Assessing Primary Care Providers Awareness of ACE

Scores

Joshua Strait, Kevin Gandhi, Brett Ostrander, Ginger Cupit, Elisabeth Guenther, MD, MPH WesternU/COMP-Northwest

What are Adverse Childhood Experiences (ACEs)?

Adverse Childhood Experiences (ACEs): a term used to describe abuse, neglect, and/or

dysfunctional household environments that are experienced by children under the age of 18.

-Partnered study between CDC and Kaiser Permanente (San Diego) from 1995-1997. -17,000 participants. -Examined the lifespan medical, social, and economic consequences in adults of adverse childhood experiences.

The Adverse Childhood Experiences (ACE) Study

Vincent J. Felitti, M.D.

Prevalence of Adverse Childhood Experiences

Abuse, by Category Psychological (by parents) Physical (by parents) Sexual (anyone) Neglect, by Category Emotional Physical Household Dysfunction, by Category Alcoholism or drug use in home Loss of biological parent < age 18 Depression or mental illness in home Mother treated violently Imprisoned household member

Vincent J. Felitti, M.D.

The ACE Study: Summary of Findings

Figure from Addressing ACEs at Local Health Jurisdictions Webinar

Figure from Addressing ACEs at Local Health Jurisdictions Webinar

Objectives Determine whether primary care providers in Linn

County, OR are aware of ACE Scores. If they are aware of ACE scores, are they

assessing the ACE Score of patients in their practices?

If they are not assessing ACE Scores, what are the

barriers toward implementing them in their practices?

Methods

Anonymous Electronic Survey Multiple choice/ short response

Contacted via phone/email/in-person: 17 offices in Linn County Primary Care Providers

Tracked estimated number of recipients Incentive: $50 Amazon gift card

Methods

Assessed: Demographic data, health profession, knowledge &

implementation of ACE Scores Timeline: 2 months to complete

One month extension One follow-up reminder

Statistical Analysis Qualtrics & Microsoft Excel

Health Care Setting of Respondents

N=82 Estimated

response rate > 24%

Mental Health 23%

Family Practice

20%

Pediatrics 12%

Emergency Medicine

12%

Internal Medicine

1%

Other 32%

Distribution of Respondents

MD 22%

DO 11%

PA 1% RN

29% LPN 3%

Other, please specify:

34%

Considering the population of patients you work with, what are the top three health risk factors you have noted?

Drugs/ETOH use/abuse

23%

Abusive Relationships

3%

Low Education 11%

Poverty/ Unemployment

[PERCENTAGE] [CATEGORY NAME]

Low self-esteem 4%

[CATEGORY NAME]

[PERCENTAGE]

Abused as a child 4%

[CATEGORY NAME]

[PERCENTAGE] Other:

7%

Do you record your patients past history regarding any maltreatment that occurred in their family of origin?

(physical, sexual, emotional, neglect)

Yes 65%

No 35%

How familiar are you with the Adverse Childhood Experience (ACE) Study? (Vincent J. Felitti, MD, FACP,

Robert F. Anda, MD, MS)

Not at all 79%

Very familiar 7%

Somewhat familiar

14%

Do you currently implement ACE Scores in your practice? If no, then why?

Lack of time 21%

Feel uncomfortable

talking to patient about

childhood trauma

0%

Extra paperwork

17%

Costs too much money

0%

Not required/mandated for practice

33%

Not necessary/ sufficient for patient care

[PERCENTAGE]

ACE questions are redundant

to those gathered from patient history

8%

Other: 21%

Limitations

Non-applicable professions: i.e. Communicable Disease, Front Desk.

Unknown exact number of recipients. Unable to confirm respondents. Sample size and population. Inefficient communication channels for health

providers in Linn County.

Addressing ACEs

Implement ACE Score in Practice. Tell me how that has affected you later in your

life How would you feel if you learned that a child you

care about was growing up exactly as you did? Team-Based Approach

Form list of referrals & other health professionals

Future Directions

Medical School Curriculum Samaritan Health Services

Chief Medical Officer & Director of Population Health

Publication Study/ Increase Knowledge of Trauma Informed

Care Get Connected Self Awareness/ Provider Assessment

How do our ACEs affect our profession?

Too much on your plate?

Image from Google

Questions?

Resources

CDC: http://www.cdc.gov/violenceprevention/acestudy/ ACE Score Questionnaire: http://acestudy.org/ace_score Academy on Violence & Abuse: http://www.avahealth.org ACEs Connection: http://www.acesconnection.com ACEs Too High: http://acestoohigh.com Addressing ACEs at Local Health Jurisdictions:

http://www.nwcphp.org/docs/ht2014/20140527/htip20140527.html