Supporting the implementation of a state policy on screening for Adverse Childhood Experiences (ACEs) in Federally Qualified Health Centers

支持在联邦合格的健康中心实施关于不良童年经历 (ACE) 筛查的国家政策

• 批准号: 10398160
• 负责人: Monica Perez Jolles
• 金额: --
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-01 至 2022-07-21
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10398160
• 关键词: Accidents; Address; Adopted; Age; Anxiety; Asthma; Attention deficit hyperactivity disorder; Brain; Budgets; California; Caregivers; Caring; Child; Child Care; Child Health; Child Mental Health; Childhood; Climate; Clinic; Clinical; Communities; Computers; Data; Disasters; Discrimination; Event; Exploratory/Developmental Grant; Exposure to; Family; Federally Qualified Health Center; Group Processes; Health Care Costs; Health Promotion; Health Services; Health Services Accessibility; Healthcare; Human Resources; Hybrids; Immigrant community; Institutional Racism; Interview; Investments; Knowledge; Lead; Leadership; Life; Link; Location; Measures; Mediator of activation protein; Medicaid; Medical; Mental Health; Mental Health Services; Methodology; Methods; National Institute of Mental Health; Outcome; Partnership Practice; Patient Care; Patients; Performance; Phase; Policies; Policy Maker; Policy Research; Poverty; Preparation; Primary Health Care; Process; Protocols documentation; Public Health; Public Policy; Randomized Controlled Trials; Refugees; Research; Resources; Schools; Site; Strategic Planning; Stress; Surgeon; Surveys; Symptoms; Testing; Trauma; Visit; Well Child Visits; acceptability and feasibility; adverse childhood events; base; community clinic; community violence; control trial; design; early screening; evidence base; experience; feasibility testing; high risk; implementation efforts; implementation framework; implementation outcomes; implementation science; implementation strategy; improved; maltreatment; marginalized population; migration; minority communities; neglect; pediatric patients; physical conditioning; pilot test; primary care setting; primary outcome; programs; routine screening; screening; screening policy; secondary outcome; social stigma; success; sustainability framework; symptomatology; tool; traumatic event; trial design; violence exposure

PROJECT SUMMARY Adverse Childhood Experiences (ACEs) are defined as traumatic events occurring before age 18, such as maltreatment, life-threatening accident, harsh migration experiences or exposure to violence. ACEs are pervasive, with 45% experiencing at least one ACE and 10% experiencing three or more ACEs, placing them at high risk for negative life outcomes. ACEs are more prevalent among minority and immigrant communities due to exposure to poverty, discrimination, community violence, national disasters, and refugee experiences. ACEs screenings have potential value in identifying children experiencing toxic stress and the physical and mental health conditions associated with it such as asthma, ADHD and anxiety. Yet, they are seldom used in primary care during well-child visits. The Surgeon General of the state of California has addressed this care gap by issuing an ACEs screening policy. Starting January 2020, MediCal, California's Medicaid health care program, will reimburse primary care settings ($29) for using the Pediatric ACEs and Related Life-events Screener (PEARLS) tool to screen children for ACEs during wellness visits. Despite significant investment in California and nationwide, evidence of the public health value of universal child screening policies is unclear. Increased screening efforts often do not translate into higher access to care for children and may even exacerbate disparities by increasing stigma and reinforcing a deficit view of marginalized groups. These results have been attributed to a lack of rigorous studies testing implementation strategies suited for pediatric screening policies. This mixed-method study will fill this gap by refining and testing an implementation strategy using a multi-site control trial with a Federally Qualified Health Center in Southern California. Using the EPIS framework, we will employ a hybrid (type 2), randomized controlled trial using a stepped-wedge design (n=5 clinics) to test to test a central hypothesis that clinics employing a multifaceted implementation strategy will have higher fidelity and reach of the ACEs screening policy. A secondary hypothesis will examine the public health impact of the ACEs policy on child patient-level mental health service and symptom outcomes. Specific aims are: Aim 1. Refine a multifaceted implementation strategy to support the implementation of the ACEs screening policy in community-based clinics, and Aim 2. Pilot test the feasibility, acceptability, fidelity and reach of the implementation strategy and the impact of the ACEs policy on child patient-level outcomes. This project capitalizes on a rare opportunity to pilot test an implementation strategy to maximize the impact of a state-wide policy intended to improve child health in under-resourced settings.

项目概要 不良童年经历 (ACE) 被定义为 18 岁之前发生的创伤事件，例如 虐待、危及生命的事故、恶劣的移徙经历或遭受暴力。 ACE 是 普遍存在，45% 的人经历过至少一项 ACE，10% 的人经历过三项或更多 ACE，这使得他们 面临负面生活结果的高风险。 ACE 在少数族裔和移民社区中更为普遍 由于遭受贫困、歧视、社区暴力、国家灾难和难民经历。 ACE 筛查对于识别遭受毒性应激的儿童以及身体和健康状况具有潜在价值。 与之相关的心理健康问题，如哮喘、多动症和焦虑。然而，它们很少被用于 儿童就诊期间的初级保健。加利福尼亚州卫生局局长已经解决了这一问题 通过发布 ACE 筛选政策来弥补差距。从 2020 年 1 月开始，MediCal，加利福尼亚州的 Medicaid 医疗保健 计划，将补偿初级保健机构使用儿科 ACE 和相关生活事件的费用（29 美元） 筛查 (PEARLS) 工具，用于在健康就诊期间筛查儿童的 ACE。尽管投入了大量资金 加州和全国范围内，普遍儿童筛查政策的公共卫生价值的证据尚不清楚。 加强筛查工作通常不会转化为儿童获得更多照顾的机会，甚至可能 增加边缘化群体的耻辱感和强化赤字观点，从而加剧不平等。这些结果 归因于缺乏严格的研究来测试适合儿科的实施策略 筛选政策。这项混合方法研究将通过完善和测试实施策略来填补这一空白 与南加州联邦合格健康中心进行多站点对照试验。使用EPIS 框架中，我们将采用采用阶梯楔形设计的混合（类型 2）随机对照试验（n=5 诊所）来测试一个中心假设，即采用多方面实施策略的诊所将 ACE 筛选政策具有更高的保真度和覆盖范围。第二个假设将审查公众 ACE 政策对儿童患者层面的心理健康服务和症状结果的健康影响。具体的 目标是： 目标 1. 完善多方面的实施策略以支持 ACE 的实施 社区诊所的筛查政策，以及目标 2. 试点测试可行性、可接受性、保真度和覆盖范围 实施策略以及 ACE 政策对儿童患者水平结果的影响。这个项目 利用难得的机会对实施战略进行试点测试，以最大限度地发挥全州范围内的影响 旨在改善资源贫乏地区儿童健康的政策。