Mike Flaningam posted:Marcus,
A colleague and I have been screening for ACEs in our internal medicine practice for a year. There's more written on addressing ACEs in a pediatric setting, such as the Center for Youth Wellness mentioned above, with very little in the literature for adult patient settings. We use the traditional ACE Questionnaire, though look at it more as a conversation starter as to how one's childhood was. We feel it has been very successful doing such screening, and the patient response has been overwhelmingly positive, with essentially no negatives. A few caveats are that I've yet to find a way to do the screening and follow up discussion without taking a longer than scheduled visit (I typically go 45-50 min, while the slots are 30 min); it's hard for me not to stop talking, as it's typically such a powerful educational opportunity, and the patients are almost always into it (if they aren't I keep the discussion short). Another very important point is that screening needs be done in a trauma informed way, with the patient feeling it's a safe environment. If I sense someone is in a anxious state, I won't screen. That being said, there are several studies looking at medical assistants, or other non-clinical staff, giving out questionnaires to parents of pediatric patients, and the results show the high majority of parents appreciate the screening. I'm not sure how well this translates to adult patients.
Hi Mike! Thanks so much for sharing your experience with me/us. This gives an insightful window into implementation in primary care and highlights one of the biggest challenges. I am familiar with a program that integrates health coaches with the potential for them taking on more of the individual dialogue and coaching related to positive ACEs, however the vast majority of providers do not have these additional staff. It sounds like any academic detailing or practice facilitation with providers/clinics should include exploring ways to streamline and include other staff in the screening and intervention process.