Pediatric Emergency Department and Primary Care Provider Attitudes on Assessing Childhood Adversity

Abstract

Although providers exhibited knowledge about childhood adversity, the perceived effect on health was only immediate and tangible. The effect of childhood adversity on lifelong health and the responsibility and potential accountability health systems have in addressing these important health determinants was not recognized by many respondents in our study. Addressing these provider perspectives will be a critical component of successful transformation toward more accountable health care delivery systems.

What Are We Missing?

“…The barriers to patient caregiver screening that providers reported are similar to the barriers previously cited in the literature: patient acuity, multiple caregivers being present, language barriers, medical assessments, workflows, and time. [12][13][14][15]19 Although providers expressed positivity toward the existing screening program and the screening card via interview, the survey responses indicate that providers are split regarding their agreement with how the IPV screening and referral program currently are, in addition to some providers reporting feeling they do not know enough about the program. It is unclear whether this is due to a lack of sufficient knowledge about the program to effectively have an opinion, providers not actually endorsing universal screening, perceived burden of the program, a combination of the above, or none of the above.…”

“…12,13 Studies conducted in pediatric settings-both ED and other hospital or primary care settings-identified lack of education, office protocols, time, and limited support staff and resources as specific provider barriers for screening patient caregivers. 14,15 In addition, there are currently no studies in adult or pediatric settings examining provider attitudes, beliefs, and behaviors with a follow-up period greater than 6 months. Therefore, there is a lack of knowledge about the long-term sustainability of IPV screening in the pediatric ED setting.…”

“…Studies conducted in adult EDs have found that high patient acuity and provider bias in assessing IPV risk level are 2 provider barriers for screening adult patients even if most providers reported feeling positively toward IPV screening 12,13 . Studies conducted in pediatric settings—both ED and other hospital or primary care settings—identified lack of education, office protocols, time, and limited support staff and resources as specific provider barriers for screening patient caregivers 14,15 . In addition, there are currently no studies in adult or pediatric settings examining provider attitudes, beliefs, and behaviors with a follow-up period greater than 6 months.…”