Center for Injury Research and Prevention

Pediatric Emergency Department and Primary Care Provider Attitudes on Assessing Childhood Adversity.

TitlePediatric Emergency Department and Primary Care Provider Attitudes on Assessing Childhood Adversity.
Publication TypeJournal Article
Year of Publication2019
AuthorsSchilling S, Murray A, Mollen CJ, Wedin T, Fein JA, PV S
JournalPediatr Emerg Care
Volume35
Issue8
Pagination527-532
Date Published2019 Aug
ISSN1535-1815
KeywordsAdult, Attitude of Health Personnel, Culture, Delivery of Health Care, Emergency Service, Hospital, Female, Health Knowledge, Attitudes, Practice, Health Personnel, Humans, Interview, Psychological, Male, Mental Health, Middle Aged, Perception, Primary Health Care, Professional-Patient Relations
Abstract

OBJECTIVE: The purpose of this study was to understand pediatric emergency department (ED) and primary care (PC) health care provider attitudes and beliefs regarding the intersection between childhood adversities and health care.

METHODS: We conducted in-depth, semistructured interviews in 2 settings (ED and PC) within an urban health care system. Purposive sampling was used to balance the sample among 3 health care provider roles. Interview questions were based on a modified health beliefs model exploring the "readiness to act" among providers. Interviews were recorded, transcribed, and coded. Interviews continued until theme saturation was reached.

RESULTS: Saturation was achieved after 26 ED and 19 PC interviews. Emergency department/primary care providers were similar in their perception of patient susceptibility to childhood adversity. Childhood mental health problems were the most frequently referenced adverse outcome, followed by poor childhood physical health. Adult health outcomes because of childhood adversity were rarely mentioned. Many providers felt that knowing about childhood adversity in the medical setting was important because it relates to provision of tangible resources. There were mixed opinions about whether or not pediatric health care providers should be identifying childhood adversities at all.

CONCLUSIONS: Although providers exhibited knowledge about childhood adversity, the perceived effect on health was only immediate and tangible. The effect of childhood adversity on lifelong health and the responsibility and potential accountability health systems have in addressing these important health determinants was not recognized by many respondents in our study. Addressing these provider perspectives will be a critical component of successful transformation toward more accountable health care delivery systems.

DOI10.1097/PEC.0000000000001220
Alternate JournalPediatr Emerg Care
PubMed ID29112109