Physicians’ knowledge and practices regarding screening adult patients for adverse childhood experiences: a survey

Abstract

Background: Adverse Childhood Experiences (ACEs) are common and associated with many illnesses. Most physicians do not routinely screen for ACEs. We aimed to determine if screening is related to knowledge or medical specialty, and to assess perceived barriers. Methods: Physicians in Ontario, Canada completed an online survey in 2018-2019. Data were analyzed in 2019.

The current state of patient-to-provider communication of childhood adversity in primary care

“…Although it is estimated that 64% of American adults have reported at least one type of adverse childhood experience (ACE) in their lifetime (Felitti et al, 1998), screening adults for ACEs (or childhood adversity) is not currently a mandatory clinical assessment standard. Very limited data suggest that less than 30% of physicians (Maunder et al, 2020; Weinreb et al, 2010) and less than 33% of nurse practitioners (NPs; Branstetter et al, 2020; Kalmakis et al, 2017) routinely screen adults for ACEs in primary care. Traditionally, ACEs are defined as events that occur before 18 years of age, cause intense fear and/or suffering, may lead to lifelong physical or psychological symptoms, and require effective and ongoing communication between primary care clinicians and adult patients (Felitti et al, 1998; SAMHSA, 2014; Strauch et al, 2020).…”

The Roadmap for Resilience: The California Surgeon General's Report on Adverse Childhood Experiences, Toxic Stress, and Health

“…Only two sites, SCPMG and Dartmouth CO-OP PBRN, tracked and reported the impact of screening on visit duration. Although time constraints were the mostcited anticipated barrier among providers completing the Becoming ACEs Aware in California training (71% of participants reported this concern), 1535,1552 Dartmouth CO-OP PBRN tracked and published data on visit duration, finding that visit length increased by less than 5 minutes for 91% of visits, 736 and SCPMG reported that ACE screening did not prolong visit length. These findings cohere with the literature, which has found little (usually adding under five minutes) or no increase in visit times.…”

“…Patients who present with significant toxic stress and nonneuropsychiatric conditions often receive care that does not adequately address the role that toxic stress physiology plays in their disease process(es). 1535,1536 Also, screening for ACEs in order to identify toxic stress…”

“…1535,1552,1553 Based on learnings from the NPPC and the Resilient Beginnings Collaborative sufficient provider training on screening for ACEs and toxic stress can not only improve provider comfort with screening, but also increase awareness of health impacts of ACEs, generate support for screening, and establish a common language 1554. Most of the case study sites conducted training for both providers and non-clinical staff, like front desk personnel, because of their essential role in implementing ACE screening and response.…”

The “3 Es” of trauma‐informed care in a federally qualified health center: TraumaticEvent‐ andExperience‐related predictors of physical and mental healthEffectsamong female patients

“…With numbers of low-income, minority patients steadily increasing (HRSA, 2019a;Nath et al, 2016), FQHCs are well-positioned to enhance underserved patients' and communities' recovery and resilience by enacting systemwide trauma-informed care. Yet, to date, many FQHCs have failed to systematically inquire about patients' trauma exposure (Selwyn et al, 2019;Weinreb et al, 2010), with primary care physicians (PCPs) citing barriers such as limited time to counsel and provide psychoeducation to patients, lack of confidence in their ability to diagnose and treat PTSD, inadequate referral options, and patient financial burden (Chung et al, 2012;Maunder et al, 2020;Meredith et al, 2009). Without trauma screening, it is likely that PCPs remain unaware of a patient's trauma history and fail to incorporate aforementioned Event-and Experience-related factors into treatment plans as key therapeutic targets, despite their documented influence on outcomes.…”