Prevention and Adverse Childhood Experiences (ACEs): The Potential of Well-Child Visits for Serving Latinx Families

• In Event: New Directions for Developmental and Prevention Science for Improving the Lives of Latinx Families

Abstract

Despite being the largest ethnic minority group in the United States, Latinx’s have poorer quality health care and outcomes compared to their non-Latinx white counterparts. Recently, scholars have identified how Adverse Childhood Experiences (ACEs), as well as their associated fiscal and health burden, are disproportionately distributed among racial/ethnic minorities, including Latinxes. Additionally, many Latinx families in the U.S. are facing heightened sociopolitical stress related to increased immigration restrictions, criminalization of immigrants, concerns about family separation and deportation, zero tolerance, the public charge rule, and changes to DACA and TPS (NCFR, 2019). These stressors likely compound adversities experienced within Latinx families (Pinderhughes et al., 2015).
There have been calls for routinely assessing for ACEs at pediatric well-child visits (AAP, 2014), with growing interest in focusing on infants for early intervention purposes. Since infants themselves are less likely to be exposed to ACEs at such a young developmental stage, an important question is whether parents’ ACEs can be considered markers of infant risk. To date, guidelines for screening and responding to parent and infants ACEs in primary care have yet to be fully established, particularly specific to Latinx populations facing unique contextual circumstances. This talk will describe preliminary results of an ongoing RCT to assess infant and parent ACEs at pediatric well-child visits and provide integrated behavioral health care and a preventive intervention, with attention to cultural considerations of serving a majority- Latinx population.
To date, 321 (95%) of eligible patients have been screened across the study’s duration. Of dyads screened, 48% met inclusion criteria (infants had an ACE score >=1 or parents had an ACE score >=2; n = 160), 72% of whom chose to participate (n = 115, 74% Latinx) and were randomly assigned to one of three different interventions. Parents’ average ACE score was 4.4 (SD 3.3); average infant ACE score was .59 (SD 1.01). There were no significant differences in scores between participants who did or did not choose to participate. For analyses, families were grouped into those whose eligibility was based on infant ACE score, and those whose eligibility was solely based on parent ACE score (meaning that the infant had a score of zero). Groups were compared across various risk indicators, with results suggesting no significant differences across parenting stress, parenting self-efficacy, and infant development.
Findings indicate that screening and intervention referral within a pediatric setting is highly feasible. In this sample, there were no major differences in ACEs among families who were or were not willing to enroll in preventive intervention. There were also no major differences in certain indicators of risk between families that screened in based on infant ACE score versus those who screened in based on parent score alone. Implications for ACEs screening and prevention in medical settings with Latinx populations, including cultural considerations related to embedding the screening in a pediatric practice with integrated behavioral health and attending to parenting and parent adversity, will be discussed.

Authors

• Maryam Kia-Keating, University of California - Santa Barbara
  Presenting Author

• Sabrina R Liu, University of California Irvine Conte Center
  Non-Presenting Author

• Miya Barnett, University of California, Santa Barbara
  Non-Presenting Author

• Chava Nerenberg, University of California, Santa Barbara
  Non-Presenting Author