6904 Pursuing a trauma-informed approach to adoption reports: a service evaluation project introducing ACE screening to child health reports in Sunderland

Field: Health Professions (Health Sciences)

Objectives

To introduce ACE screening as part of Child Health Assessments (CHA) for Adoption: To improve recording of emotional neglect and abuse within Child Health Reports (CHR) – previously found to be under-reported in 2016–17.1 To provide detailed information for Prospective Adopters (PA's) regarding the child's exposure to adversity and how this may impact on short and long-term health outcomes in addition to child's current and past medical history. To provide incentives for PA's to implement therapeutic parenting and other evidence based interventions that help child 'repair' from the effects of toxic stress and developmental trauma.

Methods

Implications for practice of using different types of ACE screens was reviewed.2 Paediatric ACE's and Related Life-events Screener (PEARLS) was identified as most practical and time efficient tool.3 PEARLS score completed for every child adopted from January 2023 to October 2023 (using paper copy only as per copyright requirements) – information collected from Initial Health Assessment, parenting assessments, consented adult health records and child permanence reports. PEARLS Score added to Child Health Report and used to guide advice regarding potential implications for health outcomes and discussed with Prospective Adopters. PEARLS scores for 2023 cohort were compared to results from 2016–2017.

Results

All ACE subtypes were recorded more frequently in 2023 compared to 2016–17 which was reflected in higher ACE scores overall. The most common score being 7/10 in 2023 compared to 4/10 in 2016/17. [table 1] 4 cases of Emotional Abuse (EA) were recorded in 2023 compared to none previously. Emotional Neglect (EN) was recorded in 96.5% cases in 2023, compared to only 15% in 2016–2017. [table 2] The most common type of ACE was Emotional Neglect in 2023 (96.5%) compared to Physical Neglect in 2016 (70.1%). [table 2]

Conclusion

This study shows AMA's are more accurately reporting emotional neglect and abuse after introducing ACE screening tool. Interestingly emotional neglect was the most common type of neglect reported, more common than physical neglect. Further work regarding how using PEARLS has changed how reports are written and impact for PA's would be helpful. Recent evidence shows that prevalence of Child Verbal Abuse maltreatment has surpassed other forms of maltreatment.4 These types of adult actions can be as damaging to child's development as other types of abuse such as physical and sexual abuse. ACE screening may have a role to play in recognition of CVA which is key to identification and prevention.

References

Bisset R 957 The case for adverse childhood experience (ACE) screening: retrospective study shows ACE's are under-reported by adoption medical advisors Archives of Disease in Childhood 2023;108: A69-A70. Rariden, et al. Screening for adverse childhood experiences: literature review and practise implications J Nurse Pract. 2021 Jan;17(1):98–104. https://www.acesaware.org/learn-about-screening/screening-tools/. Dube, et al. Childhood verbal abuse as a child maltreatment subtype: a systematic review of the current evidence Child Abuse & Neglect Oct 2023;144:106394.