NPPC's Pilot Site Case Studies: Lessons Learned from ACEs Screening Implementation

The Center for Youth Wellness' National Pediatric Practice Community on ACES  (NPPC) is a co-designed community committed to collaborative learning. To promote this learning, we have been working with six pilot sites over the last year, representing practices of various sizes and service delivery settings, to implement ACEs screening and intervention. 

Beyond supporting these practices with the logistics of implementation, the broader goal was to discover and share real-world best practices, insights and resources to help other medical practices like yours. We’re also using these learnings to enhance the journey of our second cohort of pilot sites, currently in progress. 

As these sites have completed their initiative and started screening, we have put together an overview report and case studies for five of the sites. 

A few highlights: 

  • All six sites succeeded in starting a screening program 
  • Between 7% and 58% of screened patients had a “positive score” (each site defined “positive” differently)
  • Approximately one-third to three-quarters of patients screening positive were referred to services, such as parenting classes and behavioral health
  • 50% of sites strengthened their referral networks to support patients’ newly identified needs
  • 50% of sites rolled out screening to other sites in their organization within the first six months of the pilot program, even though this was not an explicit goal 

And a few lessons learned: 

  • Buy-in is key: Involve all stakeholders early in planning and to build support among organizational leaders, providers, and clinical support and front-line staff.
  • Training is essential: Training at all levels helps build the buy-in and confidence that was critical for effectively implementing ACEs screening. 
  • It’s possible to provide the needed resources: With appropriate scoring algorithms and some attention to strengthening referral systems, sites were able to adequately respond to screening results.


To access the overview report and the individual case studies, please visit the NPPC site.

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“Approximately one-third to three-quarters of patients screening positive were referred to services, such as parenting classes and behavioral health”

I’d also be interested in referral completion rates.   

Its one thing to make a referral. It’s something else for the patient to go - though I think parents need to be very careful about going to anything associated with a Medicaid funded community mental health because it’s drugging that is the main intervention and I don’t want to see more kids ending up being drugged like we drug Foster Kids. 

You would never have appropriate referral resources in almost all places that I’ve worked except possibly West Lafayette, IN and Rochester, Minnesota.  

And we still do not have good treatments yet in many places, especially for the families with very entrenched and longstanding, generational adversity, attachment trauma and the families where parents have serious mental illness and personality disorders. 

You can screen but there is little to refer to for many of us. When all I can get is an SSRI for PPD in a new mother, there aren’t good referral resources available.  However, I do think it’s important for parents to have the information, it’s just a matter of what do we do with it? 

Because the one thing that Pediatricians should not want to do, is promise more than we can deliver or refer traumatized kids for psychotropic medications (and I fear this being the outcome in many places - more drugging of children). 

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