Date of Award

Spring 5-25-2024

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor

Romilynn Danko, DNP, PMHNP-BC


Introduction: The purpose of this evidence-based Doctor of Nursing Practice project was to pilot the implementation of the Adverse Childhood Experiences (ACEs) Questionnaire for Adults during admission to an intensive outpatient program (IOP) to identify clients who have experienced ACEs and provide risk-reduction measures to mitigate risks of ACE-related long-term health consequences. The study site is a Southern California-based large healthcare organization that provides outpatient intensive therapy programs which employ a variety of clinicians, to provide mental health care to clients across the lifespan.

Background: Adverse Childhood Experiences (ACEs) are potentially traumatic events including neglect, abuse, and certain forms of household dysfunction that occur during childhood. ACEs are associated with a lasting negative impact on health and well-being that extends into older adulthood. ACEs are associated with detrimental, long-term health outcomes in adults, including five out of the ten leading causes of death in the United States. ACEs affect approximately 61% of the population, and approximately 16% of those have experienced four or more types of ACEs. Despite increased awareness of ACES and initiatives in place to decrease toxic stress, they are still common and underrecognized. The transitional-aged youth population (TAY) are particularly vulnerable to mental health illnesses and poor health outcomes, which may correlate with increased ACE scores. ACE screening is not currently captured in the admission assessment at the chosen organization.

Methods: A small TAY IOP program associated with a large healthcare organization in San Diego, California was partnered with for this pilot project. All new patients ages 18-26 were screened, using the ACEs Questionnaire for Adults, during six-day shifts during December 2023. Based on the patient’s score, they were provided with appropriate risk-reduction measures to reduce long-term physical and emotional health consequences. Before the implementation of screening, staff employed at the site were sent a virtual in-service via email with education on ACEs and screening and asked to fill out an anonymous in-service learner evaluation survey via QR code via Google Forms. All data was collected by the DNP student and inputted into an Excel spreadsheet on a password-protected computer. In-service evaluation results (Likert scales) will be analyzed as interval data. Patient outcome measures are analyzed as percentages. All measures were interpreted on an Excel sheet with visual charts and/or graphs.

Results: During the implementation of ACE screening at the TAY IOP, seven patient participants were recruited, approached, and agreed to participate. One patient scored 0, six patients scored 1-3, and one scored 4. All patients were provided with applicable risk-reduction measures based on their scores. Ten employees were emailed an ACE In-service Pamphlet and five completed an anonymous post ACE In-service pamphlet survey. Eighty percent were satisfied with the content of the pamphlet, felt the pamphlet enhanced their knowledge of the subject matter, and deemed the provided content relevant to their daily job.

Conclusion: Implementation of ACE screening is a fast and cost-effective approach to identify those who have experienced ACEs and increase the likelihood of implementing risk-reduction measures to mitigate the risk of ACE-related long-term health consequences. Future projects should be implemented to expand screening to other areas of the chosen site, including additional behavioral health outpatient programs and inpatient psychiatric units.

Available for download on Saturday, May 03, 2025

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