Date of Award

Spring 5-22-2026

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Autumn Roque, DNP, APRN, PMHNP-BC

Abstract

Objective: This evidence-based practice project evaluated the impact of implementing adverse childhood experience (ACE) screenings for patients with substance use disorders (SUDs) in an outpatient community behavioral health clinic.

Background: ACEs are strongly associated with an increased risk of developing SUDs, chronic medical comorbidities, and negative treatment outcomes. Despite consistent evidence supporting the need for identification of ACEs and implementing trauma-informed care, standardized ACE screening is not routinely incorporated into outpatient SUD treatment, potentially limiting the identification of the need for education and referrals.

Methods: The ACE Questionnaire for Adults was implemented during routine psychiatric visits for patients diagnosed with SUDs over a 10-week pilot period. All patients screened received education on toxic stress, and all patients who scored at least one ACE were offered referrals to primary care, individual psychotherapy, and group therapy incorporating principles of the evidence-based therapy model Seeking Safety. Pre-implementation and implementation outcomes were compared to evaluate changes in the rate of education and referrals.

Results: Thirty-one patients were screening during implementation. All screened patients endorsed at least one ACE. Education on toxic stress increased from 0 of 21 patients (0%) pre-implementation to 31 of 31 patients (100%) during implementation. Primary care referrals increased from two of 21 patients (9.52%) to nine of 31 patients (29.03%). Individual psychotherapy referrals increased from three of 21 patients (14.29%) to 17 of 31 patients (54.84%). Group therapy referrals increased from 0 of 21 patients (0%) to six of 31 patients (19.35%).

Conclusion: Routine ACE screening in outpatient SUD treatment was feasible and associated with increases in trauma-informed education and referrals. Findings support structured ACE assessment as a practical strategy to enhance comprehensive, trauma-informed care for individuals with SUDs.

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