Whole Child Well-Child Visits: Implementing ACEs and SDOH Screenings in Primary Care

Abstract

Adverse childhood experiences (ACEs) and social determinants of health (SDOH) negatively affect health outcomes. This program was developed to screen for ACEs and SDOH in the primary care setting in families with children 9 months to 5 years of age at well-child checks and provide interventions that support families and build resiliency. Programmatic criteria were identified, referral resources were developed, and a database was implemented, with 246 families enrolled in year 1; 56.9% of caregivers reported 1 or more ACEs for their child, 63% of caregivers reported an SDOH need, and 39.4% of caregivers reported both. The average number of ACEs was 0.94. This program was created to address ACEs and SDOH, to empower families, build resiliency, and provide buffers to mitigate and prevent ACEs. It provides a model that can be implemented in a primary care setting while providing wraparound resources, including integrated mental health resources and referrals, to measure the success of these interventions.

Social determinants of health screening in pediatric healthcare settings

“…Development and analysis of screening tools in the outpatient pediatrics setting continues to expand [49]. There are increasing studies examining the role of SDOH screening outside of outpatient clinical settings.…”

Screening tools to address social determinants of health in the United States: A systematic review

“…Table 2 describes the SDoH screening tool characteristics of the 25 unique screening tools that were identified. Six screening tools were administered to pediatric patients [ 27 , 29 – 31 , 37 , 47 ]. One was designed to assess pregnant patients [ 34 ], and the remaining tools ( n = 18) were utilized for general screening purposes in clinical settings, such as hospitals or clinical offices [ 13 , 25 , 26 , 28 , 32 , 33 , 35 , 36 , 38 – 46 , 48 – 53 ] Six tools were administered by healthcare professionals [ 13 , 25 , 30 , 32 , 46 , 49 ]; while 12 tools were completed by patients (or parents) either electronically or on paper [ 13 , 28 , 29 , 34 , 36 , 37 , 44 , 45 , 47 , 48 , 50 , 52 ]; six tools were administered verbally or were self-administered at the patient’s request [ 26 , 27 , 31 , 33 , 35 , 53 ]; The number of questions in any given SDoH assessment tool varied considerably and ranged from 5 in Health Leads (2018) and the North Carolina toolkit [ 36 ], as well as the Core 5 social risk tool [ 28 ] to 50 in the health system’s EPIC electronic health records screening tool [ 33 ]; overall, the mean number of questions in any given SDoH screening tool assessment was 16.6 (Table 2 ).…”

“…Health Begins [ 49 ], Help Steps surveys [ 47 ]. Tools such as Accountable Health Communities Health-Related Social Needs (AHC HRSN) [ 27 ], Welcome, Engage, Communicate, Ask, Reassure, Exit (WE CARE) [ 26 ], Social Determinants of Health in Pregnancy Tool (SIPT) [ 34 ], Core 5 social risk screening [ 28 ], Accountable Health Communities (modified) [ 29 ], North Carolina [ 51 ], and Bright Future [ 52 ] examined 5 domains of SDoH (26.3%). Four screening tools (16%) evaluated at least 10 (52.6%) different SDoH domains (Well Rx [ 50 ], NLP [ 13 ], IHELP [ 45 ], MASQ [ 44 ]), while the remaining screening tools ( n = 21, 84%) evaluated fewer SDoH domains (Table 3 ).…”

The promise and pitfalls of a strength-based approach to child poverty and neurocognitive development: Implications for policy

“…Similarly, instead of solely concentrating on what caregivers can do, it could pivot towards systemic solutions addressing the origins of stress that caregivers and their children are forced to endure. Concurrently, the national conversation about toxic stress has propelled the integration of ACEs screening in primary healthcare settings ( Yaun et al, 2022 ). The utility of the types of interventions such screening prompts could be enhanced by incorporating other measures like the Benevolent Childhood Experiences questionnaire (BCEs; Narayan et al, 2023 ).…”