Abstract
Despite well-documented associations between adverse childhood experiences (ACEs) and lifelong impairments in health and well-being, few studies have examined how to facilitate implementation of ACEs screening and referral programs in pediatric settings. We sought to identify facilitators and barriers related to screening for and addressing ACEs in a large integrated healthcare delivery system in Southern California. Using a developmental evaluation approach, we conducted twenty semi-structured interviews with pediatricians, nurses, social workers, and community referral organization staff. Interviews took place across six pediatric clinic pilot sites in Kaiser Permanente Southern California, where more than 7,000 pediatric patients were screened for ACEs between July 2018 and December 2019. Thematic analysis was conducted to identify themes. Key facilitators for screening and referrals for pediatric ACEs screening included providing clinician education to normalize conversations about ACEs, using screening data to provide more holistic and compassionate care, and collaborating across different types of clinicians. Key barriers included screening tool challenges related to patient confusion and cultural differences, capacity limitations, training issues, and care team silos. When used in the context of a trauma- and resilience-informed workforce, ACEs screening may be a powerful tool to support more collaborative and impactful care decisions that move away from symptom management to address root causes and promote prevention.
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Conceptualization and design: Kelly Dumke, Courtnee Hamity, Karen Peters, Stacy Sterling, Kelly Young-Wolff. Methodology: Kelly Dumke, Courtnee Hamity, Karen Peters, Mercie DiGangi, Sonya Negriff, Stacy Sterling, Kelly Young-Wolff. Formal Analysis and Investigation: Kelly Dumke. Writing—original Draft Preparation: Kelly Dumke. Writing—review and Editing: Courtnee Hamity, Karen Peters, Mercie DiGangi, Sonya Negriff, Stacy Sterling, Kelly Young-Wolff. Supervision: Courtnee Hamity, Karen Peters, Mercie DiGangi, Sonya Negriff, Stacy Sterling, Kelly Young-Wolff. All authors read and approved the final version of the manuscript.
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Kelly Dumke is now at Kaiser Permanente’s National Social Health Practice and Courtnee Hamity is now at the Blue Shield of California Foundation.
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Dumke, K.A., Hamity, C., Peters, K. et al. Pediatric ACEs Screening and Referral: Facilitators, Barriers, and Opportunities for Improvement. Journ Child Adol Trauma (2024). https://doi.org/10.1007/s40653-024-00632-7
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DOI: https://doi.org/10.1007/s40653-024-00632-7