P0230 - Parent and Patient Perceptions of Adverse Childhood Experience Screening in Two Diverse Clinics

Background: Adverse Childhood Experiences (ACEs) are associated with increased risk of medical, mental health, and behavioral problems. The American Academy of Pediatrics recommends ACE screening, management, and prevention for toxic stress. However, many pediatricians are not screening in part due to uncertainty of families' responses and fear of jeopardizing relationships. Because quantitative studies of parent and patient perceptions of ACE screening have not been performed in pediatric populations, this study aims to address this gap.

Methods: This study examined the relationship between ACE score and parent/patient perception of screening in two pediatric clinics at Phoenix Children's Hospital: a general pediatrics primary care academic practice (GP) and a homeless youth outreach practice (HYO). The ACE screening tool in this study was modified from the Center for Youth Wellness version to include parent/patient perception on a 5-point Likert rating scale. The screen was given annually to parents or caregivers at preventive care visits, and to both parents and patients at age 13. A total of 2,887 surveys were completed between September 2018 and November 2019.

Results: Patients at the HYO clinic had higher average ACE scores than those at the GP clinic [GP: 0.81 (parent-reported), 1.45 (patient-reported) vs. HYO: 2.70 (parent-reported), 5.15 (patient-reported), p<0.001]. A greater proportion of positive parent and patient ratings were seen at the GP clinic vs. HYO clinic (p<0.001), although the majority of responses were positive for all groups (GP parents vs. patients 87.4% vs. 77.7%, HYO parents vs. patients 78.9% vs. 65%). Patients at the GP clinic with negative perceptions had higher ACE scores (p=0.02). There was no significant correlation between parent or patient reported ACE scores and parent perception (Spearman’s Rho -0.08, p=0.44 and -0.09, p=0.33). However, there was a small negative correlation between both patient and parent ACE scores and patient perception (Spearman's Rho -0.23, p=0.01 and -0.21, p=0.02).

Conclusion: Most parents and patients had a positive perception of screening. There was no correlation between ACE score and parent perception of screening, which may alleviate concerns about negatively impacting professional relationships. Further research is needed to determine how to increase teenagers' perceptions when answering these sensitive questions.