Syed Gillani DO, Kaitlin Leckie PhD, Jodi Hasenack, RN, Kristine Miller DO, and Leslie Dempsey MD Southern Colorado Family Medicine Residency Program, Pueblo, CO SCAN (Score, Connect, and Nurture) Pilot Project Primary Prevention of Adverse Health Outcomes by Assessing Adverse Childhood Experiences (ACEs) Scores in an Underserved Population

What Are ACEs? According to Felitti et. al., adverse childhood experiences (ACEs) are potentially traumatic events that can have negative, lasting effects on health and well-being: 1. Emotional abuse 2. Physical abuse 3. Parent substance abuse 4. Parent incarceration 5. Sexual abuse 6. Parent separation or divorce 7. Mother treated violently 8. Household mental illness 9. Physical neglect 10. Emotional neglect Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults, American Journal of Preventive Medicine in 1998, Volume 14, pages 245–258.

As per study (Felitti et al., 1998), compared with people with no ACEs, those with 4 or more ACEs were: Twice as likely to smoke, have cancer or heart disease 7x as likely to be alcoholics 6x as likely to have had sex before age 15 12x more likely to have attempted suicide Men with 6 or more ACEs were 46x more likely to have injected drugs than men with no history of ACEs Clear dose-response relationship between stressors and adverse health outcomes was present 50 years later Dose-Response Relationship of ACEs

Relationship between Chronic Diseases and ACEs

Centura Health Foundation Catholic Charities Southern Colorado Family Medicine Butler Institute for Families, DU SCAN- Score, Connect, and Nurture Pilot Project An initiative to screen for and address Adverse Childhood Experiences (ACES) in Primary Care SCAN is a joint initiative of the St. Mary-Corwin Health Foundation, Southern Colorado Family Medicine, Caring for Colorado Foundation, Catholic Charities, Diocese of Pueblo Inc., and the University of Denver, Butler Institute for Families

SCAN- Score, Connect, and Nurture Pilot Project Goal Reduce the risk of health conditions in children related to exposure to ACES Objectives Educate parents and increase awareness Increase capacity of organizations to engage with families about the social determinants of health Increase parents’ use of evidence-based services that will reduce children’s exposure to ACES

SCAN- Score, Connect, and Nurture Pilot Project Screen By integrating ACES into Well-child visits between birth to 5 years of age High Risk OB clinic at St. Mary Corwin Hospital OB visits in the SCFM clinic Identify High risk families Educate and Facilitate through a Social Worker Educate about ACES, parenting and health Help connect to SafeCare and Catholic Charities

SCAN- Score, Connect, and Nurture Pilot Project Data Measures ACEs Scores Resiliency Scores Self Reported General Health Emergency Department Use Rates No-Show Rates to Scheduled Clinic Appointments Families Assessed 320 families assessed since October 2015 Age Range (m=28) Average of 2 children per home 50% report always, frequently, or sometimes depressed 82% report good, very good, or excellent health

ACE Scores (n=263) 9 SCAN- Score, Connect, and Nurture Pilot Project

10 SCAN- Score, Connect, and Nurture Pilot Project Resilience Scores

SCAN- Score, Connect, and Nurture Pilot Project Emergency Department Visits Background Data Collection Limitations ED Visit Absolute Reduction of 29% A difference of 7 FEWER ED visits per month on average based on 180 patients

SCAN- Score, Connect, and Nurture Pilot Project Clinic Visit Compliance

SCAN- Score, Connect, and Nurture Pilot Project Future Goals for Expansion Parents of children 0-18 Emergency Department embedment Additional community primary care clinics Grant funding for 3 year extension pending Project used to apply for a 3 year research fellowship

Selected References Felitti, V., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14, Felitti, V. J., & Anda, R. F. (2010). The relationship of Adverse Childhood Experiences to adult medical disesae, psychiatric disorders, and sexual behavior: Implications for healthcare. In The Hidden Epidemic: The Impact of Early Life Trauma on Health and Disease. Ed. Lanius, R. & Vermetten, E. Cambridge University Press. McCrae, J., Lau, C., Dempsey, L.D. (2016). Score, Connect, and Nurture: Promoting Population Health by Integrating ACEs Intervention into Primary Care. Child Abuse & Neglect Prevention Conference. Colorado Springs, CO Questions?