Piloting a Screening Tool for Social Determinants of Health, Adverse Childhood Experiences (ACEs), and Resiliency Among Children Seen in 4 Urban Resident Clinics

PEDIATRICS ◽  
2016 ◽  
Vol 137 (Supplement 3) ◽  
pp. 172A-172A ◽  
Author(s):  
Alisa Seo-Lee ◽  
Barbara Bayldon ◽  
Melissa Ruiz ◽  
Marjorie Fujara ◽  
Jeannie Aschkenasy ◽  
...  
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Adverse Childhood Experiences ◽  
Screening Tool ◽  
Determinants Of Health ◽  
Urban Resident ◽  
Childhood Experiences ◽  
Adverse Childhood

scholarly journals Mining 100 million notes to find homelessness and adverse childhood experiences: 2 case studies of rare and severe social determinants of health in electronic health records

2017 ◽  
Vol 25 (1) ◽  
pp. 61-71 ◽  
Author(s):  
Cosmin A Bejan ◽  
John Angiolillo ◽  
Douglas Conway ◽  
Robertson Nash ◽  
Jana K Shirey-Rice ◽  
...  
Keyword(s):  
Electronic Health Records ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Adverse Childhood Experiences ◽  
Determinants Of Health ◽  
Homeless Population ◽  
Health Records ◽  
Childhood Experiences ◽  
Adverse Childhood ◽  
Electronic Health

Abstract Objective Understanding how to identify the social determinants of health from electronic health records (EHRs) could provide important insights to understand health or disease outcomes. We developed a methodology to capture 2 rare and severe social determinants of health, homelessness and adverse childhood experiences (ACEs), from a large EHR repository. Materials and Methods We first constructed lexicons to capture homelessness and ACE phenotypic profiles. We employed word2vec and lexical associations to mine homelessness-related words. Next, using relevance feedback, we refined the 2 profiles with iterative searches over 100 million notes from the Vanderbilt EHR. Seven assessors manually reviewed the top-ranked results of 2544 patient visits relevant for homelessness and 1000 patients relevant for ACE. Results word2vec yielded better performance (area under the precision-recall curve [AUPRC] of 0.94) than lexical associations (AUPRC = 0.83) for extracting homelessness-related words. A comparative study of searches for the 2 phenotypes revealed a higher performance achieved for homelessness (AUPRC = 0.95) than ACE (AUPRC = 0.79). A temporal analysis of the homeless population showed that the majority experienced chronic homelessness. Most ACE patients suffered sexual (70%) and/or physical (50.6%) abuse, with the top-ranked abuser keywords being “father” (21.8%) and “mother” (15.4%). Top prevalent associated conditions for homeless patients were lack of housing (62.8%) and tobacco use disorder (61.5%), while for ACE patients it was mental disorders (36.6%–47.6%). Conclusion We provide an efficient solution for mining homelessness and ACE information from EHRs, which can facilitate large clinical and genetic studies of these social determinants of health.

Advocacy and Ac­tion in Appalachia Aimed at Adverse Childhood Experiences

2020 ◽  
pp. 125-148
Author(s):  
Adam Hege ◽  
Denise Presnell ◽  
Kellie B. Reed-Ashcraft ◽  
Karen Caldwell ◽  
Damiana Gibbons Pyles ◽  
...  
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Adverse Childhood Experiences ◽  
Academic Research ◽  
Social Determinant ◽  
Determinants Of Health ◽  
Childhood Experiences ◽  
Adverse Childhood ◽  
Community Initiative ◽  
Rural Appalachia

Rural Appalachia faces extreme poverty-linked hardships, often referred to as ‘social determinants of health'. One social determinant of health often linked with rural poverty is adverse childhood experiences (ACEs). ACEs refer to numerous experiences (e.g., forms of abuse and maltreatment, a dysfunctional household, mental illness in the household, etc.) that one encounters before the age of 18. Local leaders of a county in the heart of Appalachia in northwestern North Carolina (Watauga) embarked on a community level initiative (Watauga Compassionate Community Initiative) aimed at preventing and treating the effects of ACEs and building resiliency. This chapter delves into the academic research related to ACEs and poverty and details the background and ongoing story of the Watauga Compassionate Community Initiative, concluding with lessons learned and insights into what other rural communities can focus on when addressing ACEs, poverty, and other social determinants of health.

