101 - Adverse Childhood Experiences Screening in Pediatric Primary Care for the Afghan Refugee Population: Is PEARLS the Right Tool?

Poster Number: 101

Gagandeep S. Dhugga, University of California, Davis, School of Medicine, Sacramento, CA, United States; Hibatallah Hummadi, Opening Doors, Inc., Davis, CA, United States; Serena Yang, UC Davis School of Medicine, Sacramento, CA, United States

Background: Adverse childhood experiences (ACEs) are associated with negative child and adult health outcomes. Pediatric providers can play an important role in trauma-informed ACEs screening, promoting protective factors, responding with evidence-based strategies, and following-up long term. In California, the PEARLS tool is used by Medicaid providers to screen for ACEs as part of the statewide ACEs Aware initiative. Last year, we implemented PEARLS screening in an FQHC pediatric clinic in Sacramento County, a region home to the largest Afghan refugee population in the US.

Objective: To gain insight from key Afghan community stakeholders regarding knowledge, attitudes, perceived barriers and solutions around ACEs and screening using PEARLS in pediatric primary care.

Design/Methods: We partnered with organizations working directly with Afghan refugees at various timepoints of resettlement. Individuals from these organizations were invited to participate in one-on-one interviews based on their roles in social work, casework, child/parent education, and psychiatry. Standardized open-ended interviews were conducted by the same interviewer for all participants. Most participants were former refugees from Afghanistan. Interviews were transcribed and analyzed for themes.

Results: Many participants were not aware of ACEs or ACEs screening, with mental health providers being most familiar with ACEs. Participant perceptions related to the PEARLS tool included themes of: 1) questions are difficult to comprehend from cultural and linguistic standpoint, 2) questions can fuel mistrust the community has with our healthcare system, 3) parents may not answer questions due to fear and suspicions related to child protective services. Regarding ways of improving ACEs screening, participants responded with themes of: 1) questions related to physical symptoms of distress may be seen as more relevant, 2) education for refugees and resettlement agency staff can help normalize the conversation around ACEs, 3) providers should build rapport with patients before screening for ACEs.Conclusion(s): By listening to key Afghan community stakeholders, we learned of gaps in ACEs knowledge and of negative perceptions toward using PEARLS in pediatric primary care. We will relook at our clinic’s ACEs screening practices, including consideration of a physical and emotional distress symptom screener for refugees. Learning from our community has strengthened our resolve to enhance ACEs education with refugees, resettlement agency staff, and providers alike, and build upon networks of care with services that effectively support refugees in Sacramento.
Gagandeep S Dhugga CVGagandeep S Dhugga CV .pdf