Gill India, Thompson-Lastad Ariana, Ruvalcaba Denise, Gottlieb Laura M, Hessler Jones Danielle
From the Social Interventions Research and Evaluation Network, University of California San Francisco, San Francisco, CA (IG, LMG, DHJ); Osher Center for Integrative Health, University of California San Francisco, San Francisco, CA (AT-L, DR); Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA (LMG, DHJ, AT-L).
J Am Board Fam Med. 2025 May 12;38(1):15-27. doi: 10.3122/jabfm.2024.240170R1.
In 2020, the state of California started financially incentivizing primary care practices to screen for adverse childhood events (ACEs). In its current Medicaid 1115 waiver, the state also has encouraged health care teams to screen for social risks (SR) - (eg, food, housing, and transportation insecurity). In this qualitative study, we explore community health center (CHC) staff and patient perspectives about opportunities and barriers to integrating adult screening for ACEs and SR.
We identified eligible California CHCs through Medicaid claims data on ACEs screening and/or participation in ACEs or SR-related learning collaboratives. Staff and/or patients in 12 clinics participated in semistructured interviews exploring opportunities and barriers to integrated ACEs and SR screening. Interviews were analyzed using a rapid qualitative data analysis approach.
Thirty-nine clinic staff (including clinic leaders, allied health professionals, licensed clinicians) and 10 patients participated. While staff and patients often conceptually endorsed integrated ACEs and SR screening, they identified substantial practical barriers to integration. Barriers primarily related to different screening frequencies and workflows. Other barriers reflected broader primary care time constraints and workforce shortages. Participants shared multiple recommendations to improve screening programs, including strategies for combining ACEs and SR screening.
California CHC staff and patients described several conceptual benefits of integrating ACEs and SR screening, but longstanding primary care challenges make it complicated to integrate these activities. Standardizing the integration of ACEs and SR screening will require institutional and structural shifts to overcome common barriers to providing whole person care.
2020年，加利福尼亚州开始在经济上激励初级保健机构筛查儿童期不良经历（ACEs）。在该州目前的医疗补助1115豁免条款中，还鼓励医疗团队筛查社会风险（SR）（例如，食品、住房和交通不安全）。在这项定性研究中，我们探讨了社区卫生中心（CHC）工作人员和患者对于整合成人ACEs和SR筛查的机会与障碍的看法。
我们通过关于ACEs筛查的医疗补助索赔数据和/或参与ACEs或SR相关学习协作项目，确定了符合条件的加利福尼亚州社区卫生中心。12家诊所的工作人员和/或患者参与了半结构化访谈，探讨整合ACEs和SR筛查的机会与障碍。访谈采用快速定性数据分析方法进行分析。
39名诊所工作人员（包括诊所负责人、专职医疗专业人员、执业临床医生）和10名患者参与了访谈。虽然工作人员和患者在概念上通常认可整合ACEs和SR筛查，但他们也指出了整合过程中存在的重大实际障碍。障碍主要与不同的筛查频率和工作流程有关。其他障碍反映了更广泛的初级保健时间限制和劳动力短缺问题。参与者分享了多项改进筛查项目的建议，包括整合ACEs和SR筛查的策略。
加利福尼亚州社区卫生中心的工作人员和患者描述了整合ACEs和SR筛查在概念上的几个好处，但长期存在的初级保健挑战使得整合这些活动变得复杂。标准化ACEs和SR筛查的整合需要机构和结构上的转变，以克服提供全人护理的常见障碍。
