P0500 - Community Health Workers in a Pediatric Emergency Department as a Resource for Caregivers with Adverse Childhood Events

Background: Adverse childhood experiences (ACEs) are factors that heavily influence adult health, and have been studied in the medical, social, and psychological realms. Studies have shown that an ACEs score ≥ 4 is correlated with decreased resilience, poor self-esteem, increased risk of chronic illnesses, intimate partner violence, substance use disorders, and problems maintaining employment. In our Pediatric Emergency Department (PED) we have stationed Community Health Workers (CHWs) to bridge gaps in needs-based resources, enabling holistic treatment of pediatric patients based on their parent or caregiver’s physical and social health profile.

Objective: We sought to analyze data collected by CHW, examining the demographics of pediatric patients and their caregivers, with regard to the high-risk ACEs scores cut-point (≥ 4). Additionally, we evaluated the type and frequency of interventions the CHWs were delivering. Finally, we developed a model to identify variables that predict high ACEs scores.

Design/

Methods: This is a prospective cohort study of pediatric patients (0-18 years old) and their caregivers who visited a PED from 2017-2019. Caregivers were asked by CHWs to complete a 10-question ACEs survey and report other demographics. Caregivers who scored ≥ 4 were assigned a care coordinator and referred to a clinical psychologist. CHWs provided a variety of resources to the families who scored ﹤4 as well. Participants who refused services were excluded from the analysis.

Results: Data were available on 2,932 caregiver/child dyads; the majority of caregivers were mothers (84.6%). There were 263 (9.0%) caregivers who met the high-risk threshold score (Table 1). A total of 448 (15.3%) received intensive support, and 339 (12.9%) psychology referrals. A total of 2,663 (90.8%) of caregivers received information on preventing ACEs. Results from a logistic regression model showed caregivers of minority children had higher odds (adjusted odds ratio [aOR] = 1.69; 95% confidence interval [CI]: 1.04-2.75) of a high-risk ACEs score (Table 2). Older caregivers were less likely to have high ACEs; for each 1 year increase in parent age, the odds decreased by 8% (aOR = 0.92, 95% CI: 0.89-0.95).

Conclusion(s): Nearly 10% of caregivers in a PED had a high-risk ACEs score and 15% received substantial support from CHWs. Younger caregivers, and caregivers of minority children, had an increased prevalence of higher ACEs scores.