Parent Perspectives on Adverse Childhood Experiences & Unmet Social Needs Screening in the Medical Home: A Qualitative Study |
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| Affiliation: | 1. Pediatrics (K Selvaraj and BW Bayldon), Ann & Robert H. Lurie Children''s Hospital of Chicago, Chicago, Ill;2. Pediatrics, Feinberg School of Medicine (K Selvaraj and BW Bayldon), Northwestern University, Chicago, Ill;3. Pediatrics and Public Health (J Korpics), Cook County Health, Chicago, Ill;4. Pediatrics (AD Osta), University of Illinois at Chicago, Chicago, Ill;5. Medicine (AD Osta), University of Illinois at Chicago, Chicago, Ill;6. Medical Education (LE Hirshfield), University of Illinois at Chicago, Chicago, Ill;7. Sociology (LE Hirshfield), University of Illinois at Chicago, Chicago, Ill;8. Anthropology (M Crowley-Matoka), Northwestern University, Evanston, Ill;9. Medical Education, Feinberg School of Medicine (M Crowley-Matoka), Northwestern University, Chicago, Ill;1. University of Washington School of Medicine, Department of Pediatrics (C Lewis), Seattle, Wash;2. Seattle Children''s (C Lewis), Seattle, Wash;3. Division of Pediatric Dentistry and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill (R Quinonez), Chapel Hill, NC;4. American Academy of Pediatrics (B Sisk), Itasca, Ill;5. American Academy of Pediatrics (L Barone), Itasca Ill;6. Child Health and Development Institute of Connecticut Inc, (D Krol), Farmington, Conn;7. American Academy of Pediatrics (KR Kornfeind), Itasca Ill;8. Denver Health and Hospital (PA Braun), Denver, Colo;9. University of Colorado School of Medicine, Department of Pediatrics (PA Braun), Aurora, Colo;1. Department of Pediatrics (AR Schroeder), Stanford University School of Medicine, Stanford, Calif;2. Department of Pediatrics (LG Solan), Golisano Children''s Hospital at the University of Rochester Medical Center, Rochester, NY;3. Department of Pediatrics (D Williams), Vanderbilt University School of Medicine and the Monroe Carell Junior Children''s Hospital at Vanderbilt, Nashville, TN;4. Pediatric Academic Societies, Inc. (B Thomas, C Smith, and G Minshew);5. Department of Pediatrics (DA Rauch), Tufts University Medical School, Boston, Mass;1. Department of Pediatrics, Wake Forest School of Medicine (CL Brown), Winston-Salem, NC;2. Department of Epidemiology and Prevention, Wake Forest School of Medicine (CL Brown), Winston-Salem, NC;3. Department of Population Health Sciences, Duke University (AC Skinner), Durham, NC;4. Department of Pediatrics, University of North Carolina at Chapel Hill (MJ Steiner), Chapel Hill, NC;5. Department of Biostatistics and Bioinformatics, Duke University School of Medicine (T Truong, CL Green), Durham, NC;6. Department of Pediatrics, Duke University (CT Wood), Durham, NC;1. Division of Hospital Medicine (C Sump, C White and S Riddle), Cincinnati Children''s Hospital Medical Center, Cincinnati, OH;2. Department of Pediatrics (C Sump, D DeBlasio, C White and S Riddle), College of Medicine, University of Cincinnati, Cincinnati, OH;3. Center for Telehealth (K Denker, J Ruschman), Cincinnati Children''s Hospital Medical Center, Cincinnati, OH;4. Division of General and Community Pediatrics (D DeBlasio) , Cincinnati Children''s Hospital Medical Center, Cincinnati, OH;1. Department of Pediatrics/Division of Pediatric Critical Care Medicine (ME McCabe, D Baker), The Children''s Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, NY;2. Department of Pediatrics/Division of Pediatric Critical Care Medicine (R Mink), Harbor-UCLA Medical Center/The Lundquist Institute, Torrance, Calif;3. Department of Pediatrics/Division of Pediatric Critical Care Medicine (DA Turner), Duke University School of Medicine, Durham, NC;4. The American Board of Pediatrics (DA Turner), Chapel Hill, NC;5. Department of Anesthesiology and Critical Care Medicine (DL Boyer), Children''s Hospital of