scholarly journals Assessing the Social Determinants of Health and Adverse Childhood Experiences in Patients Attending a Children's Hospital Cleft Palate-Craniofacial Program

2021 ◽  
pp. 105566562110487
Author(s):  
Ethan Ponton ◽  
Rebecca Courtemanche ◽  
Tanjot K. Singh ◽  
Damian Duffy ◽  
Douglas J. Courtemanche ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Adverse Childhood Experiences ◽  
Determinants Of Health ◽  
Childhood Experiences ◽  
Children's Hospital ◽  
Adverse Childhood ◽  
The Social ◽  
Children’S Hospital

This study aimed to describe the social determinants of health (SDoH) for patients receiving multidisciplinary team care in a Cleft Palate-Craniofacial program, develop responsive and consistent processes to include trauma-informed psychosocial histories, promote discussions about additional “non-medical” factors influencing health and surgical outcomes, and demonstrate that these activities are feasible in the context of multidisciplinary patient-provider interactions. Single-site, cross-sectional study using a questionnaire. Participants were recruited from a provincial quaternary care Cleft Palate-Craniofacial program at British Columbia Children's Hospital in Vancouver, BC, Canada. 290 families completed the questionnaire. 34% of families experience significant barriers to accessing primary health care, 51% struggle financially, and 11% scored four or more on the Adverse Childhood Experiences scale. Furthermore, 47% reported not having adequate social support in their lives, and 5% reported not feeling resilient at the time of the survey. Patients with cleft and craniofacial anomalies have complex needs that extend beyond the surgical and medical care they receive. It is critical that all Cleft and Craniofacial teams incorporate social histories into their clinic workflow and be responsive to these additional needs. Discussions surrounding SDoH and adversity are welcomed by families; being involved in the care and decision-making plans is highly valued. Healthcare providers can and should ask about SDoH and advocate for universal access to responsive, site-based, social work support for their patients.

scholarly journals Adverse Childhood Experiences among Adults in North Carolina, USA: Influences on Risk Factors for Poor Health across the Lifespan and Intergenerational Implications

2020 ◽  
Vol 17 (22) ◽  
pp. 8548
Author(s):  
Adam Hege ◽  
Erin Bouldin ◽  
Manan Roy ◽  
Maggie Bennett ◽  
Peyton Attaway ◽  
...  
Keyword(s):  
Risk Factors ◽  
North Carolina ◽  
Health Risk ◽  
Food Insecurity ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Adverse Childhood Experiences ◽  
Health Risk Factors ◽  
Childhood Experiences ◽  
Adverse Childhood

Adverse childhood experiences (ACEs) are a critical determinant and predictor of health across the lifespan. The Appalachian region of the United States, particularly the central and southern portions, experiences worse health outcomes when compared to the rest of the nation. The current research sought to understand the cross-sectional relationships between ACEs, social determinants of health and other health risk factors in one southcentral Appalachian state. Researchers used the 2012 and 2014 North Carolina Behavioral Risk Factor Surveillance System (BRFSS) for analyses. An indicator variable of Appalachian county (n = 29) was used to make comparisons against non-Appalachian counties (n = 71). Analyses further examined the prevalence of ACEs in households with and without children across Appalachian and non-Appalachian regions, and the effects of experiencing four or more ACEs on health risk factors. There were no statistically significant differences between Appalachian and non-Appalachian counties in the prevalence of ACEs. However, compared with adults in households without children, those with children reported a higher percentage of ACEs. Reporting four or more ACEs was associated with higher prevalence of smoking (prevalence ratio [PR] = 1.56), heavy alcohol consumption (PR = 1.69), overweight/obesity (PR = 1.07), frequent mental distress (PR = 2.45), and food insecurity (PR = 1.58) in adjusted models and with fair or poor health only outside Appalachia (PR = 1.65). Residence in an Appalachian county was independently associated with higher prevalence of food insecurity (PR = 1.13). Developing programs and implementing policies aimed at reducing the impact of ACEs could improve social determinants of health, thereby helping to reduce health disparities.

