Date Approved
6-16-2026
Graduate Degree Type
Dissertation
Degree Name
Nursing (D.N.P.)
Degree Program
College of Nursing
First Advisor
Dr. Nicole Harpold
Second Advisor
Dr. Amy Rohn
Third Advisor
Dr. Henry Pena
Academic Year
2025/2026
Abstract
Adverse Childhood Experiences (ACEs) are associated with increased risks of chronic disease, mental health disorders, substance use disorders, and premature mortality. Despite growing evidence supporting ACE screening, it remains inconsistent in many primary care settings, particularly among underserved populations. The purpose of this quality improvement project was to evaluate whether implementation of a standardized ACE screening workflow increased ACE screening completion and behavioral health referral within a nonprofit primary care clinic serving uninsured, underinsured, and refugee populations.
This project utilized a pre–post quality improvement design guided by Lewin’s Change Management Model and the Chronic Care Model. Interventions included standardized ACE screening algorithms, staff education, behavioral health referral workflows, and patient educational resources in English and Spanish. Adult patients aged 18 years and older presenting for annual wellness visits or establishment of care were eligible for screening. Data was collected through electronic health record audits during equivalent six-week pre- and post-intervention periods.
A total of 115 patient encounters were reviewed, including 33 pre-intervention and 82 post-intervention encounters. ACE screening completion increased from 21.2% pre-intervention to 31.7% post-intervention. Behavioral health referrals were indicated for six patients following implementation. Although Fisher’s Exact test analysis showed no statistically significant difference between groups (p = .369), clinically meaningful improvements in screening completion and trauma identification were observed.
Findings support the importance of standardized workflows, organizational readiness, and ACE-informed staff education to improve ACE screening implementation within underserved primary care settings.
ScholarWorks Citation
WONNACOTT, TANYA M., "Implementation of a Standardized Adverse Childhood Experiences Screening Process in a Primary Care Clinic" (2026). Doctoral Dissertations & Projects. 88.
https://scholarworks.gvsu.edu/dissertations/88
