P2.186: Implementation of Positive Childhood Experience (PCE) screening to address adversity among immigrant youth

Background: Children recently arrived in the United States are a growing and vital component of the pediatric patient population and tend to be disproportionately impacted by adversity. Exposure to adverse childhood experiences (ACEs) is a major driver of both acute and chronic disease throughout life. Interventions designed to mitigate ACEs, including the identification and promotion of protective factors, are a valuable focus of emerging research for immigrant families and other vulnerable communities. This program implemented PCE screening among immigrant youth as part of an early, strengths-based approach to mitigation of ACEs exposure.

Project Description: Screening was initiated in an established, interdisciplinary and co-located clinic delivering holistic care to immigrant children and families from 2024-2025. Situated within a larger federally qualified health center, the clinic provides medical, mental health, legal, and case management services for children and families with exposure to migration-related trauma. A mental health professional administered the 7-question PCE questionnaire (PCE-7) and Pediatric ACEs and Related Life Events Screener (PEARLS) to identify ACEs exposure. Both tools were selected for the clarity and culturally-sensitive nature of their language. The PCE-7 is a validated measure of increased resilience, which explores four domains found to reinforce bodily function during adversity: 1) Relationships, 2) Social Engagement, 3) Environment, and 4) Emotional Growth. All children 4-18 years old were screened, with guardians responding for children aged ≤10 years. Screening, in English or Spanish, was integrated into a broader, therapeutic conversation regarding past experience. When deemed appropriate and acceptable by the patients and families, referrals to the appropriate mental health treatment programs were placed. Scores for PCE, ACE, and current symptoms were recorded at program intake and at 6-month intervals to measure the potential for PCEs to mitigate the effect of ACEs on psychosocial functioning for future data analysis.

Discussion: The formal identification and promotion of protective factors within pediatric patients represent a highly promising avenue for mitigation of trauma exposure. Screeners like the PCE-7, and the strengths-based emphasis they underline, allow providers to reframe therapeutic conversations away from historical adversity and potential retraumatization and toward a more positivistic future. Specific protective factors, such as participation in community traditions and honoring family support in difficult times, may be particularly buffering for immigrant households and are worthy of investigation. By focusing on positive narratives and qualities already present in immigrant families, we may also begin to change national perspectives around the migration experience, shifting the conversation from negative rhetoric to immense possibilities.

Conclusion: When paired with measurement of ACEs exposure and changing psychosocial symptomatology, PCE screening can help to illuminate the complex interplay between trauma, resilience, and health in immigrant children. Tracing this relationship is essential to decreasing acute and chronic health disparities currently affecting children exposed to migration-related adversity.