Examining Policy Solutions to Address Barriers Impeding the Adoption of Universal Adverse Childhood Experiences (ACE) Screening in Pediatric Primary Care Settings

Abstract

Over 93% of adults in Western Ohio have experienced at least one adverse childhood experience (ACE). This figure is significantly higher than the national average of 61% of adults who have experienced at least one ACE. Exposure to adversity in childhood increases levels of toxic stress, impacts brain development, and creates a predisposition for a variety of psychological and physiological ailments known as ACEassociated health conditions. While many pediatric healthcare professionals understand the implications associated with ACE exposure, the integration of ACE screening in pediatric healthcare facilities in the region is limited. The study aimed to determine the barriers to implementing ACE screening in pediatric primary care settings in Western Ohio and identify policy levers to increase the integration of ACE screening and care among pediatric healthcare professionals. The study used thematic analysis to identify themes in the results, as there is limited existing research in this area. Key informant interviews were conducted with local pediatric healthcare professionals to determine their views regarding the potential barriers and facilitators associated with implementing universal ACE screening in their organizations. The results concluded that barriers around workforce shortages, perceived diminished patient relationships, time, ethics, reimbursement, and overall discomfort lead to low screening integration in local pediatric healthcare organizations. Ohio’s current pediatric healthcare infrastructure can be leveraged to ease the implementation of the statewide initiative. ACE screening can be integrated into Ohio’s Early and Periodic Screening, Diagnosis, and Treatment program, which provides guidelines for developmental screening. Further, advocacy for the integration of ACE screening in the American Academy of Pediatrics Bright Future Guidelines will increase the utilization of the tool. The current state General Assembly has introduced legislation focusing on ACEs, and with new streams of state tax revenue, the policy window to advance this initiative is open.