• Gabriela Alvarado, Ryan McBain, Peggy Chen, Ingrid Estrada-Darley, Charles Engel, Nipher Malika, Edward Machtinger, Brigid McCaw, Shannon Thyne, Nina Thompson, Amy Shekarchi, Marguerita Lightfoot, Anda Kuo, Darcy Benedict, Lisa Gantz, Raymond Perry, Indu Kannan, Nancy Yap, and Nicole Eberhart.
• Rand Corporation, Santa Monica, California.
• Ann Fam Med. 2023 Sep 1; 21 (5): 416423416-423.

PurposeTo understand clinician and clinical staff perspectives on the implementation of routine Adverse Childhood Experience (ACE) screening in pediatric primary care.MethodsWe 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.ResultsThemes 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.ConclusionsClinic 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.© 2023 Annals of Family Medicine, Inc.

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