Adverse Childhood Experiences
Conditions
Keywords
adverse childhood experiences, pediatrics, prevention, preventive health services, quality improvement, childhood abuse and neglect
Brief summary
Prior research suggests that it is possible to improve health outcomes in children with ACEs through multi-component interventions. The challenge for most communities is that health and education systems are fragmented and fail to accommodate families based upon different levels of need. This study utilizes cross-sectoral partnerships to mobilize three vectors (pediatricians, community health workers and parenting educators) to optimize the delivery of vital information and resources to a diverse population of families with ACEs. All vectors are trained in an evidence-informed curriculum to strengthen families and build youth resilience. The study design is a randomized controlled trial of 340 families of children between the ages of 3 to 11 who are generally healthy and have recently seen a pediatrician for a well-child visit. To evaluate the efficacy of this intervention, pediatric patients are invited to participate in repeat evaluations within 2 weeks, 3 months, 6 months, and 12 months after their well-child visit. The study will evaluate the following: 1) the association between Child-ACE scores and biomarkers of toxic stress at baseline in children age 3-11 years old; 2) whether the intervention reduces toxic stress and child health and psychosocial problems at follow-up for children with ACEs compared to usual well-child care for children with ACEs; and 3) the impact of mediating and moderating variables. These results will demonstrate that for families with ACEs the intervention will decrease toxic stress associated with ACEs, improve health outcomes, and reduce health disparities.
Interventions
BEHAVIORALThree-Tier Model
Families in the intervention will be counseled by a pediatric provider about ACEs, resilience, stress management, and healthy relationships. Families will also be referred to community health workers and parenting educators.
Sponsors
Loma Linda University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Subject)
Masking description
The pediatric patients, their caregivers and teachers are blinded to arm type.
Intervention model description
Pediatric providers are randomized to training on the intervention or usual well-child care. Three groups of patients are recruited to evaluate the efficacy of the intervention: 1) Usual well-child care for children with no ACEs; 2) Usual well-child care for children with ACEs; and 3) Well-child care by providers trained in the intervention.
Eligibility
Sex/Gender
ALL
Age
3 Years to 11 Years
Healthy volunteers
Yes
Inclusion criteria
* Ages 3-11 * Seen for a well-child visit at a participating pediatric clinic
Exclusion criteria
* \< 3 years or \>11 years of age * Significant congenital medical problems * Previous participation in parenting program (last 12 months) * Sibling enrollment in current study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Child Allostatic Load Index | Change between baseline and visit 4 (1-year post-enrollment) | A composite measurement that combines biometric data, neuroendocrine and immune markers, and executive function to determine whether the intervention lowers physiologic stress for children with ACEs. Each group will be followed over one year and growth curves will be analyzed to compare change in physiologic stress between baseline and final follow-up. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pediatric Symptom Checklist (PSC) | Change between baseline and visit 4 (1-year post-enrollment) | The Pediatric Symptom Checklist is a psychosocial screen designed to indicate psychological impairment. For participants ages 3-5, a total score of 24 indicates psychological impairment. For participants ages 6-11, a total score of 28 indicates psychological impairment. |
Countries
United States
Contacts
CONTACTAriane Marie-Mitchell, MD, PhD, MPH
PRINCIPAL_INVESTIGATORAriane Marie-Mitchell, MD, PhD, MPH
Loma Linda University
Outcome results
None listed