302 - Pediatricians’ Attitudes Regarding Adverse Childhood Experiences in Clinical Care and Perceived Barriers to Screening

Poster Number: 302
Publication Number: 302.2210

Background: Screening for adverse childhood experiences (ACEs) has garnered increased attention nationally, but uptake of screening in practice is highly variable. Little is known about pediatricians’ attitudes and barriers towards screening and addressing ACEs in care. Understanding these perspectives may provide insight into screening uptake and identify opportunities for care improvement.

Objective: 1. Describe pediatricians' attitudes towards ACEs screening and management.
2. Investigate how these attitudes vary by clinician and clinical work setting characteristics and relate to differences in screening practices.

Design/Methods: We surveyed physician members of the American Academy of Pediatrics in Southern California via an online survey distributed October 2019 – December 2019. Survey response rate was 27% (156/580), similar to other web-based surveys of physicians. The survey inquired about agreement with 26 statements on ACEs impact on health, ACEs screening, barriers to screening, and the role of ACEs in clinical care. Screening and ACEs management practices, demographics, and work settings characteristics were also reported (Table 1). Covariate-adjusted logistic and linear regressions were used to examine associations between ACEs screening and demographics, work settings, and ACEs-related attitudes.

Results: Most pediatricians agreed ACEs influence patient health (94%) and addressing ACEs can improve care (89%). Over two-thirds (70%) agreed they support screening with the current resources in their practices, and 95% would support screening with additional resources. Lack of time to screen (84%) and lack of resources to respond to ACEs (82%) were the two most frequently reported barriers to screening. Less than half (40%) reported screening most or all their patients. Physicians who disagreed that ACEs were out of their scope of practice, and those who supported screening with their current resources were more likely to screen patients for ACEs (OR=4.25, p=0.016; OR=4.77, p=0.012). Discomfort asking about ACEs, lack of training on how to ask, and lack of training on how to respond to ACEs were all negatively correlated with screening (OR=0.63, p=0.019; OR=0.56, p=0.006; OR=0.55, p=0.007).

Conclusion(s): Awareness of the health impact of ACEs and support for ACEs screening was high among pediatricians in our study. Pediatricians’ beliefs regarding their role in addressing ACEs, perceived availability of resources to address ACEs, and perceived barriers to screening are associated with clinical screening practices.