690 - Trauma-Informed ACEs Screening & Intervention Evaluation (TASIE) Demonstration Project ECHO® Quality Improvement (QI) Program

The science on Adverse Childhood Experiences (ACEs) and toxic stress continues to advance rapidly, providing the field with clarity on the relationships between adversity and health outcomes. The Trauma-Informed ACEs Screening & Intervention Evaluation (TASIE) Quality Improvement (QI) Project ECHO® program utilizes a toxic stress framework to integrate  screening, and interventions to mitigate the impact of toxic stress on children’s health.  

Objective:

Through the TASIE program, we aimed to: increase pediatricians’ awareness and knowledge of ACEs and toxic stress, to successfully implement ACEs screening and intervention, increase providers’ confidence with use of the PEARLs tool, and a standardized scoring algorithm,  increase providers’ use evidenced based interventions with caregivers/patients. 

Design/Methods:

Primary care pediatric practices engaged in a 9 month QI ECHO program; and were required to attend a Orientation Session, a ACEs training workshop, and 8 ECHO sessions that included lecture, review of QI data, and case-based learning. Practice teams had monthly calls with a quality improvement coach to review workflow, and successes and challenges with screening implementation.  Quantitative and qualitative data were collected and analyzed at both provider and patient/family level.

Results:

All 17 practices implemented pediatric ACEs screening in primary care, though with varied rates, patient volumes, and contextual considerations.  Providers increased their knowledge of ACEs, as well as comfort and confidence conducting and responding to ACEs screening. Providers found the TASIE ECHO sessions, network, and data tracking helpful to implementing ACEs screening. Caregivers generally thought ACEs screening provided useful information to providers about their child.

Conclusion(s): Results showed caregivers/patients had a positive experience related to the conversation of ACEs and toxic stress, and showed some signs of behavior change, although the evaluation does not know the type, frequency, duration, or impact of any changes. All 17 pediatric practices began or strengthened ACEs screening and provided relevant response and referral to caregiver/patients based on screening result.  At the end of the program, all providers agreed it was important to conduct universal ACEs screening in pediatric primary care and most were committed to continuing this work.  The Project ECHO® model has provided an effective way to implement a pediatric primary care model for screening and intervention to children impacted by adverse childhood experiences & toxic stress.