National Pediatric Practice Community

Nature of the Problem

According to the National Survey of Children’s Health, 34.8 million children across the United States are impacted by Adverse Childhood Experiences (ACEs). ACEs are exposures in childhood to abuse, neglect, parental incarceration, divorce, or domestic violence that have been shown to affect virtually every domain in which a child functions. Research has documented a dose-response effect between ACEs and behavioral problems, learning impairment, incarceration, drug addiction, and long-term health issues, including heart disease, diabetes, cancer, stroke, Alzheimer’s, and suicide. Over the past two decades, emerging science has identified the mechanisms through which early adversity changes the developing brain, immune systems, hormonal systems, and DNA regulation of children, resulting in a condition now known as toxic stress. We know that early detection and interventions can prevent or mitigate the effects of toxic stress. The importance of early detection cannot be over-emphasized because, although the science of toxic stress is an emerging field, all of the research indicates that early detection affords the greatest opportunity to shape the developmental trajectory of neuro-endocrine-immune pathways and DNA regulatory mechanisms.

Program Description

Population-level improvements in health outcomes are possible with early detection and early intervention of ACEs. However, routine screening is required to enable early detection. According to a 2013 periodic survey from the American Academy of Pediatricians, only 4% of pediatricians regularly screen for ACEs. At Center for Youth Wellness (CYW), our goal is to reduce the population-level burden of toxic stress by supporting pediatricians to include ACEs screening as a regular part of the pediatric well-child exam and by raising national awareness of ACEs and toxic stress by educating parents, pediatricians, and policymakers on the health risks of toxic stress and the benefits of early detection and intervention. Center for Youth Wellness’ National Pediatric Practice Community on Adverse Childhood Experiences (NPPC) is a peer group of pioneering pediatric-serving medical practitioners supporting each other in expanding knowledge, building capacity, accessing resources, and shaping the field of ACEs research and trauma informed care. The NPPC was formed to support our national effort to transform clinical understanding and practice for children exposed to early adversity and toxic stress and supports universal screening of children ACEs as a critical tool for interrupting the pathway to toxic stress and its short – and long-term consequences.

Disruption

What differentiates CYW’s project and approach is our ability to identify, understand, and translate science-based practices and research to integrate an ACEs, toxic stress, and trauma-informed framework into pediatric medical care. The NPPC engages pediatric providers in a learning community to increase screening of children for exposure to ACEs with the goal of engaging and supporting child-serving primary care medical providers (e.g. pediatricians, family medicine physicians, nurse practitioners, etc.) in including ACEs screening as a routine part of pediatric well-child exams. The NPPC includes two components: 1. An online community of pediatric medical providers sharing knowledge, best practices, information and training on relevant subject matter, and evidence demonstrating the importance of incorporating regular ACEs screening for early detection of ACEs and toxic stress 2. Partnerships with pediatric practices locally and nationally to provide coaching and guidance to aid implementation of an ACEs screening protocol

Leadership

Designed as a learning collaborative, members of the NPPC on-line community receive coaching, content and protocols on the science of ACEs, screening practices, and effective communication with parents on the issue. In addition to the online community, CYW is partnering with a select number of medical practices, representing diverse healthcare delivery models, to integrate an ACEs screening protocol into their workflows. Pilot sites work with the NPPC coach, a clinical quality improvement specialist, and receive tailored clinical quality improvement coaching to facilitate the adoption of an ACEs screening protocol relevant to the site’s delivery model and patient population. Pilot sites work in partnership with the NPPC team to collect, analyze, and utilize data to ensure a deep level of learning about clinical transformation and adoption of ACEs screening, and share lessons and resources developed learned with the broader NPPC membership.

Scalability

The NPPC is a central part of our work focused on scaling CYW’s on-the-ground, community-based clinical experience across the country. The NPPC is open to all pediatric-focused primary care medical providers, including physicians, nurse practitioners, nurses, medical assistants, and supporting teams that have direct responsibility over clinical quality improvement. Members can be at any stage of implementation of ACEs screening and intervention. We look to recruit practitioners with varying levels of experience as this allows for a rich learning environment among members. As of December 2018, CYW enrolled 729 pediatric practitioners representing over 450 institutions across the country and internationally in the NPPC virtual community, reaching two-thirds of our three-year 1,000 member goal within just 18 months. Current Funders of CYW’s NPPC: ● The JPB Foundation ● Genentech ● The David and Lucile Packard Foundation ● Hearst Foundations ● The California Endowment ● Kresge Foundation ● San Francisco Foundation

Results/Outcomes

The NPPC will advance clinical practice and national awareness through helping pediatricians understand why and how to screen for ACEs and providing them with tools to be able to address toxic stress in their clinical practices. Our goal over the next year is for the NPPC to support 1,000 pediatric medical providers in making ACEs screening and intervention part of their routine clinical practice, serving approximately 200,000 children and families across the country. • CYW will provide coaching, content and protocols on the science of ACEs, screening practices, and effective communications with parents on the issue. • NPPC will gain and share insights on pediatricians and their knowledge acquisition journey and identify successes, challenges and barriers to adopting ACEs screening in various pediatric clinical settings. • NPPC will identify and test communication, training materials, and dissemination channels, and surface ideas from practice that may need to be tested through research.