Elsevier

Academic Pediatrics

Volume 16, Issue 2, March 2016, Pages 154-160
Academic Pediatrics

Screening for ACES and Unmet Social Needs
Do Pediatricians Ask About Adverse Childhood Experiences in Pediatric Primary Care?

https://doi.org/10.1016/j.acap.2015.08.002Get rights and content

Abstract

Objective

The stress associated with adverse childhood experiences (ACEs) has immediate and long-lasting effects. The objectives of this study were to examine 1) how often pediatricians ask patients' families about ACEs, 2) how familiar pediatricians are with the original ACE study, and 3) physician/practice characteristics, physicians' mental health training, and physicians' attitudes/beliefs that are associated with asking about ACEs.

Methods

Data were collected from 302 nontrainee pediatricians exclusively practicing general pediatrics who completed the 2013 American Academy of Pediatrics Periodic Survey. Pediatricians indicated whether they usually, sometimes, or never inquired about or screened for 7 ACEs. Sample weights were used to reduce nonresponse bias. Weighted descriptive and logistic regression analyses were conducted.

Results

Only 4% of pediatricians usually asked about all 7 ACEs; 32% did not usually ask about any. Less than 11% of pediatricians reported being very or somewhat familiar with the ACE study. Pediatricians who screened/inquired about ACEs usually asked about maternal depression (46%) and parental separation/divorce (42%). Multivariable analyses showed that pediatricians had more than twice the odds of usually asking about ACEs if they disagreed that they have little effect on influencing positive parenting skills, disagreed that screening for social emotional risk factors within the family is beyond the scope of pediatricians, or were very interested in receiving further education on managing/treating mental health problems in children and adolescents.

Conclusions

Few pediatricians ask about all ACEs. Pediatric training that emphasizes the importance of social/emotional risk factors may increase the identification of ACEs in pediatric primary care.

Section snippets

PS 85 Survey Administration

The AAP has conducted a PS of pediatricians 3 or 4 times each year since 1987 to inform policy, to develop new initiatives, and/or to evaluate current projects. Data collection for the PS 85 occurred between July and December 2013. The survey contained largely closed-ended questions asking about sociodemographic and practice characteristics, and it included questions about attitudes, training, and behaviors about child/adolescent and maternal MH. The questionnaire was pretested and approved by

Results

Examination of the 321 nontrainee pediatricians who exclusively practiced general pediatrics showed that 302 answered the majority of the ACEs questions and therefore were included in the analytic sample. Pediatricians were 46 years old on average, and 68% were women (Table 1). About half (51%) practiced in suburban settings, 53% worked in pediatric group practices, and 21% were in practice for less than 5 years. Almost two-thirds saw fewer than 100 ambulatory visits per week (65%), and the

Discussion

Our data suggest that most pediatricians surveyed have never heard of the original ACEs study and do not understand the epigenetic effects of ACEs. Nevertheless, most believe that childhood stressors can have a negative impact on children, that pediatricians can help influence parenting, and that positive parenting can influence children's trajectories. Even so, almost one-third of pediatricians in our sample do not usually ask about any ACEs, and only 4% ask about all of them, representing a

Acknowledgments

Supported in part by the American Academy of Pediatrics. NIMH P30 MH09 0322 (PI K. Hoagwood) supported Dr Storfer-Isser, Dr Hoagwood, and Dr Horwitz's participation in this research.

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    The authors declare that they have no conflict of interest.

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