Addressing Adverse Childhood Experiences (ACES) in Perinatal and Well-Child Care

Introduction: Research shows a clear link between exposure to Adverse Childhood Experiences (ACES) and the occurrence of chronic health conditions in adults. Providing preventive interventions in health care settings that are aimed at addressing the social determinants of health is increasingly common. This study provides preliminary implementation and outcomes of SCAN—Score, Connect, and Nurture—a program that aims to prevent the intergenerational impact of ACES by intervening with parents receiving perinatal and well-child care. This mixed-methods, exploratory study aims to increase our understanding of the extent of ACES and resilience in perinatal and well-child care, and to describe patient and staff experiences related to implementing this preventive intervention.

Methods: Data from 200 adults receiving SCAN assessments at a Federally-Qualified Health Center (FQHC) are used to describe total ACE scores, parental resilience using the Connor-Davidson Resilience Scale, demographic correlates of ACES, and families’ receipt of referred community services. Focus group data from patients and staff are used to describe implementation strengths and challenges, and experiences integrating ACE conversations into the patient-provider relationship.

Results: Preliminary data show that patients range in age from 21 to 34, with an average of 1 to 2 children in the home. One-quarter of patients are single parents. Patients’ ACE scores average 4.23 on the 10-point scale, indicating increased health risk, and resilience scores average 72 on the 100-point scale. Patient feedback is positive, with receptivity of community and clinic-based services. Implementation successes include integrating the social worker into OB/GYN and well-child visits, engaging clinical staff in training and ongoing continuous quality improvement, and maintaining leadership involvement. Implementation challenges are training and program consistency, increasing skill use and confidence among clinical staff, and ensuring adequate resources to match family need.

Conclusions: Preliminary findings from pilot implementation of SCAN indicate that there is a level of readiness among clinical staff and patients to integrate ACES-related strategies into perinatal and well-child care. ACE scores indicate increased health risk among the families served, and substantial family need in areas associated with parenting challenges, suggesting that addressing such problems upstream with parents may help reduce the intergenerational impact of ACES.