I left the healthcare system 2 years ago and at that time we were not able to identify/locate existing validated protocols for Acute care settings for ACEs or other traumatic antecedents except for ED JCAHO requirements for Intimate Partner Violence screening.
Given the current acute care emphasis and metrics on preventing re-admission to the hospital, we used this opportunity to address the importance of both having a complete history, the known interplay of psycho-social factors and stress on health status, and discharge planning to address patient needs. We had several basic goals in acute care. Some were protocols regarding provider orientation and training. Others identified who would be responsible for taking a psycho-social history and assuring this was addressed in all phases of acute care from admission to discharge. Because we had hospitalists in acute care, and many hospitalists were locum tenens, we tried to include material on trauma in all new employee orientation, CMEs at the hospital, and informal 'lunch and learns'. We also tried to maintain an identified "champion" in each setting to build relationships in practice. This was an ongoing struggle due to competing time and priorities.
The actual specific screening in the acute care setting was completed by a medical social worker. This was both a pragmatic and functional consideration. As a member of the team, she/he was to share this information with others and advocate for appropriate care.
Readily available clinical resources that supported knowledge and understanding for all staff was key to engagement . The providers found the medical text chapter by Dr. Felitti and Dr. Anda to be particularly helpful and interesting. I have attached it here.
Because the nature of acute care is to respond to acute, chronic and critical conditions, we are often limited in opportunities and appropriate frameworks for delivering even the most basic intervention as Dr. Felitti's describes: “Asking, listening, and implicitly accepting are a powerful form of doing that appears to provide great relief to patients.”
If the patients condition allows, It is certainly within all of our capacities to have a brief discussion of what we have learned in recent decades about how what happens in childhood can impact adult health. A few key points connecting this knowledge to patient health and the importance of having further discussion with their PCP may be the brief but powerful role a nurse, physician, or social worker may have in the acute care setting. It will not "fix" everything, but it can enhance pt. health literacy and perhaps instill a seed of interest, and one point in the continuum of care.
Primary care was always the focus of our follow-up for identified adversity not mental health. Particularly with the current integrated medical home model.
Two attachments:
Medical text chapter on ACEs
Resource from Child Traumatic Stress Network on Medical Trauma - Teens.