Nurse practitioner screening for childhood adversity among adult primary care patients

Abstract

Background and purpose Researchers have demonstrated an association between experiencing childhood abuse and multiple chronic health conditions in adulthood, yet this evidence has not been routinely translated to practice. The purpose of this research study was to examine nurse practitioner (NP) practices, skills, attitudes, and perceived barriers associated with screening adult patients for childhood abuse to determine the extent to which evidence of the association between childhood abuse and negative health outcomes has been translated to NP practice. Methods A mixed‐method approach with web‐based questionnaires and online focus groups was used to examine NP screening for histories of childhood abuse. Conclusions A total of 188 complete NP surveys were analyzed along with data from focus groups with 12 NPs. One third of the NPs regularly screened for childhood abuse and believed screening was their responsibility. Six barriers, including insufficient time and lack of confidence when inquiring about abuse, were significantly associated with NP screening practices. The focus group participants discussed how and when one should ask about childhood abuse, and the need for education about screening. Implications for practice Time constraints and NPs’ lack of confidence in their ability to screen for histories of childhood abuse must be addressed to encourage routine screening in primary care practice.

Screening Adults With Substance Use Disorder for Adverse Childhood Experiences

“…A Level II systematic review of health consequences of ACE provided evidence for the necessity of screening for ACE in the primary care setting (Kalmakis & Chandler, 2015). Based on the work of Kalmakis and Chandler (2016), two pilot translational research studies demonstrated the impact of ACE on primary care patients, contributing additional evidence for the necessity of screening for ACE to reduce negative health consequences in the primary care setting (Aponte, 2017, Kalmakis, et al, 2018, & Shafer, 2017.…”

“…A literature review for SBIRT, trauma, and motivational interviewing (MI) was conducted to contribute additional evidence for the use of three-phase protocol developed by Kalmakis and Chandler (2016) for this study. SBIRT and MI have been extensively studied and are utilized in a variety of healthcare settings.…”

“…The lack of trauma-informed practitioners precludes identification of a trauma history among individuals presenting for SUD treatment because of the entrenched belief that mental health issues are separate from substance abuse and should be addressed separately (Grupp, 2008;Kalmakis, Chandler, Roberts, & Leung, 2016). Thus, screening and referral for treatment opportunities are missed.…”

“…The plan for this study is to recruit individuals with a diagnosis of SUD participating in an intensive outpatient program (IOP) and/or residing in a recovery house for screening for ACE based on previous studies implemented in the primary care setting with an adult population (Kalmakis & Chandler, 2015;Kalmakis, Chandler, Roberts, & Leung, 2016;Shafer, 2017). In addition, the treatment staff received education and training on the screening protocol, to assure fidelity to the original protocol (Kalmakis et al, 2016).…”

“…In addition, the treatment staff received education and training on the screening protocol, to assure fidelity to the original protocol (Kalmakis et al, 2016). (Appendix C).…”