Aces Screening and Referral Pathways in Pediatric Primary Care in Northern Arizona

Abstract

Purpose. The purpose of this Quality and Process Improvement project was to enhance the education of pediatric primary care providers in Northern Arizona on the importance of recognizing physical and mental impacts of Adverse Childhood Experiences (ACEs), while emphasizing the value of Positive Childhood Experiences (PCEs) as protective factors. The intervention aimed to promote the importance of integrating Trauma Informed Care (TIC) into clinical practice, offer recommendations for ACEs screening during well child visits, and establish a referral pathway to the Center for Resiliency and Wellbeing (CRW). Background. ACEs are associated with poor physical, mental, and behavioral health outcomes in children that may persist into adulthood. Toxic stress caused by adversity can cause systemic inflammation, increasing the risk of chronic health conditions. Despite growing recognition of these impacts, many providers remain hesitant to screen for ACEs in routine practice or consider ACEs as contributing factors to medical complaints. Methods. A recorded educational session was provided to pediatric providers at North Country Healthcare. The intervention was intended to reinforce existing knowledge on foundational concepts, while introducing or expanding awareness on related topics. The session provided guidance on referring patients to the CRW program as a supportive resource. Pre- and post- intervention surveys assessed provider knowledge, confidence, and intended practice changes. Referral activity was tracked over a five-day implementation period following the educational training. Results. Pre- and post-survey data reflected a 38.83% increase in provider knowledge, confidence, and intended practice change. All three participating providers reported an intent to implement ACEs screening and make referrals to resources such as the CRW program. Although no referrals were made during the five-day post intervention period, participants expressed interest in utilizing the resource when appropriate clinical applications arise. Conclusions. This project supports the use of brief, structured educational interventions as a strategy to improve provider knowledge, confidence, and readiness to implement TIC strategies into daily practices. While the short implementation period limited a measurable change, the educational intervention successfully established a framework for a referral process that can be sustained with continued education, support, and provider engagement.