Caregiver Adverse Childhood Experiences (ACEs) in Pediatric Primary Care

Addressing ACEs Among Hispanic Caregivers in a Pediatric Primary Care Population to Improve Child Health and Decrease Early Adversity

This longitudinal study will evaluate if increased caregiver awareness of their own ACEs through provider-led discussions will lead to improved child health via fewer emergency department, urgent care visits and missed primary care appointments.

Study Overview

• Status: Completed
• Conditions: Child Development
• Intervention / Treatment: Behavioral: Training on study procedures; Behavioral: Training for ACEs and study procedures

Detailed Description

This longitudinal study will examine whether screening for caregiver adverse childhood experiences (ACEs) and a provider-led discussion of how exposure to ACEs impacts parenting will improve child health outcomes over an 18 month period compared to treatment as usual in a pediatric primary care setting during infant well-child visits. Child health outcomes examined will be rates of emergency department and urgent care visits. Potential protective factors, including parental warmth and resilience will also be examined. The population being studied will include caregivers to infants (ranging 1 week-18 months) receiving care at Mercy Care Clinic (MCC) in Chamblee, Georgia (GA), which primarily serves Hispanic families. Contact will be made by approaching patients present for an infant well-child visit in the clinic. Informed consent will be obtained by a study staff member in the waiting room of the Mercy Care Chamblee Clinic. Electronic or written consent (in English or Spanish based on patient preference) will be obtained. This is not a no-contact study. Data will not be publicly available, but deidentified data will be available upon request beginning 12 months after the study is completed. Only direct study staff will have access to identifying information for participants. Privacy of existing data is not a concern. Interactions will include participant's filling out surveys (or having surveys read aloud to them in their preferred language) and chart review. Those participants who meet with providers randomized to the ACEs discussion will also have a short discussion with their provider about any experienced ACEs and forms of resilience they note on the surveys. Data will be collected in the clinic setting and for follow-up visits by phone or internet based on participant preference.

Topics assessed will include exposure to adverse experiences in childhood, depression and posttraumatic stress disorder symptoms, resilience, and parenting. Each assessment will take less than one hour to complete. All participants will be given a subject identification (ID) number upon consent and all data will be deidentified and only associated with that ID number for the remainder of the study. Medical records will be examined for appointment confirmation (eligibility) and for infant medical visits over the course of the study (outcome variable) and only study staff will have access to identifiable information.

• Study Type: Interventional
• Enrollment (Actual): 181
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Georgia
    • Chamblee, Georgia, United States, 30341
      • Mercy Care Chamblee

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 14 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Caregivers will be eligible to enroll in the study if they bring children to the MCC for either a 4-month, 6-month, 9-month, 15-month, or 18-month WCC. Notably, we anticipate the majority of participants to be of Hispanic origin and many to be exclusively Spanish-speaking. All Research Assistants (RAs) working directly with caregivers will be bilingual according to Emory Spanish fluency testing. We will solicit expert opinion from faculty that work with these communities and the staff of MCC that work with these patients on a regular basis.

Exclusion Criteria:

