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Baby's Clutch

Addressing ACEs among Hispanic Caregivers in a Pediatric Primary Care Population to Improve Child Health and Decrease Early Adversity

PIs: Abigail Lott, PhD ABPP & Maneesha Agarwal, MD


What are ACEs?

ACEs are a leading risk factor for multiple negative health outcomes, including- increased risk of chronic diseases, infant health problems, developmental delays, healthcare utilization, psychiatric illness, substance abuse, and early death. ACEs are also strongly linked to unemployment, educational underachievement, poverty,  exposure to other traumas, and suicide (Madigan et al., 2017; Shonkoff, 2012; Zielinski, 2009). It can also impact how one parents. Over half of Americans experience ACEs, and rates are even higher in Hispanic communities (Bruskas& Tessin, 2013; Iniguez & Stankowski, 2016). National surveys find that rates of ACEs are 38% higher in Hispanic children than in their White counterparts (Bruskas & Tessin, 2013).

Why might this study be helpful?

This study will help us fill existing gaps in research by evaluating effective strategies for reducing the harmful effects of ACEs on child outcomes in a pediatric primary care setting. This study will assess the impact of caregiver ACEs screenings and provider-led discussions on child health outcomes. Through this intervention, we hope to reduce health disparities by mitigating the impact of caregiver ACEs on child health outcomes in a primarily Hispanic population. Though rates of ACEs are higher in Hispanic populations, the majority of existing research has been conducted in non-Hispanic populations. The population seen at the primary care setting where this study will take place consists of 85-90% Hispanic patients. Therefore, the present study’s focus on Hispanic population is both innovative and impactful.

What is the objectives of this study? 

There are two objectives:

Primary Objective: To evaluate if increased caregiver awareness of their own ACEs through provider-led discussions will lead to improved child health via fewer emergency department visits, urgent care visits and missed primary care appointments.

Secondary Objective: Potential mediators (caregiver resilience and warmth toward children) in the associations between provider-led ACEs discussion and improved child health outcomes will be examined.

What are we measuring and what are the procedures? 

There will be:

Intake/Baseline Assessment: When infants (0-18months) are presented at their well-child-care visit, the caregiver (if interested) will be given the study packet/survey onsite.

The survey will include:

  • A brief consent explaining the purpose of the study

  • Baseline demographic data: age of caregiver, country where caregiver spent majority of childhood, primary language, race, ethnicity, household monthly income, educational attainment, caregiver history of mental illness, and multiple types of contact information (e.g. phone numbers, email addresses) for subsequent data collection.

  • A caregiver ACEs screening

  • Measures of resilience, parenting style, and psychological symptoms

  • Medical record information on child medical care visits

What happens after enrollment and how will data be collected?

This is a longitudinal study. After enrollment at Mercy Care Chamblee there will be Follow-up Assessment(s):

Caregivers and their children will be followed for 18 months following enrollment at 1 week, 6 months, and 18 months.

Who are our participants? 

The goal sample size is 840 families. The population we are focusing on are caregivers and their infants receiving routine well child care at a primary care clinic called Mercy Care in Chamblee serving a primarily Hispanic population.

Contact Information:

Mel Pomales


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