E07 – Screening and Treating Families for Adverse Childhood Experiences and Depression in a Safety-Net Pediatric Health Home Population

Summary

Research on Adverse Childhood Experiences (ACE) has demonstrated a significant association between childhood maltreatment and later life health and well-being. Other research has linked the impact of parental trauma and intergenerational trauma. Adults who experienced trauma as children are at higher risk incidence of parenting poorly. Additionally, mothers and fathers who experience postpartum depression are at greater risk for abusing or neglecting their children. The aim of this pilot study was to implement a screening process and intervention to address trauma, anxiety, and postpartum depression in parents with the intent of improving parental well-being. We conducted a brief pilot study implementing ACE, depression, anxiety, child quality of life and social determinants of health screening in our integrated behavioral health and primary care pediatric-focused health home, Jefferson Plaza Family Health Home (JPFHH) in Lakewood, Colorado. Medicaid was the predominant payer at this clinic and almost 50% of the population were of Latinx heritage. This health home is unique in that it is a bidirectional model providing a full range of both mental health services and medical services. The establishment of the health home was made possible by support and funding from the Colorado State Innovation Model (SIM), with the overarching goal of increasing access to integrated physical and behavioral healthcare services. Starting in January 2018, we implemented ACE Questionnaire, PHQ-9 depression screen, Edinburgh Postnatal Depression Scale (EPDS), Generalized Anxiety Disorder Screen 7 (GAD-7), and a self-scaled questionnaire on the Substance Abuse Mental Health Administration’s (SAMHSA) 8 Dimensions of Wellness for the caregivers of infants as part of our intake process. Additionally, the child’s quality of life was tracked using the age appropriate KINDL measure. Parents who screened positive on these tools were offered a variety of services from Jefferson Center, including, but not limited to, behavioral health assessment and education, individual therapy, navigation services, wellness services (health coaching), and family services . Patients received an average of 12 services. Of note, is that fathers who were screened appreciated being asked about their depression and trauma history and welcomed the opportunity to receive supportive services. Assessing and treating parental behavioral health may positively impact child well-being.