Document Type



Doctor of Nursing Practice



Date of Defense


Graduate Advisor

Cathy Koetting, DNP, APRN, CPNP-PC, PMHS, FNP-C (Department of Nursing)


Carla Beckerle, DNP, APRN

Theodore Kremer, MD


Implementation of Pediatric Adverse Childhood Experiences Screening in Primary Care

Problem: Over half of children worldwide have experienced abuse in the past year. In 2012, The American Academy of Pediatrics released a policy statement emphasizing the importance of primary care providers implementing Adverse Childhood Experience (ACE) screening into all well-child examinations.

Methods: This quality improvement project was a descriptive, observational pilot study in which Center for Youth-Well ACE Questionnaire (CYW-ACE-Q) was implemented into a large, metropolitan pediatric primary care clinic. A convenience sample was utilized composed of pediatric patients between the ages of 5 and 18 being seen for a well-child examination. The aim of this project was to implement ACE screening in the pediatric primary care setting between January 2021 and April 2021. A secondary aim included increasing behavioral health referrals by referring all patients with an ACE score greater than two to behavioral health.

Result: A total of 22 pediatric patients were screened for ACEs during well-child examinations. The average ACE score was 1.8. (n=22). Of those, over half had ACE scores of 2 or more. All patients who had two or more ACEs were recommended to behavioral health. The number of BH referrals increased slightly with ACE screening implementation.

Implications for Practice: This pilot study provided additional insight regarding implementation of pediatric ACE screening in primary care. While the screening rates were low (31%), significant barriers were identified that will provide insight in future PDSA cycles.