Assessing for and Intervening upon Early Childhood Violence Exposure in Pediatric Primary Care Settings

PROJECT ABSTRACT Childhood exposure to violence (CEV) is a significant and preventable public health problem in the United States. Children of all ages are at risk for CEV, but children ages five and under are particularly vulnerable. The traumatic stress caused by early CEV has a significant, deleterious effect on developmental outcomes. Young children

consistently interact with the healthcare system for well-child visits, and this system can play a critical role in identifying and responding to CEV. Yet, research to date indicates that clinicians in pediatric healthcare settings do not consistently assess for CEV, particularly recent or current CEV. The Joint Commission’s 2023 mandate

to assess social risks (e.g., CEV) across healthcare settings provides a unique opportunity to routinely assess CEV. The objectives of the proposed research in this Pathway to Independence Award are to examine the implementation of CEV assessment in pediatric primary care settings, assess patterns of early CEV assessment

across one health system, and investigate whether these assessments are associated with healthcare and health outcomes. The specific aims are to: (1) identify existing practices for CEV assessment and follow-up in pediatric primary care settings; (2) delineate facilitators and barriers to CEV assessment and follow-up; (3) characterize

patterns of early CEV assessment patterns by patient, clinician, and site; and (4) elucidate how early CEV assessment is associated with healthcare referral, healthcare receipt, and child health outcomes. This study directly attends to the Joint Commission mandate, and findings will inform related measurement development

and implementation efforts. To acquire the necessary skills to accomplish this project, I will receive training in four critical areas: (1) psychometrics; (2) implementation science; (3) social determinants of health research methodology; and (4) big data analysis techniques. I will also engage in professional development, extend my

professional networks, and further develop my grant writing and oral presentation skills. I have assembled an interdisciplinary mentorship team with expertise in pediatrics, violence prevention, implementation science, social determinants of health research, and psychometrics to ensure completion of the proposed research and

training plan. This Pathway to Independence Award will enable me to develop into an interdisciplinary, independent investigator who examines strategies to prevent CEV and reduce its negative consequences across the life course.