Social determinants of health, adverse childhood experiences, and maternal-infant relationship

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
J Kapp ◽  
A Frech ◽  
B Hall ◽  
A Kemner
Keyword(s):  
Early Childhood ◽  
Childhood Obesity ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Adverse Childhood Experiences ◽  
Home Visiting ◽  
Obesity Risk ◽  
Childhood Experiences ◽  
Adverse Childhood ◽  
Early Childhood Obesity

Abstract Background Low strength of maternal-infant relationship (MIR) is consistently associated with early childhood obesity risk. Because obesity often persists once it develops, primary prevention is needed early. Home visiting programs support families with social determinants of health (SDH) and adverse childhood experiences (ACEs); SDH and ACEs contribute to health inequities. Addressing SDH and ACEs may facilitate improvements in MIR and ultimately mitigate early childhood obesity risk. Limited to no research has examined the association between ACEs, SDH, and MIR. In the context of a national, evidence-based home visiting program, we asked: are SDH and ACEs associated with low MIR? Methods This sample includes 6,972 children ages 0–<24 months enrolled in the Parents as Teachers home visiting program across the United States from sites using the Life Skills Progression (LSP) instrument through February 2020. Low MIR is dichotomized from a 1-5 scale, with low scores reflecting low nurturing, bonding, and responsiveness. We used the literature, theory, and a stepwise logistic regression model-building process to identify a parsimonious model for MIR. Results Preliminary results reflect 34.2% Hispanic or Latino, 22.7% non-Hispanic Black, 35.3% non-Hispanic Other race; 83.9% low income; 36.9% low education; and 13.4% mothers scoring low for MIR. Notable findings from modeling include: physical ACEs, captured here as child abuse or neglect (OR: 5.01, 95% CI: 4.10-6.11); mental illness ACEs, captured here as a mother/parent with mental illness (OR: 1.31, 95% CI: 1.05-1.63), or the mother/parent treated violently (OR: 1.95, 95% CI: 1.56-2.40). Protective associations include mothers' support of child development and self-esteem scores. Conclusions Understanding the complex interplay of SDH, ACEs, and MIR is critical for developing interventions that address “upstream” family characteristics in order to mitigate early childhood obesity risk. ACEs play a predominant role. Key messages This is the first known study to concurrently examine maternal-infant relationship, social determinants of health, and adverse childhood experiences. Home visiting programs may be critical partners in addressing these needs given their reach.

scholarly journals Using simulation to increase resident comfort discussing social determinants of health

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
John M Morrison ◽  
Sarah M. Marsicek ◽  
Akshata M Hopkins ◽  
Robert A Dudas ◽  
Kimberly R Collins
Keyword(s):  
Food Insecurity ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Clinical Setting ◽  
Comfort Level ◽  
Determinants Of Health ◽  
Childhood Experiences ◽  
Curricular Intervention ◽  
Adverse Childhood ◽  
A Prospective Study

Abstract Background Social determinants of health (SDoH) play an important role in pediatric health outcomes. Trainees receive little to no training on how to identify, discuss and counsel families in a clinical setting. The aim of this study was to determine if a simulation-based SDoH training activity would improve pediatric resident comfort with these skills. Methods We performed a prospective study of a curricular intervention involving simulation cases utilizing standardized patients focused on four social determinants (food insecurity, housing insecurity, barriers to accessing care, and adverse childhood experiences [ACEs]). Residents reported confidence levels with discussing each SDoH and satisfaction with the activity in a retrospective pre-post survey with five-point Likert style questions. Select residents were surveyed again 9–12 months after participation. Results 85% (33/39) of residents expressed satisfaction with the simulation activity. More residents expressed comfort discussing each SDoH after the activity (Δ% 38–47%; all p < .05), with the greatest effect noted in post-graduate-year-1 (PGY-1) participants. Improvements in comfort were sustained longitudinally during the academic year. More PGY-1 participants reported engaging in ≥ 2 conversations in a clinical setting related to food insecurity (43% vs. 5%; p = .04) and ACEs (71% vs. 20%; p = .02). Discussion Simulation led to an increased resident comfort with discussing SDoH in a clinical setting. The greatest benefit from such a curriculum is likely realized early in training. Future efforts should investigate if exposure to the simulations and increased comfort level with each topic correlate with increased likelihood to engage in these conversations in the clinical setting.

