ORIGINAL RESEARCH
India Gill, PhD, MPH; Ariana Thompson-Lastad, PhD; Denise Ruvalcaba, BA; Laura M. Gottlieb, MD, MPH; Danielle Hessler Jones, PhD
Corresponding Author: India Gill, PhD, MPH; Social Interventions Research and Evaluation Network, University of California San Francisco
Email: india.gill@ucsf.edu
DOI: 10.3122/jabfm.2024.240170R1
Keywords: Adverse Childhood Experiences, Community Health Centers, Health Disparities, Integrated Health Care Systems, Interdisciplinary Health Team, Patient-Centered Care, Physician-Patient Relations, Primary Health Care, Qualitative Research, Screening, Social Determinants of Health, Social Risk Factors, Trauma
Dates: Submitted: 04-23-2024; Revised: 06-21-2024; Accepted: 07-01-2024
FINAL PUBLICATION: |HTML| |PDF|
BACKGROUND: In 2020, the state of California started financially incentivizing primary care practices to screen for adverse childhood events (ACEs). In its current Medicaid 1115 waiver, the state also has encouraged healthcare teams to screen for social risks (SR) – (e.g., food, housing, and transportation insecurity). In this qualitative study, we explore community health center (CHC) staff and patient perspectives about opportunities and barriers to integrating adult screening for ACEs and SR.
METHODS: We identified eligible California CHCs through Medicaid claims data on ACEs screening and/or participation in ACEs or SR-related learning collaboratives. Staff and/or patients in twelve clinics participated in semi-structured interviews exploring opportunities and barriers to integrated ACEs and SR screening. Interviews were analyzed using a rapid qualitative data analysis approach.
RESULTS: Thirty-nine clinic staff (including clinic leaders, allied health professionals, licensed clinicians) and 10 patients participated. While staff and patients often conceptually endorsed integrated ACEs and SR screening, they identified substantial practical barriers to integration. Barriers primarily related to different screening frequencies and workflows. Other barriers reflected broader primary care time constraints and workforce shortages. Participants shared multiple recommendations to improve screening programs, including strategies for combining ACEs and SR screening.
DISCUSSION: California CHC staff and patients described several conceptual benefits of integrating ACEs and SR screening, but longstanding primary care challenges make it complicated to integrate these activities. Standardizing the integration of ACEs and SR screening will require institutional and structural shifts to overcome common barriers to providing whole person care.