Name
ACEs and Escalating Care: How Adverse Childhood Experiences Impact Psychiatric Level of Care in a Tiered Pediatric Collaborative Care Model
Description

Adverse childhood experiences (ACEs) are well-established drivers of poor mental health outcomes in children. Yet, to our knowledge, they are not consistently screened for in pediatric Collaborative Care (CoCM) Models, and the relationship between ACEs and positive outcomes in CoCM is unknown. This presentation examines how ACE burden influences the level of psychiatric services required by pediatric patients within a tiered collaborative care framework, exploring whether higher ACE scores are associated with escalation beyond what a pediatrician can manage within a traditional integrated care setting. Additionally, we look at if ACE scores are predictive or poorer outcomes in collaborative care and the need for long term care from a psychiatrist. Our findings suggest that ACE burden is a meaningful predictor of care escalation and but not necessarily long term care needs, with implications for how collaborative care models can be structured to better identify and support children with adverse childhood experiences.

Speakers
Celina Jacobi, MD
Nathaniel Dell, PhD, LCSW
Shae Strom, MSW, LCSW
Co-Authors
Alla Dorfman, MD; Kindra York, RN; Elias Smith, MD; Lauren Grimes, MPH
Content Level
Intermediate
Tags
Collaborative Care Model of Integrated Care, Pediatrics, Social determinants of health or SDoH
Session Type
Poster
Objective 1
Describe the Pediatric ACEs and Related Life Events Screener (PEARLS) and how this can be utilized as a screening measure in pediatric collaborative care.
Objective 2
Identify the relationship between adverse childhood experience (ACE) burden, as measured by the Pediatric ACEs and Related Life Events Screener (PEARLS), psychiatric level of care, and discharge disposition in a community-based pediatric collaborative care program.
Objective 3
Apply knowledge of ACE screening and its association with care escalation to inform clinical decision-making and resource allocation within integrated pediatric mental health care settings.
Content Reference 1

Zarse, E. M., Neff, M. R., Yoder, R., Hulvershorn, L., Chambers, J. E., & Chambers, R. A. (2019). The adverse childhood experiences questionnaire: Two decades of research on childhood trauma as a primary cause of adult mental illness, addiction, and medical diseases. Cogent Medicine, 6(1). https://doi.org/10.1080/2331205X.2019.1581447.

Content Reference 2

Negriff, S., Digangi, M., Sidell, M., Liu, J., & Coleman, K. (2022). Assessment of Screening for Adverse Childhood Experiences and Receipt of Behavioral Health Services Among Children and Adolescents. JAMA Network Open, 5. https://doi.org/10.1001/jamanetworkopen.2022.47421.

Content Reference 3

Koita, K., Long, D., Hessler, D., Benson, M., Daley, K., Bucci, M., Thakur, N., & Harris, N. (2018). Development and implementation of a pediatric adverse childhood experiences (ACEs) and other determinants of health questionnaire in the pediatric medical home: A pilot study. PLoS ONE, 13. https://doi.org/10.1371/journal.pone.0208088.

Content Reference 4

Long, D., Hessler, D., Koita, K., Bucci, M., Benson, M., Gilgoff, R., Thakur, N., & Harris, N. (2022). Screening for adverse childhood experiences in pediatrics: A randomized trial of aggregate-level versus item-level response screening formats. PLOS ONE, 17. https://doi.org/10.1371/journal.pone.0273491.