The Implementation of Screening for Adverse Childhood Experiences in Pediatric Primary Care

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Objective

To assess the implementation of screening, screening rates, and prevalence of adverse
childhood experiences (ACEs) in a large integrated healthcare system.

Study design

Kaiser Permanente Southern California is a large integrated healthcare system with
15 medical centers/hospitals and 233 medical office buildings that serve approximately
1.5 million children. Screening for ACEs began in July 2018 at 1 medical center (Downey,
Bellflower medical office) for 3- and 5-year-old well-child visits (yearly physical
examination). It quickly expanded to 3 other medical centers (6 clinics in total)
and now also includes the 10- and 13-year-old well-child visits.

Results

Since July 2018 we have screened 3241 3-year-olds (53% of the target population),
2761 5-year-olds (53%), 545 10-year-olds (37%), and 509 13-year-olds (13%). Of the
3-year-olds who were screened, 15% had an ACEs score of 1 or higher. Of the 5-year-olds
that were screened, 17.5% had an ACEs score of 1 or higher. Of the 10-year-olds, 30.5%
had an ACEs score of 1 or higher and of the 13-year-olds, 33.8% had an ACEs score
of 1 or higher.

Conclusions

Although we have encountered some challenges, particularly with follow-up for those
screening positive for ACEs, screening was feasible. The data show an increasing trend
of ACEs in 3- to 13-year-old children, highlighting the need for early education about
ACEs to mitigate the effects of toxic stress.

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