Doctor of Nursing Practice (DNP) Projects

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Open Access

Embargo Period


Degree Program

Doctor of Nursing Practice

Degree Track

Psychiatric Mental Health Nurse Practitioner (PMHNP)

Year Degree Awarded


Month Degree Awarded



: adverse childhood experiences, chronic disease, screening tools, pediatrics, toxic stress, prevention of adverse childhood experiences


Kalpana Poudel Tandukar

DNP Project Chair

Kalpana Poudel Tandukar

DNP Project Member Name

Kristen Hickey

DNP Project Outside Member Name

Allison Beckler, D.O.


Background: Adverse childhood experiences (ACEs) are associated with the development of chronic health problems as well as increased risk for negative mental health outcomes. Research supports the need for health care providers (HCP) to change current practice by adding one of the many types of screening tools for ACEs, such as the ACEs Q, to well-child visits. The information obtained from the assessment leads to early identification of children who are at risk for negative mental health outcomes, allowing HCPs to initiate early interventions potentially decreasing the negative outcomes.

Purpose: The purpose of this quality improvement project was to provide education to HCPs regarding the impact of ACEs on mental health outcomes because HCPs are in an ideal position to screen, detect and intervene for ACEs in their patients and to improve their knowledge and skills to implement an ACEs screening tool in their practice.

Methods: A 45-minute in-service presentation was given to 12 HCPs that included the current recommendations from the Centers for Disease Prevention and Control (CDC) and the American Association of Pediatrics (AAP) and trends in states utilizing the ACEs screening in a small local health care system. Pre and posttest surveys were administered to assess the effect of education on knowledge and skills for screening of ACEs. Open response questions were included in both surveys. Paired t-tests was used to the compare the mean differences between pre and post-test scores on knowledge and practices.

Results: Six of the twelve (50%) HCPs completed the ACEs screening program. We found mean score improvements in overall HCP’s knowledge, skills, and intent to utilize ACEs (by 5.1 points) as well as individual components such as knowledge of HCP’s role in screening for ACEs (by 0.8 points), and knowledge of available resources (by 1.0 points) from baseline to post-test. HCP’s knowledge and skills improved in the following key areas: ACEs screening tool (48% vs 52%); negative health impacts of ACEs (49% vs 51%); initiation of ACEs treatment at any age (46% vs 54%); CDC’s prevention plan (47% vs 53%); available resources (42% vs. 58%); and confidence in ACE assessment (45% vs 55%). The qualitative results uncover themes indicating the education improved the HCP’s knowledge of ACEs, desire to learn more about ACEs and need to incorporate ACEs screening into practice. Conclusions: The ACEs screening education program was helpful to improve HCP’s knowledge, skills, and intent to utilize ACEs screenings in their practice. This educational program may have the potential to change way the HCPs assess their patients by including the screening for ACEs in their clinical practice.

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