Date of this Version

7-15-2025

Document Type

DNP Project

Abstract

Adverse Childhood Experiences (ACEs) include abuse, neglect, and household dysfunction experienced from ages 0 to 17. These events are linked to long-term physical and mental health issues (CDC, 2024). The ACE questionnaire identifies many forms of trauma, such as exposure to violence, family mental illness, substance use, or incarceration. However, it does not capture all potential adverse experiences, highlighting the importance of comprehensive assessments.

Research by Hughes et al. (2017) and Colich et al. (2020) has shown strong associations between ACEs and later mental illness, substance use, and chronic disease. Thakur et al. (2020) emphasized the importance of tools like the Pediatric ACEs and Related Life-Events Screener (PEARLS), while Dumke et al. (2024) identified barriers to ACE screening in pediatrics, such as limited clinician training and workflow issues.

This quality improvement project integrated the PEARLS tool and trauma-informed education into an outpatient psychiatric clinic for children and adolescents. Clinicians completed a pre-test, attended an educational session, and then completed a post-test, which showed increased knowledge and confidence. The PEARLS questionnaire was added to the standard intake process and completed for all new pediatric patients over four weeks. While the standard trauma question identified trauma in 10 percent of cases, PEARLS identified 40 percent, with 10 percent reporting four or more ACEs. These results suggest that structured screening tools, alongside provider education, enhance trauma identification and support the implementation of trauma-informed care practices in psychiatric settings.

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