and associated symptoms in the patients seen. Results: The number of PMC patients that fit into the category of “refer to treatment”, because their total ACE Q Score was between 1-3 with associated symptoms or over 4 with or without symptoms was 8 out of 43, or 19%. %. The average age for ”refer to treatment” was 7.5 years old for the younger age group, and 17.6 years old for the adolescent group. The average total ACE Q score was 3.25, and the average number of associated symptoms was 2.5. The most common associated symptoms reported by the PMC patients was weight gain or loss, unexplained somatic complaints, conflicts with friends and family, and developmental or speech delays. The data also showed a positive relationship between the ACE Score and the total number of relevant symptoms. Conclusions: There is a positive relationship to the total number of ACEs and life stressors and the total number of ACE associated symptoms. Routine screening for ACEs offers the ability to identify at-risk individuals, raise awareness of the importance of preventing additional exposure to ACEs, and the opportunity for intervention and treatment.With the current low sample size, the hypothesis was not supported by the data, with less than the majority of the PMC patients fitting the “refer to treatment” category. The study will continue to reach an appropriate sample size and the level of privacy the patient has while completing the questionnaires will be noted and taken into consideration for results. In the future, the PMC hopes to adopt a system of screening for ACEs and life stressors in their patients, educating the at-risk children and families about the role of ACEs on future negative health outcomes, and intervening when necessary.