From Planning to Implementation: Developing an ACE Screening Protocol in a Rural Integrated Primary Care Clinic Serving Latino Children

Objective: The purpose of the study was to implement a comprehensive adverse childhood experiences (ACEs) screening protocol in a rural Integrated Primary Care Clinic serving Latino Children utilizing implementation science as a framework. Methods: The Exploration, Preparation, Implementation, Sustainment (EPIS) framework was utilized to guide and evaluate the implementation. There were 2,347 children who were screened with the developed protocol which included screening for ACEs, psychosocial problems, adolescent depression, and parental depression. Several implementation outcomes were collected and are reported, including a list of screening barriers and adaptations, a list of developed staff training, a clinician stakeholder survey and focus group, and a patient stakeholder survey. Results: Clinicians reported being satisfied with the protocol and indicated that screenings provided new clinical information, changed their clinical care and helped to inform the medical needs of patients. Barriers included inadequate time to complete screenings and over-screening for prevalent stressors in the community. Conclusions: Implementation science provides a reliable framework for the implementation of a comprehensive ACE screening process by identifying the necessary conditions for high-quality implementation. With the appropriate resources in place, screenings are possible and enhance patient care. More attention is needed to identify primary care interventions for ACEs.