Table 2.

Clinical workflow Themes From Interviews With Physicians Who Screened for ACEs With Quotes Illustrating Each Theme

Themes	Representative Quotes
ACEs Screening Workflows without a Protocolized Intervention	“There’s quite a limitation on services like child therapists and social workers…So it is not like you can just refer everybody that has an ACE greater than something for an assessment. I think that’s contributing to that case-by-case basis kind of situation.”
ACEs Screening Workflows with a Protocolized Intervention Threshold	“Whether [their ACE score is] a zero through three, our protocol is to always reflect that each additional ACE or ongoing adversity can increase the risk to physical and behavioral health, and therefore we want to try to connect the dots for the patient.”
Screening Tool(s) Used	“…The formal anonymous screening is easier for parents to admit that they are struggling, as opposed to me just saying, “Hey, like are you able to feed your kid every day?”
Timing of Screening	“We decided we would screen …patients between the ages of zero and five…hoping that we’d be likely to encounter fewer positive screens.”
Clinic Staff Involvement	“I don’t have to think about [screening], honestly. The receptionist just gives it. The patient fills it out. The nursing puts it into the computer. So, all I have to do is see the score. And then my only burden, of course, is to discuss it with the patient but at that point, all the screening is done already.”
Intervention	“The real opportunity is for that pediatrician to make a connection with [the] parent or whoever the caregiver is.”

ACEs indicates adverse childhood experiences.