Date of Award


Document Type



College of Nursing

Degree Name

Doctor of Nursing Practice (DNP)

Project Mentor

Heather DePuydt


Robin Narruhn


Introduction: Adverse Childhood Experiences (ACEs), such as abuse, neglect, and various household stressors, are common, connected, and contribute to multiple adverse health and wellbeing outcomes throughout life. Consequently, there has been a push to screen for adversity and toxic stress in primary care to facilitate prevention and early intervention. The purpose of this project was to evaluate and optimize the use of the Broad Level Integrated Screener (BLIS) in Neighborcare Health (NCH) School Based Health Centers (SBHCs) in Seattle, WA.

Methods: An online survey including nineteen Likert-scale questions and five open-ended free response questions was administered to all middle school and high school NCH SBHC providers.

Results: The survey had a response and completion rate of 100% (N=10). The most common barrier identified was time and the most common benefits identified were patient honesty and identification of issues that patients would otherwise be reluctant to bring up. Knowledge about ACEs emerged to be a determining factor for survey responses, influencing perceived utility and content of the BLIS as well as perceived responsibility to screen for and address ACEs in practice.

Discussion: The data highlights the need to provide more education about ACEs and toxic stress to providers working with pediatric and adolescent populations. The study suggests that screening for ACEs and other determinants of health using the BLIS is feasible, acceptable, and yields actionable results.

Included in

Nursing Commons