Doctor of Nursing Practice
Post Master's DNP Completion
Year Degree Awarded
Month Degree Awarded
adverse childhood experiences, adult, screening, primary care
Karen Kalmakis PhD, FNP-BC
DNP Project Outside Member Name
Erin Palmer MD
Adverse childhood experiences (ACE) are important to future health outcomes. Many health care providers lack the knowledge or training to assess for ACE. Purpose. The purpose of this quality improvement project is to increase the identification of ACE among adult clients in a primary care clinic in Saint John New Brunswick Canada, through the delivery of an education session for the health care team members and patient screening for ACE. Methods. Staff at one clinic attended an educational program about ACE. Staff completed a pre and post education survey questionnaire (N = 8). Additionally, clinic patients (N= 32) were screened for childhood trauma using the ACE questionnaire. Post-screening surveys were completed by the clinicians who screened for ACE. Results. Most staff (85.7%) reported inadequate training/knowledge of ACE pre-education session; improvement in knowledge/understanding of ACE post session; and better prepared to discuss/screen patients for ACE. Nearly all of the 32 clinic patients reported a positive ACE score, and 62.7% had a score of four or more. Time to screen was not reported as a barrier by clinicians, and 10.0% of patients who screened positive were referred for counselling or booked a follow-up appointment. Conclusion. Health care providers lack education/training on ACE and patients are not regularly screened for ACE. To do this effectively, a trauma informed care approach must be used. A history of ACE in the patient sample was found to be high, yet previously unknown to the clinicians. This information has implications for primary care practice, community programming and policy development.
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