Philadelphia/ Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa;6. Department of Pediatrics/Division of Pediatric Critical Care Medicine (MH Tcharmtchi), Baylor College of Medicine/Texas Children''s Hospital, Houston, Tex;7. Department of Pediatrics/Division of Pediatric Critical Care Medicine (J Werner), St. Louis University School of Medicine, St. Louis, Mo;8. Department of Pediatrics/Division of Pediatric Critical Care Medicine (J Schneider), Northwell Health/Zucker School of Medicine at Hofstra University, Queens, NY;9. Department of Pediatrics/Division of Pediatric Critical Care Medicine (V Armijo-Garcia), University of Texas Health Sciences Long School of Medicine, San Antonio, Tex;10. Department of Pediatrics/Division of Pediatric Critical Care Medicine (M Winkler), University of Alabama School of Medicine, Birmingham, Ala;11. Department of Pediatrics/Division of Pediatric Critical Care Medicine (KE Mason), Warren Alpert Medical School of Brown University, Providence, RI;1. Division of Pediatric Rheumatology, Allergy and Immunology, Department of Pediatrics (K Schultz), University of Iowa Stead Family Children''s Hospital, Iowa City, Iowa;2. Department of Pediatrics (M Klein, H Sucharew, D DeBlasio, S Poynter, J Huggins, FJ Real), University of Cincinnati College of Medicine, Cincinnati, Ohio;3. Division of General and Community Pediatrics, Department of Pediatrics (M Klein, D DeBlasio, E Cooperstein, FJ Real), Cincinnati Children''s Hospital Medical Center, Cincinnati, Ohio;4. Division of Biostatistics and Epidemiology, Department of Pediatrics (H Sucharew), Children''s Hospital Medical Center, Cincinnati, Ohio;5. Division of Pediatric Rheumatology, Department of Pediatrics (J McDonald), University of Chicago, Chicago, Ill;6. Division of Pediatric Critical Care Medicine, Department of Pediatrics (S Poynter), Cincinnati Children''s Hospital Medical Center, Cincinnati, Ohio;7. Division of Pediatric Rheumatology, Department of Pediatrics (J Huggins), Cincinnati Children''s Hospital Medical Center, Cincinnati, Ohio |
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| Abstract: | ObjectivesTo explore parental perspectives regarding disclosure of child and parental adverse childhood experiences (ACE) and family unmet social needs (USN) and to elicit parental recommendations for screening in the pediatric medical home.MethodsWe conducted a qualitative study using a purposive sample of English- and Spanish-speaking parents in our urban academic community clinic. Between January 2018 and March 2019, each parent underwent one semistructured interview that was audiotaped, transcribed, and independently coded in Atlas.ti by 2 study team members. Data analysis was based in constructivist grounded theory methodology to identify common themes and subthemes.ResultsWe interviewed 25 English-speaking and 15 Spanish-speaking parents who were mostly female, racial/ethnic minorities with ≥1 ACE. English-speaking subjects were more likely to have a high school degree and be single parents. Four themes were identified: 1) Pediatricians should ask about ACE and USN. 2) Disclosure is a longitudinal process, not a discrete event. 3) Barriers to disclosure are significant, involving concrete and emotional risks for the family. 4) Trauma-informed providers and practices support disclosure.ConclusionsFamilies support pediatricians addressing ACE and USN in the medical home despite significant barriers. Even if providers screen using trauma-informed principles, parents may prefer not to disclose ACE initially because they regard disclosure as a stepwise process. These findings contribute to a new conceptual framework for thinking of ACE screening not merely as a way to generate information, but as an interactive, therapeutic relationship-building activity irrespective of whether or when it produces disclosure. |
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