Pediatric ACES assessment within a collaborative practice model: Implications for health equity

Area of Science:

• Pediatric Health
• Mental Health Services
• Health Equity

Background:

• Adverse Childhood Experiences (ACEs) negatively impact lifelong health.
• Racial and ethnic minorities face higher ACEs risk and healthcare disparities.
• Primary care screening for ACEs lacks established guidelines, especially culturally responsive ones.

Purpose of the Study:

• To explore the feasibility, acceptability, and utility of routine ACEs inquiry in a diverse pediatric population.
• To assess ACEs screening within a unique collaborative practice model (CPM) in primary care.
• To inform culturally responsive models for ACEs assessment and intervention.

Main Methods:

• Mixed-methods approach.
• Utilized a collaborative practice model (CPM) with an integrated, multidisciplinary team.
• Collected ACEs questionnaires from 158 children in a safety-net health system during mental health evaluations.

Main Results:

• High ACEs exposure rates: 40% of children and 56% of teens had scores of four or more.
• Significant associations found between ACEs exposure levels and mental health impairment in children and teens.
• Providers deemed the ACEs assessment process feasible, acceptable, and useful for diverse pediatric patients.

Conclusions:

• Primary care integrated ACEs assessment models can promote health equity.
• Findings highlight benefits, challenges, and cultural considerations for implementing ACEs screening.
• Recommendations are provided for improving ACEs assessment and response in routine pediatric care.