SCMF Needs Assessment for Practitioners and Physicians

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Please complete this ACEs Regional Assessment Questionnaire to help us understand the implementation of ACEs screenings in Colusa, Nevada, Placer, Sutter, and Yuba counties.

Name *

What is the best way to contact you? Please list phone number and/or email address. *

Clinic Name *

Type of Clinic *

Which county(ies) is your clinic(s) located in? *

Colusa

Nevada

Placer

Sutter

Yuba

Sacramento

Required

On a scale from 1-10, how knowledgeable are you about ACEs and their impact on long term health outcomes of your patients? *

Not much

Very knowledgeable

Have you visited www.acesaware.org to learn about the ACE Initiative?

Yes

Have you completed certification for Becoming ACEs Aware in California?

Yes

How many of your staff members have completed the Becoming ACEs Aware in California training?

1-3

4-8

9 or more staff

No other staff have completed the training.

Are you aware of the ACEs Aware Provider Directory?

Yes

Does your clinic screen for ACEs as part of standard practice?

Yes

Sometimes

Which screener(s) do you use? *

Pediatric ACEs and Related Life-events Screener (PEARLS)

ACEs Aware Questionnaire for Adults

Other:

Required

Are you in the process of developing systems that would integrate the use of an ACEs screener as part of standard clinical workflow?

Yes

Do you have a champion in your clinic/office that strongly advocates for ACEs screenings?

Yes

Do you have information in your clinic to educate patients about ACEs, self-care, and/or toxic stress?

Yes

Are you aware of the Stress Busters handout (Seven Ways to Manage Stress) that ACEs Aware provides?

Yes

What type of educational materials (i.e., ACEs, Self-care, Seven Ways to Manage Stress, Positive Childhood Experiences) would be helpful in your clinic?

Posters

Prescription Pads with Stress Busters strategies

Flyers

Nothing needed at this time

Required

Do you have an inventory or list of referral resources readily available?

Yes

What are your barriers to implementing ACEs screenings? (Check all that apply.)

I do not have barriers and implement ACE screenings.

Lack of time (for screening, entering into EHR, billing)

Lack of staff (for screening, entering into EHR, billing)

Lack of referral resources

Lack of knowledge of resources located in the neighboring county

Lack of staff to navigate referrals

Lack of ways to incorporate ACEs information into EHR systems

Telemedicine makes it harder to screen

Lack of medical assistants and scribes

Required

Besides time and money, what do you see as being helpful to increase your ability to screen? Check all that apply.

Time to complete Becoming ACEs Aware in California

Access to the screeners that should be utilized

Access to a network of care for referrals

Availability of resources/referrals

Share or learn best practices to implement screenings

Hire a community health worker (CHW) and other skilled clinic staff, to support the implementation

Access to a mentor colleague who is successfully implementing screenings

Required

Have you considered utilizing Sierra Community Medical Foundation (SCMF) to serve as a community clinical linkage to facilitate referrals and provide resources within communities? *

Yes

Would you consider hiring SCMF personnel to assist with implementing ACEs screenings?

Yes

Maybe

What do you need to begin implementing ACEs screenings? (i.e., training, personnel, etc.)

List any suggestions you have for ACEs promotional material.

Explain how you have utilized Sierra Community Medical Foundation in your work.

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