Utilizing MHS Genesis to Identify and Treat Military Children Exposed to Adverse Childhood Experiences (ACEs)

Purpose/Objectives:

Introduction: In 2011, the AAP issued a policy statement directing pediatricians to “actively screen for precipitants of toxic stress that are common in their particular practices.” As a result of expanding evidence, the profound impact of ACEs on childhood development is becoming more widely understood, as is the chance to intervene and change outcomes. However, it is not yet standard screening practice in most pediatric clinics in the Military Health System. This project highlights ACEs screening implementation at a military treatment facility utilizing the new medical record system MHS Genesis (MHSG), thus providing valuable insight for other clinics hoping to do the same.

Objective: To comply with the AAP’s policy, our pediatric clinic at Madigan Army Medical Center launched a quality improvement project with a goal of screening at least 80% of children ages 3-10 years old with ACEs questionnaires at annual well-child checks.

Design/Methods: Methods: Using Plan-Do-Study-Act quality improvement methodology, a team including faculty, residents, nursing, and front-desk staff was formed to guide ACEs screening implementation. The project launched in November 2019, where all providers were trained in the background and significance of ACEs, how to do document screening scores in MHSG, and how to respond to positive scores. ACEs questionnaires were then provided at every well child check in 2020 within the target age range and a monthly data query was performed. The team leadership met each month to analyze barriers to screening and documentation in MHSG, eliciting frequent feedback from involved staff and providing relevant training and interventions in response.

Results:

Results: Since implementation of this process improvement project, our ACEs screening rates increased from 0% to 59%. Of the 1192 children screened in 2020, 286 were deemed at-risk and connected with appropriate resources, though numbers would likely have been higher since many of the target age group were not seen in 2020 due to the COVID-19 pandemic. Identified barriers to ideal MHSG screening implementation include: software updates that alter formatting, provider variation in understanding score documentation, and workflow breakdowns in the setting of staffing shortages.

Conclusion/Discussion:

Discussion: We successfully implemented ACEs screening into our pediatric clinic with the project being met with strong enthusiasm by providers, nurses and families. It will soon be expanding to military family medicine and the other pediatric clinics on base. Recognizing how MHSG helped and hindered our efforts was a valuable learning experience and one we feel can significantly benefit our comrades at other military treatment facilities. This project provides the necessary foundation for enterprise-wide ACEs implementation utilizing MHSG.