More effective and efficient to complete one integrated screening.

Reduce discussion of overlapping topics.

Offer more resources for referrals.

“I would say that the shorter the better, the quicker the better for everybody.” – primary care clinician

“We see a lot of patients a day… sometimes over 30 patients a day… So to be honest, yes [integrated screening] will be helpful, if it's shorter screening, or less time-consuming, especially for adult patients, they have a lot of comorbidities.” – primary care clinician

“That could definitely be harder for some people. If I had gotten all of that at the same time, I think that would've been fine. Especially if you're a new patient…it'd just kind of be nice to get that out of the way.” – patient

Data collection frequency for ACEs and SR differs.

ACEs screening are generally administered once a lifetime.

SR screening varies (e.g., during new patient intake, every visit, or annually).

“We were talking about the frequency because it's like, ‘Okay, do you do the social determinants, every visit every time or how do you do it?’ With ACEs it's easy after the age of 18, you only do it once in a lifetime because it never changes. Right? So with social determinants that can change in a day. Right? You could lose your job.” – clinic leader

“I feel if we ask both of them together every year, we can probably miss out on a opportunity to help out somebody that's in need before the year hits.” – medical assistant

Brief visit time (10 to 15 minutes).

Clinic staff have competing needs to address.

Clinic staff may feel hesitant to “open a can of worms”.

"I guess my input is that for it to happen at the same visit isn't totally necessary. Would both of that information be useful? Absolutely. I'm just not certain that getting all of that done in one swoop is totally advisable in terms of the timing.” – primary care clinician

“It's more conversation around what the patient is facing both in their past and their present, and an opportunity to intervene if we have the resources to do so. So I think it's a good idea. Whether it's feasible is the only piece that you would have to really think about, just because our visits are 15 minutes.” – clinic leader and primary care clinician

“There's just so many things that have to be done and it could become overwhelming for staff, the provider and the patient… So I think that's where we get less compliance because it's like, ‘Now I have to do this, now I have to do that.’ It's like some of them say, ‘I don't even want to fill out this paperwork anymore. Why is there so much paperwork?’” – clinic leader

“Those are delicate subjects, and they're delicate things that people go through in life. It's not just something that you can put somebody in a room and say, ‘Oh, yeah, we'll do this for half an hour,’ and then send them on their way.” – patient

High staff turnover and burnout impacts morale and results in fewer staff trained in ACEs/SR.

Differences in clinic staff responsible for administering ACEs and SR screening (e.g., medical assistants, ACEs navigators, social workers, clinicians).

Sustainability of grant-funded roles (e.g., ACEs navigator)

“I mean we try to fill the gaps as much as we can on the areas that we can, but the way that I look at it is that we can't be everything to all because it takes a village in some regards. And we got in this business being focused on this particular area and now it's kind of grown into, okay, we got to be your primary care provider, we got to be your mental health provider, we got to be your electric company, we got to be your taxi cab, we got to be your food bank, your grocery store, we got to be your landlord. That's a lot.” – clinic leader

“From front desk to MAs to medical clinicians, we had gone through an incredible rotation of clinicians. So that's a huge challenge. So whoever you train or whoever you have conversation about this, you have to retrain because we getting new clinicians and who knows, these new clinicians may be gone in a year or so.” – clinic leader