Date of Award

Spring 5-31-2026

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Briony M. DuBose, PhD, MHI, RN, LSSBB, Faculty Advisor

Abstract

Purpose: This evidence-based practice project implemented Adverse Childhood Experiences (ACEs) screening in an adult Cognitive Behavioral Therapy Intensive Outpatient Program (COG IOP) at San Diego's largest behavioral health hospital to identify ACE exposure, deliver supportive interventions, and enhance clinician competency in trauma-informed care.

Background: ACEs are potentially traumatic experiences occurring before age 18 that are associated with toxic stress and worsening health outcomes. Despite evidence linking ACEs to adverse outcomes and substantial healthcare costs, routine ACE screening is not standardized in behavioral health settings.

Methods: Guided by the San Diego 8A's Evidence-Based Practice model, eligible patients were offered ACEs screening and trauma-informed supportive interventions based on scores. Clinician education was delivered through an in-service with pre- and post-learning self-assessment surveys. Primary outcomes were assessed using the ACE Questionnaire for Adults; secondary outcomes were collected through anonymous Likert-scale staff surveys.

Results: Of the 31 patients offered screening, 27 completed screening (87.1%). Among those screened, 9 (33%) had ACE scores of 1–3, and 18 (66.7%) had scores ≥4. All patients received psychoeducation, and all 18 with scores ≥4 received goal-setting worksheets. Staff education was provided to 19 members. Pre-learning Likert mean scores ranged from 4.13-4.60; post-learning mean scores ranged from 4.17-4.42. Welch’s t-test showed no significant differences (p > 0.05), indicating high baseline competence.

Conclusion: This project demonstrated the acceptability and feasibility of integrating ACE screening with supportive interventions in behavioral health settings. High baseline staff competence suggests education should focus on reinforcement rather than foundational training.

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