Sarah Kottenstette1, Rachel Segal2, Victoria Roeder3, Hannah Rochford4, Eric Schnieders5, Levent Bayman6, Devin A McKissic7, Greta J Dahlberg8, Rebecca Krewer9, James Chambliss10, Jennifer L Theurer11, Resmiye Oral12. 1. Carver College of Medicine, University of Iowa, 375 Newton Road, Iowa City, IA, 52242, USA. Electronic address: sarah-kottenstette@uiowa.edu. 2. Carver College of Medicine, Department of Pediatrics, University of Iowa, 100 Hawkins Drive, Iowa City, IA, 52242, USA. Electronic address: rachel-segal@uiowa.edu. 3. Carver College of Medicine, University of Iowa, 375 Newton Road, Iowa City, IA, 52242, USA. Electronic address: vstinson@phoenixchildrens.com. 4. College of Public Health, Department of Health Management and Policy, University of Iowa, 145 N. Riverside Dr., Iowa City, IA, 52242, USA. Electronic address: hannah-rochford@uiowa.edu. 5. Carver College of Medicine, University of Iowa, 375 Newton Road, Iowa City, IA, 52242, USA. Electronic address: eric-schnieders@uiowa.edu. 6. College of Public Health, Clinical Trials Statistical & Data Management Center, University of Iowa, 2400 University Capital Centre, Iowa City, IA, 52242, USA. Electronic address: levent-bayman@uiowa.edu. 7. Carver College of Medicine, University of Iowa, 375 Newton Road, Iowa City, IA, 52242, USA. Electronic address: devin-mckissic@uiowa.edu. 8. Carver College of Medicine, University of Iowa, 375 Newton Road, Iowa City, IA, 52242, USA. Electronic address: greta-dahlberg@uiowa.edu. 9. Carver College of Medicine, University of Iowa, 375 Newton Road, Iowa City, IA, 52242, USA. Electronic address: rebecca-krewer@uiowa.edu. 10. Carver College of Medicine, University of Iowa, 375 Newton Road, Iowa City, IA, 52242, USA; College of Public Health, Department of Health Management and Policy, University of Iowa, 145 N. Riverside Dr., Iowa City, IA, 52242, USA. Electronic address: james-chambliss@uiowa.edu. 11. Stead Family Children's Hospital, Child Protection Program, University of Iowa, 100 Hawkins Drive, Iowa City, IA, 52242, USA. Electronic address: jennifer-theurer@uiowa.edu. 12. Carver College of Medicine, Department of Pediatrics, University of Iowa, 100 Hawkins Drive, Iowa City, IA, 52242, USA. Electronic address: resmiye-oral@uiowa.edu.
Abstract
BACKGROUND: Two-generational trauma-informed assessment (TIA) helps providers conduct holistic family well-being assessment (FWbA). This tool makes it possible to use families' trauma history in the case-finding process. OBJECTIVE: This study compares the documentation and frequency of adverse childhood experiences (ACEs) and service referral rates for index children and their caretakers in two groups of families evaluated in a child abuse clinic (CAC). PARTICIPANTS AND SETTING: The sample consisted of 364 children stratified into two groups: Group 1 - children seen in the CAC after implementation of FWbA in years 2014, 2015, 2016 and Group 2 - children seen in the CAC prior to implementation of FWbA in years 2011, 2012, 2013. METHODS: Researchers utilized retrospective chart review method and analyzed data regarding ACEs and service referrals for patients and their caregivers. RESULTS: Documentation of ACEs was higher in Group 1 for children (77.7 % vs 26.6 %,p < 0.0001) and caretakers (60.7 % vs 7.3 % p < 0.0001). Caretakers in Group 1 had a higher rate of four or more ACEs (47.0 % vs 5.1 % p < 0.001) while the increase for children was not statistically significant (61.4 % vs 51.1 %, p = 0.110). Both children and caretakers were referred to more services in Group 1 (2.7 + 1.5 vs 1.5 + 1.3, and 3.0 + 1.9 vs 1.2 + 1.2, respectively, p < 0.0001). CONCLUSIONS: In families evaluated for child abuse and neglect, conducting TIA in addition to conventional psychosocial evaluation increased documentation regarding trauma history, which led to increased referral rates.
BACKGROUND: Two-generational trauma-informed assessment (TIA) helps providers conduct holistic family well-being assessment (FWbA). This tool makes it possible to use families' trauma history in the case-finding process. OBJECTIVE: This study compares the documentation and frequency of adverse childhood experiences (ACEs) and service referral rates for index children and their caretakers in two groups of families evaluated in a child abuse clinic (CAC). PARTICIPANTS AND SETTING: The sample consisted of 364 children stratified into two groups: Group 1 - children seen in the CAC after implementation of FWbA in years 2014, 2015, 2016 and Group 2 - children seen in the CAC prior to implementation of FWbA in years 2011, 2012, 2013. METHODS: Researchers utilized retrospective chart review method and analyzed data regarding ACEs and service referrals for patients and their caregivers. RESULTS: Documentation of ACEs was higher in Group 1 for children (77.7 % vs 26.6 %,p < 0.0001) and caretakers (60.7 % vs 7.3 % p < 0.0001). Caretakers in Group 1 had a higher rate of four or more ACEs (47.0 % vs 5.1 % p < 0.001) while the increase for children was not statistically significant (61.4 % vs 51.1 %, p = 0.110). Both children and caretakers were referred to more services in Group 1 (2.7 + 1.5 vs 1.5 + 1.3, and 3.0 + 1.9 vs 1.2 + 1.2, respectively, p < 0.0001). CONCLUSIONS: In families evaluated for child abuse and neglect, conducting TIA in addition to conventional psychosocial evaluation increased documentation regarding trauma history, which led to increased referral rates.