• Caregivers will be excluded if they are unable to speak and read either English or Spanish. Caregivers will also be excluded if they have already been enrolled in the study protocol via another child or prior WCC. Caregivers who are under the age of 18 years will also be excluded.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Standard of Care Arm; During the study period, standard of care providers will continue to provide standard of care treatment(s); however, families receiving care from the standard of care providers will complete all study surveys. Instead of ACEs training, standard of care providers will undergo training on study procedures including obtaining survey instruments from caregivers and proper storage of survey instruments. This training will stress the importance of not reviewing caregiver ACE scores and minimizing possible treatment contamination. However, standard of care providers will still be able to provide resources to the families as part of standard of care.	Behavioral: Training on study procedures; Instead of ACEs training, standard of care providers will undergo training on study procedures including obtaining survey instruments from caregivers and proper storage of survey instruments. This training will stress the importance of not reviewing caregiver ACE scores and minimizing possible treatment contamination.
Experimental: Intervention Arm; Intervention providers will undergo training for ACEs screening and discussion. Eligible families will be enrolled into the study at the intake of their child's 4-month, 6-month, 9-month, 15-month, or 18-month well child check. Caregivers will complete the intake surveys including demographics, caregiver ACEs, resilience, warmth, PTSD, and depression. The providers will lead a discussion regarding the impact of caregiver ACEs. Patients will be contacted 1-week, 6-months, and 18-months following their enrollment to obtain repeat measures of the survey instruments. At the 18-month time point, the electronic medical record (EMR) will be queried to obtain outcome measures.	Behavioral: Training for ACEs and study procedures; The providers will lead a resilience-based conversation discussion regarding the impact of caregiver ACEs, after receiving training for ACEs and study procedures. The first training component will provide an overview of ACEs using the ACE Interface Training. The second training component will address the implementation of the caregiver ACEs screening in the clinic.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of emergency department (ED) visits documented in chart at 18 months post-intervention	Number of emergency department (ED) visits documented in chart from baseline to 18 months post-intervention	18 months post-intervention
Number or urgent care (UC) visits documented in chart at 18 months post-intervention	Number or urgent care (UC) visits documented in chart from baseline to18 months post-intervention	18 months post-intervention
Number of medical visits at Mercy Care at 18 months post-intervention	Number of medical visits at Mercy Care over the course of the study period will be obtained from baseline to 18 months post-intervention.	18 months post-intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Primary Care PTSD score for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) from Baseline Caregiver's PTSD symptoms due to ACEs screening	The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) is a 5-item screen designed for use in primary care will assess for presence of PTSD symptoms. This measure will be used to evaluate baseline PTSD symptoms and changes in symptoms as a result of ACEs intervention. The total score is the sum of "yes" responses. Possible range is 0 to 5. Lower score correlates with better outcome.	Baseline, 1 week post-intervention, 6 months follow up, 18 months follow up
Change in Brief Resilience Scale score from baseline	The investigators will utilize the Brief Resilience Scale (BRS) that focuses on an individual's ability to bounce back from stress. It includes 6 items for caregivers to answer, with the total ranging from 6-30. Higher scores indicate greater levels of resilience. The Brief Resilience Score will be examined as a potential mediator between provider-led ACEs discussion and child health outcomes.	Baseline, 6 months follow up, 18 months follow up
Change in Parenting Questionnaire (PQ) warmth subscale (PQ-warmth) score from Baseline	The PQ (McCabe & Clark, 1999 )is a 50-item parent self-report of parenting practices, including warmth; that was modified to include only 13 items relevant for young children. The warmth subscale total ranges from 13-65. Higher scores indicate greater parental warmth. Parental warmth will be examined as a potential mediator between provider-led ACEs discussion and child health outcomes.	Baseline, 6 months follow up, 18 months follow up
Rate of referrals to Division of Family and Child Services (DFACS) at 18 months post-intervention	Number of referrals to DFACS will be obtained during follow up period (from baseline to 18 months post-intervention).	18 months post-intervention
Attendance at well child check (WCC) visits at 18 months post-intervention	Number of visits at WCC be obtained during follow up period (from baseline to 18 months post-intervention).	18 months post-intervention
Rate of referrals to non-DFACS services at 18 months post-intervention	Number of referrals to non-DFACS will be obtained during follow up period (from baseline to 18 months post-intervention).	18 months post-intervention
Rate of clinic-based social worker visits at 18 months post-intervention	Number of clinic-based social worker visits will be obtained during follow up period (from baseline to 18 months post-intervention).	18 months post-intervention
Subjective experience of caregiver ACEs screening on clinic staff at baseline	It will be assessed with a brief qualitative questionnaire. The investigators will ask if staff felt that the ACEs screening negatively/neutral/positively impacted patient experience and staff experience of well-child visits. Scores will range from -1 to +1 for each item and total scores may range from -2 to +2 with higher scores reflecting a more positive outcome.	Baseline

Collaborators and Investigators

• Sponsor: Emory University
• Collaborators: Centers for Disease Control and Prevention
• Investigators: Principal Investigator: Abigail Lott, PhD, ABPP, Emory University

Study record dates

Study Major Dates

• Study Start (Actual): April 29, 2022
• Primary Completion (Actual): July 31, 2025
• Study Completion (Actual): July 31, 2025

Study Registration Dates

• First Submitted: August 18, 2021
• First Submitted That Met QC Criteria: August 18, 2021
• First Posted (Actual): August 19, 2021

Study Record Updates

• Last Update Posted (Actual): August 14, 2025
• Last Update Submitted That Met QC Criteria: August 13, 2025
• Last Verified: August 1, 2025

More Information

Terms related to this study

• Keywords: Adverse Childhood Experiences
• Other Study ID Numbers: STUDY00002897 (Other Identifier: University of Arizona Cancer Center - Prevention Research Clinic); 1R49CE003072-01-4 (Other Grant/Funding Number: CDC); 1R49CE003072-01 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Data will not be publicly available, but deidentified data will be available upon request beginning 12 months after the study is completed. Deidentified data files, the data dictionary, and the final protocol will be shared via Emory Dataverse, which is a long-term repository hosted within the University of North Carolina (UNC) Dataverse (listed in the global Registry of Research Data Repositories [re3data.org]).
• IPD Sharing Time Frame: Data will be available for sharing beginning 12 months after this study is complete.
• IPD Sharing Access Criteria: Data will be available for sharing with investigators who email the PI to request access to the deidentified data for any type of analysis.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No