Telephone-Based Care Coordination for Services Addressing Childhood Adversity

In the United States (US), more than one-third of children have experienced an adverse childhood experience (ACE)—a stressful and potentially traumatic event associated with higher risk of long-term behavioral problems and chronic illnesses—and ~14% have experienced 2 or more. Although the Centers for Disease Control and Prevention (CDC) recommends screening for ACEs, screening remains inconsistent and lacks standardization, and screening effectiveness has not been rigorously studied. Thus, whether universal pediatric ACEs screening and response can improve child health is largely unknown. In a pilot randomized controlled trial (RCT) to demonstrate feasibility and acceptability of ACEs screening using 2-1-1 Los Angeles County (211 LA), a member of the 2-1-1 health and human services call center network serving 95% of the US, preliminary data after ~4 months showed that families who received telephone-based care coordination from 211 LA were more likely to be referred to and receive ACEs-related services than families who received usual clinical care. We also previously showed that 211 LA care coordination increased receipt of early childhood developmental services in a clinic population. Multiple barriers prevent children exposed to ACEs from being detected and receiving services. Beyond initial screening, children must be appropriately referred to service organizations, be evaluated and deemed eligible for services, and then access these services. At every step there are leakages, or “voltage drops,” that cumulatively reduce screening effectiveness. Pairing screening with subsequent care coordination may reduce these voltage drops. In the proposed R01, we conduct a Type I hybrid effectiveness-implementation RCT to evaluate whether, compared to usual care, telephone-based child ACEs screening and care coordination through 211 LA increased rates of a) referral to ACEs-related services and b) receipt of ACEs-related services (Aim 1); and improves parent PROMIS-10 health and wellbeing scores and child social-emotional wellbeing scores (Aim 2). Finally, we will use 211 LA call logs and qualitative interviews with parents and ACEs-related service providers to examine factors related to successful implementation of the intervention (Aim 3). 2-1-1 call centers are an existing national infrastructure for telephone-based care coordination and linkages to community services. If effective, this model has potential for rapid dissemination to health systems serving communities throughout the country.