PC2095: Understanding Parent and Child Aces and Social Care Needs to Build Community Connections in Primary Care

Background: Adverse childhood experiences (ACEs) and social care needs are predictors of lifelong health, therefore it is recommended to implement screening during pediatric health supervision visits. Parental childhood trauma has been associated with poor child health outcomes, so including parental ACE screening may offer an opportunity for early intervention to break the cycle of toxic stress. Connection to community partners in an integrated pediatric primary care clinic offers ways to address these needs.

Methods: We developed a screener for parental and child ACEs and social care needs in 7 domains (financial, housing, food security, educational, legal, and family stability). Ten parental and child ACE questions related to abuse, neglect, and family dysfunction were adapted from the original ACE study and administered to caregivers of all patients in an academic urban pediatric primary care clinic at 0, 6, 12, 18, and 24-months, then annually. Univariate odds ratios were used to compare parental ACEs and social care needs between children with ACE scores of 1-3 and at least 4, to those with a score of zero. Utilizing this data, we created a longitudinal method of connecting with community partners in our urban, academic primary care clinic.

Results: Parents/caregivers, primarily mothers (78%), completed the survey on 3377 children mostly insured by Medicaid (89%) and identified as black race (76%). Social care needs included financial instability (16%), food insecurity (14%), struggling in school (12%), and housing instability (6%). Parent and child ACE scores were reported at lower rates than in previous studies (Table 1). Caregivers that reported higher ACE scores for themselves also reported higher ACE scores for children. Unadjusted, univariate analysis revealed a reported parent ACE score of 4 or more was the highest indicator for reported child ACE of 1-3 and 4 or more, followed by issues with custody, foster care, and housing instability. Odds ratios from our multivariable analysis were highest for a child’s reported ACE score of 4 or more when a parent reported their own ACE score as 4 or more, followed by foster care, issues with custody, and housing instability. Understanding this data led to new community connections in our urban, academic primary care clinic. We built foundational relationships with a wide variety of community partners, prioritized longitudinal implementation of community connections, as well as launched a new community health worker role into our multi-disciplinary clinical care team.

Conclusion: Screening for parental ACEs may be more predictive of high child ACEs than social care need screening alone. Implementation of strong community connections into pediatric primary care offers ways to treat ACEs and social care needs. Further data is needed to understand which methods of building community connections in primary care are the most effective to break the cycle of toxic stress.