Families Implementing Resilient Systems Together (FIRST)

Background/Objectives: Prior research suggests that it is possible to improve health outcomes in children with adverse childhood experiences (ACEs) through multi-component interventions that promote protective factors. We designed the Families Implementing Resilient Systems Together (FIRST) study to address the gaps in research on the potential effectiveness of screening for specific ACEs through pediatric practice. Methods: As part of our clinical quality improvement efforts to improve patient care for children impacted by ACEs, we trained a random sample of pediatricians on strategies to promote protective factors and encouraged them to make referrals to community health workers (CHWs) and parenting education resources. This manuscript describes our clinic data on practice changes associated with the FIRST physician training, and our data collection plan for our research study. Results: Physician training resulted in attitudinal shifts and measurable behavioral changes. Trained providers made referrals to CHWs for approximately 5-10% of well-child care visits. The majority (84%) of referrals were for multiple risk factors, most commonly ACEs and socioeconomic concerns. The most common ACEs were parental divorce/separation, parent-child verbal abuse, and caregiver mental health problems. Conclusions: FIRST training improves counseling, education and referrals for children exposed to ACEs. Our research study will evaluate the impact of the FIRST intervention and address important questions about associations between specific ACEs, protective factors, and biomarkers of toxic stress.