P3.071: Title: Adversity-Informed Collaborative Evaluations (ACEs) Clinic: Initial Program Results from a Developmental Evaluation Clinic Supporting Children Experiencing Trauma

Background: Children with social services involvement have high rates of developmental and behavioral disorders, mental health concerns, and chronic medical conditions; yet there is often a delay in diagnosis and intervention for these needs. Care for this population can be time-consuming and complex due to care coordination needs, frequent transitions between caregivers/providers, and involvement of multiple systems (e.g., social services, multiple caregivers, legal involvement). Specific to children with neurodevelopmental concerns, there are often long wait times for specialty (Developmental Pediatrics) evaluations, which can further delay diagnosis and intervention.

To address these challenges, the Adversity-informed Collaborative Evaluations (ACEs) clinic was developed in collaboration with our hospital’s foster care medical home and later expanded to include other referral sources. The following were our program goals:

1. Develop a referral stream that accurately identifies children who need multi-disciplinary trauma-informed developmental evaluations to ensure accuracy of diagnosis.

2. Expedite time from referral to evaluation (≤3 months) and achieve equitable completion of evaluation and feedback appointments (goal to match section of Developmental Pediatrics late cancellation/no-show rate of 7%).

3. Demonstrate collaboration across medical providers and systems.

Methods: The ACEs evaluation team consisted of 2 clinical psychologists (expertise in trauma and medical complexity) and 1 developmental-behavioral pediatrician with trauma-focused training. Referrals included primarily children ≤7 years with a history of traumatic experiences. Evaluation included clinical interview, record review, direct testing as clinically indicated (autism-specific, adaptive, and/or developmental/cognitive), and typically a separate feedback appointment. A collaborative and flexible approach to referrals, scheduling, and hospital-approved medical record sharing was used to address access to each part of the evaluation process. The program evaluation period was January 2024-March 2025. Child and family demographics (Table 1) and program outcomes (Table 2) were gathered via an internal program tracking sheet and medical record review.

Results: During the program evaluation period, we completed 35 evaluations (out of 38 referrals) and maintained a similar no show/cancellation rate to our section (9%). 80% of children were evaluated within 3 months from referral and 91% within 4 months. Most children received one or more neurodevelopmental disorder diagnoses following evaluation and many had significant adaptive needs. The majority had experienced multiple forms of trauma and many also received a trauma-related diagnosis. Collaboration with systems was high, with involvement from multiple caregivers and representatives from social services (particularly for children in foster/kinship placements).

Conclusion: The ACEs clinic approach was successful in developing a referral stream, achieving timely evaluation completion, and collaborating across systems. Next steps are to determine if timely diagnosis results in receipt of recommended intervention services. We also plan to expand awareness of the clinic within the hospital and outside community settings to further enhance our referral stream, given several appropriate referrals received from medical specialty care clinics.