PC2049: Pediatric Primary Care Model to Increase Resiliency in Patients with Elevated Aces Scores

Background: Pediatricians have an opportunity to prevent and treat the negative health effects of ACEs (Adverse Childhood Experiences) that result from toxic stress. Yet time constraints within pediatric visits and lack of resources make it challenging to provide support to families. This pilot program aimed to address this problem by partnering a pediatric medical group in Southern California with a social service organization.

Methods: We screened for ACEs at pediatric well child visits using the PEARLS (Pediatric ACEs and Related Life Events Screener). We assessed 10 ACEs categories including abuse, neglect, and household dysfunction, as well as 7 additional categories. Patients with a PEARLS score greater than 3 or those who had a PEARLS score greater than 1 with ACE-associated health conditions were referred to the social service organization for resiliency education and referrals to community resources. The social service organization assessed patients using a six-question resiliency questionnaire (fig. 1) at baseline and one month post-intervention. Wilcoxon matched-pairs signed-rank test was used to assess the change in resiliency score (STATA 16, College Station TX).

Results: During the study period from February 1, 2021 through March 15, 2022, 3052 children were screened and 875 identified with at least one adverse life event. After being assessed by their primary care provider, 39 patients were referred to the social service organization. The median (interquartile range (IQR)) number of ACEs identified in those referred for resiliency training was 4 (3, 6). Of the 39 patients referred, 2 declined services and 4 did not respond to 3 contact attempts, resulting in 33 (84.6%) parents/patients completing both pre and post evaluations. The median score for patients refusing/unreachable was 4.5 (2, 5). The baseline resiliency score for patients/parents was 2 (1, 3). The matched median resiliency increase was 2 (1, 2); p < 0.001.

Conclusion: Most families who were identified to have elevated PEARLS scores during a well child visit were determined by their primary care pediatrician to not need referral to the social service agency. Among the patients that were referred, these findings indicate a promising model for a brief intervention that improves resiliency. Initial results show significant increases in resiliency scores among patients referred for elevated PEARLS scores.