Applying Adverse Childhood Experience (ACE) Screening in Adolescent Inpatient Mental Health

This quality improvement project aimed to implement screening for adverse childhood experiences (ACEs) and other related life stressors in inpatient adolescent psychiatry and to assess their relationship with mental health clinical and quality indicators. The project was conducted in a 25-bed adolescent inpatient unit in Los Angeles County from 2022 to 2023. The Pediatric ACEs and Related Life Events Screener (PEARLS) was used for systematic ACE screening. ACE screening results, demographic and clinical data, youth perceptions of trauma-informed care, new PTSD diagnoses, and length of hospitalization were collected throughout the project period. Linear and logistic regression models were used to examine the relationship between ACE scores, stressful life events, and outcome measures. The sample included 103 adolescents admitted for a psychiatric emergency. Most patients were girls (75.7%), and 94% had at least one ACE. The average length of stay was 6.4 days, and 30% of youth received a new diagnosis of PTSD during hospitalization. Higher ACE scores were associated with increased odds of a new PTSD diagnosis. Sexual abuse and death of a parent/caregiver were the only individual items associated with new PTSD diagnosis. This quality improvement project implementing ACE screening in inpatient adolescent psychiatry demonstrated a high prevalence of ACEs among the target population and the need for trauma-informed care. Our findings contribute to the growing efforts to address ACEs and improve the quality of trauma-informed care in child-serving systems.