Assessing the Feasibility of Integrating Trauma-Informed Practices Into the Primary Care Setting

Background: Disadvantaged social, economic, and environmental factors create Adverse Childhood Experiences (ACEs), which can harm a child’s developing brain and have lasting effects on health. These experiences range from physical, emotional, or sexual abuse to parental divorce or substance abuse. Afflicted children have a significantly increased risk of behavioral and health issues later in childhood, as well as adult onset chronic health problems. We hypothesize that primary care ACEs screening, intervention by a primary care-behavior health care integrated care team, and referrals for parenting support and resources will be feasible, acceptable, and beneficial from parent and provider perspectives. Methods: Parents with an ACE score of four or higher at the one-month checkup will be offered The Incredible Years interactive video intervention during checkups through 9 months of age. Parents or children with an ACE score of four or higher at the 1-4 year well child visits will be referred to participate in Nurturing Parenting group visits provided by a partnering community agency. Both programs are evidence-based, family-centered trauma-informed programs supporting positive child rearing practices. Process and outcome variables will be assessed using surveys administered after patient screening and following each program session, and primary care providers will be surveyed at the end of the project period. Process and outcome measures include; number of families screened for ACEs, number referred to parenting programs, the number of program sessions completed and attendance and changes in selfassessed parenting competence. This study will demonstrate the feasibility of integrating traumainformed practices into primary pediatric care, document an increase in referrals to community support services and document an increase in self assessed parenting competence among parents who have suffered 4 or more ACEs. Results: Preliminary survey results show that families evaluate the process of undergoing ACEs screening and follow up discussion with providers in a favorable manner. Additionally, families with elevated ACEs scores that meet criteria for additional interventions, received the corresponding program in as acceptable and appropriate. Provider surveys are forthcoming, however the additional screening, intervention provided by the Behavioral Health Team, and feasibility survey collection has not affected the clinic’s productivity or delayed patient care. Upon initially starting screening and survey administration at clinic, an error was noted in the reporting of ACEs screening results in the EMR. Data collection was delayed while the EMR function was edited by IT administrator. Conclusions: Our multidisciplinary team will continue to collect data and continue to evaluate and streamline all aspects of the project in order to enhance the care of our patients and families. Additionally, will evaluate concerns and recommendations noted with provider administration survey at conclusion of data collection