PT  - JOURNAL ARTICLE
AU  - Gill, India
AU  - Thompson-Lastad, Ariana
AU  - Ruvalcaba, Denise
AU  - Gottlieb, Laura M.
AU  - Hessler Jones, Danielle
TI  - Integrating Adverse Childhood Experiences and Social Risks Screening in Adult Primary Care
AID  - 10.3122/jabfm.2024.240170R1
DP  - 2025 Apr 04
TA  - The Journal of the American Board of Family
                Medicine
PG  - jabfm.2024.240170R1
4099  - http://www.jabfm.org/content/early/2025/03/28/jabfm.2024.240170R1.short
4100  - http://www.jabfm.org/content/early/2025/03/28/jabfm.2024.240170R1.full
AB  - 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 health care teams to screen for social risks (SR) − (eg, 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 12 clinics participated in semistructured 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.