Identifying adverse childhood experiences in maternity services

2021 ◽  
Vol 29 (2) ◽  
pp. 70-80
Author(s):  
Vivien Mortimore ◽  
Michelle Richardson ◽  
Sally Unwin
Keyword(s):  
Adverse Childhood Experiences ◽  
Screening Tool ◽  
Childhood Experiences ◽  
Improvement Project ◽  
Maternity Services ◽  
Parental Exposure ◽  
Qualitative Feedback ◽  
Adverse Childhood ◽  
Services Implementation ◽  
Additional Support

Background Maternity services have a unique opportunity to support women and families to build resilience and mitigate against the harmful impact of parental exposure to adverse childhood experiences (ACEs) but, most importantly, to prevent exposure to ACEs in future generations. Aim To identify ACEs in families who use maternity services in order to improve the professional response to risk, build parental resilience and strengthen parenting capacity. Methods A quality improvement project piloted an ACEs screening tool with 44 women and their partners when booking for maternity services. Implementation was supported by the development of a range of bespoke tools. Evaluation took place through quantitative data analysis and qualitative feedback from professionals and parents. Findings The use of the ACEs screening tool successfully identified ACEs which would otherwise not have been known using the previous antenatal booking questions. The bespoke tool kit was well-received by women, their partners and professionals. Identification and discussion of ACEs enabled appropriate support to be offered. Conclusion Identifying ACEs in maternity services and offering additional support requires further work before wider implementation. These interventions have the potential to reduce risk, build resilience and strengthen parenting capacity which could protect infants from experiencing a cycle of adversity.

scholarly journals Teaching Family Medicine Residents How to Identify and Address Social Determinants of Health

PRiMER ◽  
2021 ◽  
Vol 5 ◽  
Author(s):  
Lisa Schoenberger ◽  
Rajaa Mourabet ◽  
Binju Bose ◽  
Qian Gu ◽  
Benita Benjamin ◽  
...  
Keyword(s):  
Family Medicine ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Screening Tool ◽  
Primary Care Providers ◽  
Practical Experience ◽  
Social Needs ◽  
Determinants Of Health ◽  
Care Providers ◽  
Family Medicine Residents

Introduction: This educational program aimed to teach family medicine residents how to address social determinants of health. The literature reviewed suggested that curricula addressing social needs of patients were sporadic and failed to provide residents with practical ways to apply the knowledge. The program objectives were to provide residents with a thorough understanding of social determinants of health and to provide a practical experience where they could address social needs. Methods: The program consisted of four didactic sessions in which the residents discussed why addressing social determinants of health is important, designed a screening tool, and were educated on how to assess and communicate with patients. As a longitudinal experience, the residents used the screening tool in their clinic and connected patients with resources. We performed a mixed-methods data analysis to determine if program goals were met. Results: Survey data showed a statistically significant change in the comfort, understanding, and consistency of addressing social determinants of health. Reflections showed similar results. Residents recognized the importance of being aware of social needs, having conversations with patients about their needs, and considering cost when they implement treatment plans.  Conclusions: Family medicine residents are the future primary care providers for our communities. Therefore, it is important to equip them with the knowledge and ability to address all of the factors affecting their patients’ health. Graduates will be able to apply this knowledge to their future patients, and educators can be assured family physicians have the skills to address social determinants of health.

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