Implementation of the adverse childhood experiences conversation in primary care

Abstract

Background Research has focused on screening for adverse childhood experiences, rather than provision of education as a part of routine anticipatory guidance. An adverse childhood experiences ‘conversation’ is one method that has not been studied empirically but represents a complimentary or alternative approach to screening which could overcome many existing barriers. Objectives This study aims to examine parent/guardian and provider acceptability/feasibility of the adverse childhood experiences conversation during well-child visits in primary care. Methods Providers engaged in a conversation with parents/guardians of patients during well-child visits in a family medicine residency clinic. Parents/guardians and providers were surveyed following the visit to examine acceptability and feasibility. Quarterly assessments to further examine provider perspectives were completed. Data were collected for 1 year. Results In total, 238 parent/guardian and 231 provider surveys were completed. Most parents/guardians felt positively (76%) about and comfortable (81%) with the information discussed and 97% felt that the conversation should be had with their primary care provider specifically. Most providers (71%) indicated that parents/guardians were receptive to the conversation, that the conversations took 1–2 minutes (60%) and that there were few disclosures of adversity (9%), none of which required mandatory reporting. Conclusions Results suggest that the adverse childhood experiences conversation is well received by parents/guardians and providers and is feasible to implement into primary care. The conversation could be used as a complimentary or alternative method to screening to further spread knowledge of toxic stress and health, provide resources for families and promote resilience.

Adolescent Patient Perspectives on Addressing Childhood Adversity in the Primary Care Setting

“…The only published intervention to discuss ACEs with patients is part of routine anticipatory guidance. 17 Further study is needed to develop models— rooted in the ideals of a trauma-informed approach to care—to guide pediatricians in the discussion of adversity with patients and their families. These discussions need not center on screening for adversity, but instead could potentially focus on helping patients to understand their diagnoses in the context of past histories of trauma.…”

Influence of race/ethnicity and income on the link between adverse childhood experiences and child flourishing

“…Since ACEs are distributed widely across race/ethnicity and FPL and not just concentrated in children from Black and Hispanic and socio-economically disadvantaged families, both universal prevention and targeted intervention efforts are needed (25,28). ACE conversations should be routinely incorporated into well-child visits to provide foundational knowledge of toxic stress and health and share resilience-promoting resources with children and parents as early as possible (42). Addressing ACEs within a social determinants of health and trauma framework using a two-generational approach can improve the ability to reduce health and achievement inequities, while strengthening resilience for children and families facing many risks (43).…”

A Scoping Review of Trauma-Informed Curricula for Primary Care Providers

“…The resulting 19 articles, with two conference abstracts, 21,22 were examined in-depth to determine the participants, mode and length of training, topics, and evaluation methods and results. [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] We identified 17 different curricula in the 19 articles included for final analysis. The two articles by Green et al discuss the same curriculum, but evaluate different outcomes.…”

“…Trainings were taught by a mixture of health professionals including TIC experts, clinical psychologists, social workers, physicians, and nurses. [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] (Continued on next page)…”