Document Type



Doctor of Nursing Practice



Date of Defense


Graduate Advisor

Cathy Koetting, DNP, APRN, CPNP-PC, PMHS, FNP-C, College of Nursing


Carla Beckerle, DNP, APRN

Ali Husain, MD


Problem: Exposure to Adverse Childhood Experiences (ACEs) is associated with chronic diseases in adulthood. Several studies found over 60% of adults have had exposure to one or more ACEs. While guidelines for ACEs screening exist, most primary care practices do not perform screening at this time. This results in a lack of referrals for adults with history of ACEs for proper behavioral health (BH) intervention.

Methods: This quality improvement (QI) initiative utilized a descriptive observational design. The Centers for Disease Control and Prevention (CDC) ACEs screening tool was administered to a convenience sample of adult patients aged 18 years and older, seeking routine care. Quantitative data was collected during primary care visits. Data collected during the time period of this quality improvement project included the number of screenings administered, ACEs score and the number of BH referrals generated.

Results: Following implementation of this QI effort, a total of 111 ACE screenings were administered. Of those screened, 47% (n= 52) of individuals had an ACE score of two or greater. Eighteen new BH referrals were initiated, resulting in a percentage increase of 260%.

Implications for Practice: Widespread utilization of the ACEs screening tool in primary care settings could further identify and refer at risk populations for BH intervention.

Included in

Nursing Commons