Presenting Author:

Kavitha Selvaraj, M.D.

Principal Investigator:

Barbara Bayldon, M.D.

Department:

Pediatrics

Keywords:

Toxic stress, social determinants of health, adverse childhood experiences, universal screening

Location:

Ryan Family Atrium, Robert H. Lurie Medical Research Center

C82 - Clinical

Universal Screening for Toxic Stress During Well-Child Visits

Background: Primary care providers under-identify toxic stress, such as adverse childhood experiences (ACE) & unmet social needs (USN), although it is a well-established risk factor for poor health outcomes. Studies found screening for ACE & USN separately can improve identification of & response to family stressors and is acceptable to families. Objective: Determine 1. Prevalence of ACE & USN with universal screening using Addressing Social Key (ASK) Questions for Health Questionnaire. 2. Referral rates to community resources pre & post implementation of ASK screening. 3. Family acceptability of screening. Design/Methods: The ASK questionnaire is a 13-question screen of both ACE and USN. English & Spanish speaking parents /guardians of children 0-18 years received the ASK tool at well child visits (WCV) as quality improvement, beginning Aug 2016 (data collection ongoing). Four academic pediatric clinics in Chicago participated (Ann & Robert H. Lurie Children's Hospital, University of Illinois at Chicago Medical Center, Rush University Children's Hospital, and John H. Stroger Jr. Hospital of Cook County. Providers reviewed the ASK tool & made referrals to community resources as needed. Families consenting to the study portion of the project completed demographic and family satisfaction surveys. Prevalence of ACE & USN, referral rates pre & post screening implementation, & family acceptance of screening were measured. Analyses included frequency distribution, correlation coefficients, and the Wilcoxon rank-sum test. Results: To date, 1765 parents & guardians completed an ASK tool, representing 57% of eligible WCV. Study patients were younger (4.3 vs. non-study 7.6, p<0.001); sex & toxic stress prevalence were similar in the two groups. 47% of WCV identified ≥ 1 toxic stressor; 5% of families reported ≥1 ACE & 44% reported ≥1 USN. ACE were not correlated with USN or age. WCV ASK screening lead to an 11% community referral rate, compared to the prescreening referral rate of 2.0%. Patients from the 270 study families were 52% male; 69% Medicaid; 88% reported adequate health literacy. 244/270 (90%) of study families completed the family satisfaction survey; 72% felt comfortable completing the ASK tool, 80% felt supported by/glad for toxic stress screening. Conclusion(s): Universal WCV screening of ACE & USN in 4 urban pediatric primary care settings is feasible, well-received by families, & improved identification & response to family needs. Prevalence of USN is consistent with prior studies; prevalence of identified ACE is low. Further evaluation and modification is needed to increase screening rate and identification.