13 - The Role of Adverse Childhood Experiences in Early Intervention Referral Completion

Publication Number: 3012.13

David A. Resto, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; James Guevara, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Roy Wade, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Knashawn H. Morales, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States

Background: Parental adverse childhood experiences (ACEs) can affect child development by influencing parenting practices and stress regulation. ACEs are categorized as conventional (family-level abuse, neglect, or household dysfunction) and expanded (broader social and environmental stressors, including community violence, discrimination, and foster care). Early Intervention (EI) programs under IDEA Part C support children aged 0-3 years with developmental delays, yet only a small fraction of eligible families complete referrals. Families with high parental ACE exposure may face additional barriers, including socioeconomic hardship, systemic distrust, and competing stressors, which may limit EI engagement. Family Navigation (FN) may assist in addressing this gap in service use by providing emotional, informational, and practical assistance to help families overcome these barriers and access EI services.

Objective: Evaluate whether Family Navigation improves EI referral completion among families with parents who have ACEs, and assess whether the number or type of ACEs (conventional vs. expanded) is associated with referral completion.

Design/Methods: This study is a secondary analysis of a randomized controlled trial (NCT03625115) in six urban pediatric practices. Children (>35 weeks gestation, < 30 months of age) referred to EI services were randomized 1:1 to FN (Intervention) or usual care. FN provided families with education about EI, motivational support, and ongoing assistance to overcome barriers to completing referrals. Parents completed a 21-item survey capturing conventional and expanded ACEs. The primary outcome was EI referral completion within 3 months. Logistic regression examined associations between FN, ACE type and number, and referral completion, adjusting for demographics and socioeconomic covariates.

Results: Of 357 enrolled participants, 27 were excluded for incomplete ACE surveys, resulting in 330 parent-child dyads. Families receiving FN were significantly more likely to complete EI referrals than those receiving usual care in both models. Conventional and expanded ACEs were not significantly associated with completion. Higher maternal education was positively associated with completion in both models.

Conclusion(s): Parental ACE type alone did not predict EI referral completion. FN significantly improved completion, highlighting the value of support strategies that help families overcome barriers to developmental services. Interventions addressing structural and logistical obstacles as well as misunderstanding, rather than parental adversity alone, may be key to promoting equitable EI access.

EI Referral Demographics
* 4 missing in Race/Ethnicity section
** 4 missing in Income section

Conventional vs. Expanded ACEs Comparison