Chronic childhood stress – adverse childhood experiences (ACEs), social drivers of health (SDOH), and trauma – is associated with negative health outcomes across the lifespan. Early identification supports whole-child wellbeing and enables families to connect to resources. Pediatric primary care represents an ideal avenue for these efforts given its wide reach and the trusting relationships providers form with families. This paper reports on the chronic stress portion of a quality improvement initiative to implement a comprehensive screening tool for children ages 0-5 at well-child checks (WCCs) in a rural academic medical center. Between June 2023 and April 2024, caregivers of 1,754 unique patients (89.0% White; 49.7% female) completed the screener at 2,787 of 3,470 total WCCs (80%). Overall, 14% of caregivers reported on their child’s experience of early adversity (14%), unmet SDOH needs (20%), and potential trauma (14% of children ages 3-5). Parents only skipped 0.4-5.8% of early adversity, SDOH, and trauma questions. Early adversity and SDOH were significantly weakly correlated, suggesting that these constructs capture related yet unique variance describing chronic stress. After implementation, average monthly pediatric resource team referrals did not change, but the percentage of referrals for young children significantly increased. The first year of data supports the potential for screening initiatives to identify social and material needs, improve health equity, and increase access to community resources.
Implications for Impact
This study demonstrated that it is possible to systematically identify early chronic stress and supports the justification, design, and implementation of universal screening tools in pediatric settings. Health systems and providers should embrace the trauma-informed conversations with children and families that begin to support whole-child wellbeing.
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