Lessons learned from a quality improvement intervention to support implementation of childhood adversity screening in pediatric primary care

Adverse childhood experiences (ACEs) are traumatic exposures that can derail child health and development. This quality improvement intervention implemented and evaluated a process to adopt ACEs screening in five New Hampshire pediatric primary care clinics. Clinics received support including coaching, training, and tools to plan and pilot ACEs screening over a 15-month period. Despite the co-occurring COVID-19 pandemic, the five clinics conducted 1195 screens with 142 (12%) families indicating a level of risk. Significant increases in clinician knowledge and confidence with these screening and response processes were noted. Increases in clinic self-assessment scores were observed. Lessons learned included shortening the intervention period to 12 months and the importance of building local referral relationships. Recommendations for advancing ACEs screening are offered.