Addressing ACEs Among Hispanic Caregivers in a Pediatric Primary Care Population to Improve Child Health and Decrease Early Adversity
Principal Investigators:
Maneesha Agarwal, MD | Children's Healthcare of Atlanta
Abby Lott, PhD | School of Medicine, Emory University
Co-Investigators:
Tanja Jovanovic, PhD | School of Medicine, Emory University
Angela Boy, DrPH | Children's Healthcare of Atlanta
Partner Organization:
Research Gap:
There is a paucity of data on whether brief structured physician involvement with a parent with ACEs may have an effect on parental behaviors that lead to improvement of health in the child.
Description:
Case series conducted in other populations have provided initial evidence that disclosure/discussions regarding caregiver ACEs have positive effects on mental and physical health for both the caregiver and child. Additionally, a small, growing, body of work has found that ACEs screenings are feasible in busy clinical settings and are not viewed as a significant burden by providers. However, wide-scale implementation of such a model is currently limited by several factors. First, previous research has focused on the implementation of ACEs screenings. These studies fail to leverage the fact that dialogue regarding ACEs constitutes an intervention with demonstrated positive physical and mental health benefits. Second, while prior ACEs work has been promising in primarily Caucasian and African American populations, there is a paucity of research in primarily Hispanic populations. The objective of the present study is to conduct a rigorous quasi-experiment that compares child health outcomes between families who discuss ACEs with their provider and comparison families who do not, in a primarily Hispanic population. This project will be the first to evaluate whether a caregiver ACEs screening and provider-led ACEs discussion will improve child health outcomes. Additionally, if the intervention is successful, we aim to evaluate potential underlying mechanisms of change through which caregiver disclosure and discussion of ACEs might lead to improved child health outcomes; if it is unsuccessful, we will investigate where these posited pathways linking the intervention to the outcomes broke down.
Aims:
- To evaluate whether a provider-led discussion of caregiver ACEs will improve child health.
- To evaluate potential mechanisms that mediate the link between provider-led discussion of ACEs and child health outcomes, or that explain why the intervention failed.
Why is this project important?
Brief interventions with parents with ACEs by pediatric primary care providers may impact child and parental health. This project will develop a generalizable model for implementing screens of caregiver ACEs and provider-led discussions on how ACEs impact parenting for underserved populations to reduce intergenerational effects of ACEs. Our central hypothesis is that increased caregiver awareness of their own ACEs and associated impacts on parenting will lead to increased caregiver resilience, warmth, and positive parenting behaviors toward children and reduce negative child health outcomes.
- At this time, we have approached 307 individuals and successfully enrolled 145 participants.
- Of the 145 enrolled, 111 have completed 1-week follow-up assessments (77%).
- Thirty-six (out of 67 due; 54%) have completed the 6-month follow-up assessment.
- Recruitment and data collection is ongoing so none of the primary analyses have been conducted yet.
- Recruitment will occur through the end of December, 2023 and chart abstraction for currently enrolled participants has begun and will continue throughout the duration of the project.
Next steps: Continuing enrollment.
