An Integrated Pediatric Primary Care Model to Address Trauma, Inequities and Health Disparities
Johnson, Christopher S.
Research Subject Categories::INTERDISCIPLINARY RESEARCH AREAS::Caring sciences::Nursing , Quality Improvement , Depression , Primary Health Care , Social Determinants of Health , Adverse Childhood Experiences , Patient Health Questionnaire
Background: Toxic stress in the form of adverse childhood experiences (ACE) and unmet social determinants of health (SDoH) are prevalent issues in the pediatric population and remain a cause of concern. Evidence reveals unmet SDoH and ACEs impact childhood health and wellness, predisposing pediatric patients to poor health outcomes. Evidence supports the usefulness of screening for ACEs and SDoH. Currently, many pediatric primary care providers do not routinely assess for ACEs or SDoH. Purpose: The goal of this quality improvement (QI) project was to improve the health and wellness of children. We sought to increase identification of children ages 1 to 18 with ACEs and SDoH in the pediatric primary care setting. Intervention: The care model implemented included education for clinicians, screening for ACEs and SDoH using the Pediatric ACEs and Related Life Events Screener (PEARLS) tool, administration of resources, referral, and documentation in the EHR with a Dot Phrase. Screening for depression with the PHQ-9 tool was completed simultaneously. The project was implemented over a three-month period. Results: The provider and staff successfully and completely implemented the care model. We noted 34 patient visits having 100% compliance with screening, resource administration, and use of Dot Phrase. Correlations between the ACE and SDoH scores and the PHQ-9 score were noted; for every one-point increase in ACE and SDoH, the PHQ-9 increased by 1.62 and 1.8 units, respectively. Conclusions: Routine, standardized screening for ACEs and SDoH with a valid tool, should be implemented in pediatric primary care. This process should be coupled with PHQ-9 screening. Assessing and treating ACEs early, coupled with assistance addressing unmet social needs resulted in improved identification of ACEs and SDoH.