P2.081: Youth Services ACEs Case Management – Care Delivery beyond ACEs screening in a large Latin(x)-serving, community primary care practice

Background: Insurance reimbursement of adverse childhood experiences (ACEs) screening during well child visits in California incentivized primary care practices to utilize Pediatric ACEs and Related Life Events Screening (PEARLS) to identify childhood trauma and develop a response tailored to the needs of their community. Minoritized populations, including those in the Latin(x) community, have higher rates of ACEs requiring a multidisciplinary team to address the broad medical and social ACEs identified. This approach has been utilized in studies where holistic, trauma-informed care (TIC) decreases the negative mental and physical health effects associated with ACEs. To provide tailored care services for a predominantly Latin(x) pediatric population following a positive ACEs screen, we implemented the Youth Services-ACEs Case Management program (YS-ACEs).

Project Description: YS-ACEs was adapted from an existing program supporting pregnant and parenting youth, offering home visits, social support, and medical care coordination. In 2021, two bilingual, Latinx case managers with community ties joined the initiative, receiving training in motivational interviewing and TIC. Initially, the program managed referrals from four pediatric clinics for children aged 6 months to 19 years, based on positive PEARLS screens. To address sensitive topics, an open-ended, culturally sensitive intake questionnaire was created to assess additional needs beyond the well-child visit. Based on this, case managers determined if a home visit or telehealth session was needed and developed a care plan, including assistance with medical appointments, social services, supplies, and local resources. They maintained weekly check-ins until the family's needs were met and the case could be closed. Over the past four years, PEARLS screening has been implemented across 25 pediatric clinic sites. In response to growing demand for these services, the YS-ACEs has expanded to include 7 case managers who share similar backgrounds and cultural ties to the community they serve.

Discussion: Identification of ACEs requires the simultaneous implementation of an intervention that is acceptable and appropriate for the community being screened. This program likely found success among patients, as seen in the increasing need for YS-ACEs staff, by the ability of the enhanced case managers to address patient needs across multiple medical and social sectors. Moreover, staff ascertained patient needs in a culturally-appropriate manner and ensured resolutions were trusted and locally-sourced.

Conclusion: In Latin(x)-serving, community primary care practices, PEARLS administration can be successfully coupled with tailored case management services to mitigate the effects of ACEs on an individual’s wellbeing.