Outcome | Measurement | Data source | Frequencya |
---|---|---|---|
Clinic level outcomes (primary) | |||
Reach of ACE screenings | Proportion of eligible children participating in ACE screenings. We expect between 80 and 92% of eligible children will be screened; based on pediatric screening studies in primary care [49, 50] | FQHC EMR system | Week 10 of each time period |
Mental health referral rates | Number of mental health referrals (behavioral analysis, behavioral health, care coordinator, care management, child development center or social work) divided by the total # of eligible children. For children deemed at high risk for toxic stress and/or mental health needs. Expect 11.4% increased referral rate based on a similar study [29] and using current referral rate of 3.8% to inform this threshold and per FQHC i2itracks report | FQHC EMR system | Week 10 of each time period |
Clinic level outcomes (secondary) | |||
Implementation feasibility [6] | Self-reported 4-item survey evaluating feasibility of implementation efforts. 4-pt Likert scale; average score of 4+ shows ACE policy and implementation strategy perceived as feasible. Good internal consistency (α=0.89). Test-retest reliability r = 0.88 | FQHC personnel | Week 10 of the intervention time period |
Implementation acceptability [6] | Self-reported 4-item survey evaluating acceptability of ACE policy and implementation efforts. 4-pt Likert scale; average score of 4+ shows acceptability. Good internal consistency (α = 0.83). Test-retest reliability r = 0.83 | Week 10 of the intervention time period | |
Fidelity | Checklist assessing adherence to ACE screening protocols and competence of performance. Deviations/concerns will be documented and immediately reported back to clinic personnel. We expect at least 67% fidelity (number of endorsed deviations/all items in the checklist) based on a previous study [49]. Adaptations and emerging challenges will be documented and reported to the research team. Observation checklists/audits are effective strategies to improve fidelity of performance [51] | Implementation coach | Weeks 5 and 10 of each time period |
Child/parent level outcomes | |||
Changes in PSC scores | Mean score differences from eligible screened children who were deemed at high or at intermediate risk. | Randomly selected group of caregivers | 10 weeks after child’s ACE screening |
Mediators | |||
Implementation leadership [48] | 12-item survey comprised of four subscales measuring proactive leadership, knowledgeable leadership, supportive leadership, and perseverant leadership. Strong reliability for the total scale (α = 0.98). An average score of 4+ will be used as threshold; 5-point Likert scale (not at all-very great extent). Subscale score is based on the mean score for the items; total score is the mean of the subscale scores [48] | Clinic personnel | Week 7—intervention period—and week 9—every other time period |
Implementation climate [52] | 6-item survey measuring the strategic climate for the implementation of interventions. Items are rated on a 5-item Likert scale (completely disagree-completely agree) | Week 7—intervention period—and week 9—every other time period | |
Other measures | |||
Child socio-demographic characteristics | Variables include sex, self-identified race and ethnicity, age, language of preference for health care receipt, born in the USA. Note: EMR system does not report data on caregivers of child patients | EMR system | Week 10 of each time period |