Adverse childhood experiences (ACEs), including child maltreatment and household dysfunction, define adverse events that occur before 18 years of age. National and state data show that between 12.5 and 14.5% of the adult population report ≥4 ACEs (HIGH-ACE), respectively. HIGH-ACEs are associated with more chronic health problems. To date, the interaction between ACEs and burn injuries has not been studied. Herein, we sought to define the ACE exposure in our burn patients and its impact on early outcomes. Inpatient and outpatient adult burn survivors (≥18 years of age) were enrolled. Subjects completed surveys assessing adverse experiences (ACEs-18), needs, strengths, and resiliency at consent, and pain, depression, post-traumatic stress disorder (PTSD), and social participation surveys at 2 weeks to 3 months postinjury. Demographics, burn, and hospital course data were also collected. Chi-square and student’s t-tests were used for descriptive analysis and to compare the groups (HIGH-ACE vs LOW-ACE). The HIGH-ACE group (n = 24; 45.3%) reported more depressive symptoms (P < .04) than the LOW-ACE group (n = 29, 54.7%). HIGH-ACE patients were less resilient when facing stressful events (P ≤ .02) and more likely to screen positive for probable PTSD (P = .01) and to score lower on the Life Impact Burn Recovery Evaluation Profile (LIBRE Profile), which assesses for social participation, in the domain of Family and Friends (P = .015). Our exploratory study suggests that ACE screening may help detect burn patients at risk for a more complicated recovery, thereby promoting personalized assistance in recovery.
Objective To determine the prevalence, type, and associations of parental and child adverse childhood experiences (ACEs) in children presenting with burn injuries. Methods Parents of burned children completed an ACE-18 survey, including questions on parent and child ACEs, needs, and resiliency. Demographics, burn injury, hospital course, and follow up data were collected. Family needs and burn outcomes of children with and without ACEs’ exposure (NO ACE vs. 1-2 ACE vs ≥ 3 ACE) was analyzed. P < 0.05 was considered significant. Results Seventy-five children were enrolled; 58.7% were male, 69.3% white. The average age was 6.0 ± 5.2 years. The average total burn surface area was 4.4 ± 5.7% (0.1 to 27%). Parent ACE exposure correlated with child ACE exposure (r = 0.57; p = 0.001) and this intensified by increasing child age (p = 0.004). Child ACE exposure showed a graded response to family needs, including food and housing insecurity and childcare needs. Stress and psychosocial distress of the parents was significantly associated with their children’s ACE burden. Conclusions The ACE burden of parents of burned children can affect the ACE load of their children. Burned children with more ACEs tend to have significantly more needs and more family distress. Awareness of past trauma can help identify a vulnerable population to ensure successful burn recovery.
Using a modified Safe Environment for Every Kid Questionnaire (Needs Survey), we previously showed a significant correlation between adverse childhood experiences (ACEs) and family needs. Herein, we retrospectively assessed whether patients’ and their families’ needs identified using the Needs Survey were addressed prior to discharge. We hypothesized that, without the knowledge gained by administering this tool, many basic needs may not have been fully addressed. Seventy-nine burn patients and families previously enrolled in our ACE studies were included. Answers to the Needs Surveys were reviewed to identify families with needs. Medical records were reviewed to determine if a social worker assessment (SWA) was completed per standard of care and if their needs were addressed prior to discharge. Of the 79 burn patients who received inpatient care and completed the Needs Survey, family needs were identified in 67 (84.8%); 42 (62.7%) received a SWA, 25 (37.3%) did not. Those who did not receive a SWA had a shorter hospitalization and suffered less severe burns. Demographics, socioeconomics, ACEs, and identified needs were similar between the groups. Our study showed that SWA was performed on many patients with basic needs. However, with the focus of SWAs being on discharge arrangements, not all needs were addressed, and individualized resources were often not provided. Administering the Needs Survey on admission may help our social workers streamline and expedite this process to help support successful recovery for our burn patients and their families.
Introduction Healing from a burn injury is a complex process that takes months to years. Survivors and families with basic needs or mental health issues may experience additional challenges during recovery. We previously showed a significant and positive correlation between adverse childhood events (ACEs) and number of needs (r = 0.5), housing insecurity (r = 0.23), food insecurity (r = 0.34), stress (r = 0.39), and symptoms of depression (r = 0.44). Herein, we assessed whether these needs were identified and addressed prior to discharge. Methods Medical charts of the 175 burn patients enrolled in our ACEs study were reviewed to assess if a social worker assessment (SWA) was done. SWA is primarily performed for discharge planning. We collected patient/family identified needs, resources provided, mental health consultation (adults only), and whether patients received additional information (burn bag) on support programs, burn/wound care guide, alternative dressings, post-traumatic stress disorder, and intimacy; the latter being only distributed to adult patients. Collected data were compared to the Family Strengths and Needs Assessment Survey (Strengths and Needs Survey) completed at the time of consent and analyzed using SPSS. Results SWA was completed on 50 inpatients (63.3%) and one outpatient. Based on the Strengths and Needs Survey, patients receiving SWA were more likely to rent (45.2% vs. 30%) or live in shared/temporary housing or be homeless (9.4% vs. 5.7%; p = 0.035) and report police interaction (15.1% vs. 4.1%; p = 0.023). Housing was addressed in only three SWA (5.7%). A higher number of patients with SWA reported food insecurity (22.6% vs. 12.3%; p = 0.082). Five SWA included food stamp status, with only one patient being provided information on food stamps. No difference was observed regarding stress and symptoms of depression between those who received a SWA and those who did not (45.3% vs. 39.3%; p = 0.36 and 39.6% vs 29.5%; p = 0.5, respectively). Psychosocial assessment need was noted in 46 SWA (90.6%). Only 12 adult inpatients (15%) were seen by mental health providers; 10 had a SWA. Burn bags were provided to 30 patients (58.8%), more often to adult than to pediatric patients (73.3% vs. 40%; p = 0.04). Conclusions Our study shows that many of our patients’ needs are not adequately assessed with the current social work and mental health capabilities. While SWA is performed on many of our patients with basic needs, many are not addressed, and individualized resources are often not provided. Moreover, only a third of our patients with identified psychosocial needs received consultation. Further study is warranted to develop a targeted approach to better meet the needs of our burn patients and their families. Applicability of Research to Practice By further assessing our patients’ needs, we will be able to better connect them with relevant resources to lighten the burden they face during their recovery.
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