Increasing Staff Knowledge and Screening Practices for Adverse Childhood Experiences in Primary Care

Adverse childhood experiences (ACE) are important to future health outcomes. Many health care providers lack the knowledge or training to assess for ACE. Purpose. The purpose of this quality improvement project is to increase the identification of ACE among adult clients in a primary care clinic in Saint John New Brunswick Canada, through the delivery of an education session for the health care team members and patient screening for ACE. Methods. Staff at one clinic attended an educational program about ACE. Staff completed a pre and post education survey questionnaire (N = 8). Additionally, clinic patients (N= 32) were screened for childhood trauma using the ACE questionnaire. Post-screening surveys were completed by the clinicians who screened for ACE. Results. Most staff (85.7%) reported inadequate training/knowledge of ACE pre-education session; improvement in knowledge/understanding of ACE post session; and better prepared to discuss/screen patients for ACE. Nearly all of the 32 clinic patients reported a positive ACE score, and 62.7% had a score of four or more. Time to screen was not reported as a barrier by clinicians, and 10.0% of patients who screened positive were referred for counselling or booked a follow-up appointment. Conclusion. Health care providers lack education/training on ACE and patients are not regularly screened for ACE. To do this effectively, a trauma informed care approach must be used. A history of ACE in the patient sample was found to be high, yet previously unknown to the clinicians. This information has implications for primary care practice, community programming and policy development

Coming Out of Crisis: Patient Experiences in Primary Care in New Orleans, Four Years Post-Katrina

Examines the network of neighborhood clinics funded with federal, state, and local money that emerged after Hurricane Katrina as a model for serving vulnerable populations. Looks at access, communication, chronic illnesses management, and preventive care

Language Barriers in Health Care Settings: An Annotated Bibliography of Research Literature

Provides an overview of resources related to the prevalence, role, and effects of language barriers and access in health care

Practical Strategies for Pharmacist Integration with Primary Care: A Workbook.

This workbook is a practical set of tips and resources to assist pharmacists in providing clinical pharmacy services to primary care providers and their patients. The content was written based on experiences in Vermont in 2014, however the topics should generalize to pharmacists in other areas

Systematic review of transition models for young people with long-term conditions: A report for NHS Diabetes.

Aims For many young people with Type 1 diabetes, transition from paediatric to adult care can result in a marked deterioration in glycaemic control. A systematic review assessed the effectiveness of transition models, or components of models, for managing the transition process in young people with long-term conditions, including Type 1 diabetes. This involved identifying (i) the main barriers and facilitators in implementing a successful transition programme, and (ii) the key issues for young people with long-term conditions and professionals involved in the transition process. Methods The following databases were searched from inception to August 2012: MEDLINE, EMBASE, PsychINFO, CINAHL, ASSIA, Social Services Abstracts, Academic Search Complete, Social Science Citation Index, Cochrane and Campbell Libraries. Selected studies included young people aged 11 to 25 diagnosed with long-term conditions who were in transition from paediatric to adult secondary health care services. Results 16 systematic reviews and 13 primary studies were included from 9992 records retrieved. No single transition model was uniquely effective. The most successful transitions centred around: young person-focused; age and developmentally appropriate content and delivery; self-management education; family participation; paediatric and adult collaboration; designated transition clinics; transition co-ordinator; young person’s portfolio; specific professionals training; multidisciplinary approach; structured process embedded in service delivery. There were no distinctive characteristics of condition-specific Type 1 diabetes services. Conclusion This important and timely review summarises the key factors that need to be considered for the development of transition programmes for young people with long-term conditions, including those with Type 1 diabetes

Guiding Transformation: How Medical Practices Can Become Patient-Centered Medical Homes

Describes in detail eight change concepts as a guide to transforming a practice into a patient-centered medical home, including engaged leadership, quality improvement strategy, continuous and team-based healing relationships, and enhanced access

Impact of the Sierra Health Foundation's Clinic Capacity Building Program: Final Evaluation Report

Sierra Health Foundation (Sierra Health) launched the Clinic Capacity Building Program in 2013 as part of the Sacramento Region Health Care Partnership. The goal of the Clinic Capacity Building Program was to respond to the anticipated growth in demand (i.e., number of patients) created by the implementation of the Affordable Care Act by strengthening community health centers' administrative and operational capacity. The program aimed to improve clinic leadership, care quality and financial sustainability, thereby increasing the number of high performing Federally Qualified Health Centers in the region.In July 2014, Sierra Health contracted with the Center for Community Health and Evaluation (CCHE) to evaluate the effectiveness of its Clinic Capacity Building Program. The goal of the evaluation was to assess the effectiveness of the Clinic Capacity Building program and contribution of the program to changes in capacity among the five grantees. This is the Executive Summary of the final evaluation report, which was submitted to Sierra Health in December 2015

Providing Maternity Care to the Underserved: A Comparative Case Study of Three Maternity Care Models Serving Women in Washington, D.C.

Compares the content and structure of maternity care provided at a city birth center, a safety net clinic, and a not-for-profit teaching and research hospital; populations served; providers; costs; and the women's and providers' perceptions of each model

Addressing Childhood Adversity and Social Determinants inPediatric Primary Care:Recommendations for New Hampshire

Research has clearly demonstrated the significant short- and long-term impacts of adverse childhood experiences (ACEs) and the social determinants of health (SDOH) on child health and well-being.1 Identifying and addressing ACEs and SDOH will require a coordinated and systems-based approach. Pediatric primary care* plays a critical role in this system, and there is a growing emphasis on these issues that may be impacting a family. As awareness of ACEs and SDOH grows, so too does the response effort within the State of New Hampshire. Efforts to address ACEs and the SDOH have been initiated by a variety of stakeholders, including non-profit organizations, community-based providers, and school districts. In late 2017, the Endowment for Health and SPARK NH funded the NH Pediatric Improvement Partnership (NHPIP) to develop a set of recommendations to address identifying and responding to ACEs and SDOH in NH primary care settings caring for children. Methods included conducting a review of literature and Key Informant Interviews (KII). Themes from these were identified and the findings are summarized in this report

Screening For Trauma In the Foster Care Community

Children within the foster care community experience health disparities on a variety of levels, from physical and mental health conditions, developmental delay, and impaired social interactions. Many of these conditions can stem from the experience of trauma or adverse childhood events that color each component of their lives. For healthcare providers to be successful in the assessment and treatment of this community, an understanding of traumatic events and the delivery of trauma-informed care is essential. The complex needs of this community are such that the provision of healthcare must be specialized, multidimensional, and organized. The purpose of this project is to assist in the development of a clinic that specializes in the delivery of primary care to the foster care community, with a focus on screening and assessment for the experience of trauma. Children were screened for child trauma as well as for resiliency behaviors, and a tool for chart review was used to examine current health status and services. With the assistance of stakeholders, meticulous follow up on screening results, referrals and recommendations made ensured that no opportunities were missed to provide the highest quality care for this underserved community