P3B107: Prevalence of Adverse Childhood Experiences Among Adolescents at a Bilingual Pediatric Primary Care Clinic

Purpose/Objectives: Adverse Childhood Experiences (ACEs) and subsequent supraphysiologic stress responses are associated with many of the leading causes of death in adults—including ischemic heart disease, depression, substance abuse, suicide attempt, and smoking—and can even contribute to reduced life expectancy of up to twenty years. The work of Dr. Nadine Burke Harris, ACEs Aware, and others promotes improved screening practices for ACEs in hopes of mitigating these long-term health risks and building resilience. Numerous recent studies suggest varying prevalence of ACEs among minority and immigrant populations, but none of these studies compare patient-reported ACEs via screens to documented ACEs in medical records. In collaboration with providers from the Medical University of South Carolina (MUSC) Northwoods Primary Care Clinic in North Charleston, SC—an urban, bilingual pediatric practice where over 60% of patients identify as Hispanic or Latino and many of whom are children of immigrant families—we employed strategies from the ACEs Aware initiative to pilot ACE screening of adolescent patients and to compare patient-reported versus provider-documented ACE scores.

Design/Methods: Over four weeks in the spring of 2023, we deployed the Pediatric ACEs and Related Life Events Screen (PEARLS) item-level version in both English and Spanish to patients ages 12-19 presenting to MUSC Northwoods for annual and/or new patient visits. Chart review of patient progress notes, medical history, and social history was performed to assess for any additional documented ACES, which were compared to patient-reported ACES on the PEARLS. Upon the project's conclusion, providers also completed a survey to evaluate the screening pilot and promote quality improvement.

Results: A total of 115 patients completed the PEARLS in its entirety, 77% of whom identify as Hispanic or Latino and 18% of whom identify as Black or African American. 30% of patients reported at least 1 ACE and 16% of patients reported 2 or more ACEs. Upon chart review, an additional 38 ACEs were documented in patient charts that were that were not self-reported on the PEARLS. Incorporating these data, 54% of patients demonstrated an ACE score of 1 or more, representing a significant increase compared to self-reported ACE scores (t = -2.212, p < 0.014). Parental or caregiver separation by divorce, deportation, or other means repeatedly arose as the most common and most underreported ACE, affecting nearly 2 in 5 patients.

Conclusion/Discussion: Among this population of predominantly Hispanic or Latinx adolescents, significant discrepancy between patient-reported and provider-documented ACE scores suggests underestimation of the prevalence of adverse experiences when using the PEARLS item-level version. Further research is needed to investigate best-practice ACE screening formats for Hispanic or Latinx patients, children of immigrant families, and similar pediatric populations, especially those affected by parental or caregiver separation.