30 - Adolescent and Parent/Caregiver Attitudes toward Addressing Adverse Childhood Experiences in School-Based Health Centers

Publication Number: 3027.30

Rebecca K.. Tsevat, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA, United States; Rosina Franco, Los Angeles Unified School District, Los Angeles, CA, United States; Roberta L.. Villanueva, Los Angeles Unified School District, Los Angeles, CA, United States; Kate Diaz Roldan, University of California, Los Angeles David Geffen School of Medicine, Covina, CA, United States; Gery Ryan, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States; Shannon M. Thyne, Olive View-UCLA Medical Center, Sylmar, CA, United States; Bahareh Gordon, UCLA Mattel Childrens Hospital, Sylmar, CA, United States; Ron Tanimura, Los Angeles Unified School District, Los Angeles, CA, United States; Shirley A. Russ, UCLA, Los Angeles, CA, United States; Rebecca N. Dudovitz, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA, United States

Background: Many pediatric health settings screen routinely for adverse childhood experiences (ACEs), with the goal of connecting youth to needed resources and supports. Although school-based health centers (SBHCs) likely serve many children impacted by ACEs, little is known about adolescent and parent attitudes toward addressing ACEs in SBHCs.

Objective: This qualitative study sought to explore the barriers and facilitators to addressing ACEs in SBHCs from the perspectives of adolescents and parents/caregivers.

Design/Methods: We conducted semi-structured interviews with adolescents (ages 16-22) and parents/caregivers of school-aged youth (ages 3-17). Using purposive sampling, participants were recruited from patient and family advisory groups, primary care clinic waiting rooms, and snowball sampling. The interview guide was developed with input from adolescents and young adults and included questions about attitudes toward and experiences with ACEs screening in SBHCs. Interviews were audio recorded and transcribed verbatim; discrepancies were resolved through consensus. The data were coded independently by two members of the research team. A multi-step thematic analysis approach was used and continued until thematic saturation was reached.

Results: Twenty semi-structured interviews were conducted with 10 adolescents (age 16-22 years) and 10 parents/caregivers (age of children 4-17 years). The themes reflected in the interviews underscored the importance of relational context when addressing ACEs in SBHCs. Four key themes emerged: 1) Participants expect a foundation of trust between the patient and the provider conducting ACEs screening; 2) The social community within the school environment can influence comfort with ACEs screening in SBHCs; 3) Relationships and community influences outside of the school environment can impact perceptions of ACEs screening in SBHCs; and finally, 4) Addressing ACEs in SBHCs is one way to promote the health of the school community at large.

Conclusion(s): This study reflects the centrality of relational context when addressing ACEs in SBHCs and, to our knowledge, is the first to explore perceptions of adolescents and parents/caregivers on this subject. SBHCs may have advantages that can be leveraged to promote the health and well-being of youth with ACEs. However, for the screening process to be acceptable to patients and families, it will be important to develop strategies and best practices that address the relationship between patients and providers, the school environment, and the social community within and outside of school.

Table 1: Sample Characteristics


Emergent Themes


Figure 1
Relational context impacts adolescents' and parents/caregivers' perceptions of addressing ACEs in SBHCs. This diagram captures the three levels of relational context and the influential factors at each level.