PC3057: Acceptability of Screening for Social Influencers of Health and Adverse Childhood Experiences in the PICU

Background: The impact of individual and neighborhood level social influencers of health is increasingly documented in the critical care setting, including differential access to pediatric intensive care units (PICUs), admission rates, and mortality. While knowledge of social risks may create opportunities for improved understanding and approaches to pre-, intra-, and post- hospital conditions, it presents a challenge in the high acuity setting of the PICU and is not widely implemented.

Methods: We conducted a cross-sectional qualitative semi-structured interview study of a convenience sample of parents of PICU patients. Domains of interest included experience with screening for social influencers of health (SIOH) and adverse childhood experiences (ACEs), attitudes towards screening, thoughts on how social needs or trauma could impact child health, and perspectives on how needs without resources should be addressed. We also elicited perspectives on how and when to screen. Interviews were transcribed verbatim and coded using modified thematic content analysis with predefined domains of interest. The study was approved by the institutional review board (IRB# 2021-4781).

Results: Eleven participants were interviewed. Most respondents indicated experience with screening for social influencers of health, in clinic and inpatient settings (Participant 7, 9), although some reported no experience (Participant 6) (Table 1). The majority had no experience with screening for ACEs (Participant 5), and of those with experience, most commented that they were asked about safety (Participant 4). Most respondents indicated that screening for SIOH was acceptable (Participant 7) and valuable (Participant 4), although some noted that questions could be uncomfortable (Participant 2) and that framing was particularly important (Participant 8). Most respondents also indicated they would answer questions screening for ACEs, with some noting the value of such screening (Participant 9), but some raising concerns about judgment of their responses (Participant 2). When asked about perspectives on being screened for issues without resources, many respondents indicated that they would answer such questions because it could provide a useful context (Participant 7) or opportunities for systemic advocacy (Participant 8). Others noted frustration with being asked such questions. (Participant 6) Many respondents commented on the relationship between trauma and their child’s health. (Participant 10) (Table 2) Most respondents preferred self-reported screens (Participant 7), although some noted that giving options could be useful (Participant 2). The majority of respondents indicated screening should not occur at admission but rather after patient stabilization. (Participant 8). Participants noted the importance of knowing that screening was universal (Participant 7), and that any available resources were made available (Participant 9)

Conclusion: Screening for SIOH and ACEs in the PICU setting is generally acceptable, although logistics and approach to screening need to be PICU sensitive. These results will help to inform development of a strength’s based, parent-informed PICU screening tool.