Purpose: The purpose of the current research was to develop and implement an electronic tool to screen for toxic stress in pediatric primary care settings. Toxic Stress is defined as strong, frequent and/or prolonged adversity without adequate adult support and includes adverse life experiences, such as physical or emotional abuse, neglect, caregiver substance abuse or mental illness, exposure to violence or economic hardship. Many studies have found correlations between these adverse life experiences and specific diseases, both physical and mental. Methods: A web-based interactive assessment tool was designed to present assessment questions in a choice of languages (English, Spanish, and Creole) and also includes an audio component and a color-coded touch-screen response system that accommodates users of low literacy levels. Parents complete a set of questions and children ages 12 and older independently provide their own responses on a separate device. Using an HL7 interface engine, the responses are captured and stored in a secured central server that generates a report for the healthcare provider that is incorporated into the electronic medical record. A workflow has been established that includes intervention from pediatricians and psychologists working within an interdisciplinary team to address positive screens. The screening process was implemented within a pediatric unit of a community health center. Data has been collected for 400 pediatric patients ages 6 to 17 and a subset of parents have completed a patient satisfaction questionnaire related to their experience using the technology. Results: Preliminary findings indicate that 42.4% of children screened had experienced 1 or more ACE events, with 8.1% having 4 or more ACE events (Figure 1). The ACE event most frequently reported was the incarceration of a family member. Approximately 32% of positive screenings resulted in a referral to Behavioral Health and 17% of positive screenings resulted in a Case Worker referral. Patient (parent) satisfaction reports indicate that 87% of parents endorsed feeling comfortable answering questions asked; 93% of parents endorsed that the computerized questionnaire helped express concerns with their child’s doctor. Conclusion: The use of electronic platforms to screen patients for adverse childhood experiences can enhance the early identification of toxic stress and can also improve parent perceptions of the well visit. Software can be designed with modifications for users of varying computer-literary levels, linguistic backgrounds, and reading levels. Such technology can be implemented with minimal staffing resources and can be integrated into existing workflows while enhancing patient care and future health outcomes.

Figure 1

Percent of Respondents Endorsing ACE Events

Figure 1

Percent of Respondents Endorsing ACE Events

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