612 - Utilization of a Therapy Referral Process for Adverse Childhood Experiences (ACEs) in Pediatric Emergency Department (PED) Patients.

Publication Number: 1589.612

Karli Okeson, Emory University School of Medicine/Children's Healthcare of Atlanta, Atlanta, GA, United States; Alexis B. Stokes, Emory University School of Medicine, Atlanta, GA, United States; Chartia Byrdsong-Flowers, Children’s Healthcare of Atlanta, Austell, GA, United States; Tori Watson, Children's Healthcare of Atlanta, Decatur, GA, United States; Angie Boy, Children's Healthcare of Atlanta, Atlanta, GA, United States; Timothy Moran, Emory University School of Medicine, Atlanta, GA, United States; Sagar D. Mehta, Emory University School of Medicine, Atlanta, GA, United States; Anna Rodenbough, Emory University School of Medicine, Atlanta, GA, United States; Mark Griffiths, Emory University School of Medicine, Atlanta, GA, United States; Maneesha Agarwal, Emory University / Children's Healthcare of Atlanta, Dunwoody, GA, United States

Background: A high prevalence of patients with Adverse Childhood Experiences (ACEs) present to the pediatric emergency department (PED). ACEs screening and warm referrals for therapy resources may be a strategy to address ACEs in the PED.

Objective: To determine behavioral mental health (BMH) therapy resource utilization between in-person versus telehealth referrals and compare parental versus child-reported ACEs and Positive Childhood Experiences (PCEs) in PED patients.

Design/Methods: This randomized controlled study was IRB approved. English-speaking PED patients 12-17 years and their caregivers were surveyed regarding the patient's ACEs, PCEs, therapy referral preferences, and perceived treatment barriers. Participants with ACEs ≥2 were contacted by a BMH specialist at least twice to arrange an in-person or virtual therapy referral via a randomized protocol and subsequently asked if an appointment was attended. Patients already in therapy were excluded.

Frequencies, percentages, medians and interquartile ranges are reported. Parent and child ACEs/PCEs comparisons used McNemar's, Cohen's Kappa, Wilcoxon sign rank, and Krippendorff's alpha tests, with 95% confidence intervals (CI) using bias-corrected and accelerated bootstrap resamples.

Results: Of 61 participants, 28 (45.9%) had ≥2 ACEs. Most were female (59%), Black (75.4%), and Non-Hispanic (96.7%). (Table 1)

Caregivers and patients reported similar median scores for ACEs (1) and PCEs (7). (Table 2). Age-by-respondent interaction was significant in ACEs (p=0.02) and PCEs (p= < 0.001). Age was significantly positively correlated with caregiver-reported PCEs (r=0.39 [CI:0.16-0.56]) but not child-reported PCEs (r =-0.10 [CI:-0.34-0.18]), caregiver-reported ACEs (r =-0.07 [CI:-0.34-0.23]) or child-reported ACEs (r =0.22 [CI:-0.07-0.50]).

There were 7/28 (25%) families who responded to the BMH specialist for therapy referrals; only 1 (3.6%) confirmed attending an in-person therapy appointment. The most reported perceived barrier to therapy was work schedule conflicts (32.1%). (Figure 1) Most caregivers (57.1%) had no preference for appointment type; among those with a preference, most preferred telehealth (39.2%).

Conclusion(s): Patients and caregivers reported similar child ACEs and PCEs, with some variability depending on patient's age. PED-based ACEs screening with therapy referrals showed minimal benefit as few patients pursued BMH resources regardless of in-person vs virtual format. Work scheduling conflict was the highest perceived barrier to therapy. Further research is needed to determine effective processes to connect patients to care.

Table 1: Demographics of Enrolled Patient Participants
Represents the demographic information (sex, race, ethnicity) for the patient participants and the caregiver relationship to the patient.
*For race, participants were able to select more than one category.

Table 2: Alignment of Caregiver vs Child ACEs and PCEs Responses
Represents the caregiver-reported and child-reported ACEs and PCEs for the patient with total median scores.

Figure 1: Caregiver Report of Therapy Preferences and Barriers to Therapy Treatment
Represents the caregiver reported therapy preference between in-person vs telehealth and perceived barriers to therapy treatment for their child.