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.

Grant Number: 5K99HD115745-02
NIH Institute/Center: NIH
Principal Investigator: Anna Bender Sweet