Reviewed by Amber L. Pendleton, M.D.

Implementing the principles of trauma-informed care across a primary care team and community resources provides an opportunity to focus on adverse childhood experiences and social-care needs, with the potential to improve lifelong health.

Norton Children’s Medical Group, affiliated with the UofL School of Medicine, embarked on a program to provide trauma-informed care education to the entire primary care team, including primary care providers, clinical staff, nurses, chronic care coordinators, child psychiatrists, social workers and community health workers.

The team also worked to build bridges to over 25 community partners, including representatives of food pantries, housing support, wellness and safety resources, legal aid, after-school and child care programs, mental health organizations, and Medicaid health insurance providers.

Using this team approach, Norton Children’s started by providing trauma-informed care education to every provider, staff member, nurse and multidisciplinary team member. The team used the principles of trauma-informed care to design a social care needs screening form that included questions about adverse childhood experiences for both children and their care providers. Meeting with community partners, everyone worked together to help families connect with existing community resources.

This provided an opportunity to address social care needs as well as mental and physical health care resources for parents and caregivers.

Team members also provided direct services to families for mental, social and legal needs. Resources available within the clinic included car seats, books, portable cribs, bike helmets and firearm trigger locks.

“It takes a village to raise a child, and our goal has been to help connect families to their village to get the support that they need,” said Amber L. Pendleton, M.D., a Norton Children’s Medical Group pediatrician who headed the team.

Priority was given to resources that highlighted the importance of promoting health equity and/or enhancing resilience, such as home-visiting programs, after-school programs and parenting groups available in the neighborhoods where families live.

Principles of trauma-informed care led to social care needs screening tool

The team also developed and implemented a social care needs screener looking at financial, housing and food insecurity, and educational, legal and family stability.

The strongest predictor of adverse childhood experiences scores of 4 or more were when the parent scored 4 or more, followed by foster care, issues with custody and housing instability.

The research was conducted by Dr. Pendleton, Marian E. Morris, M.D., also a pediatrician with Norton Children’s Medical Group, and Yana Feygin, M.S., senior biostatistician at the University of Louisville Medical School’s Department of Pediatrics. They presented their work in a poster at the American Academy of Pediatrics National Conference and Exhibition.

The project was supported by a Passport Improved Health Outcomes Program grant and Norton Children’s Research Institute, affiliated with the UofL School of Medicine.

The findings support the effectiveness of a pediatric primary care clinical team working with the community to help meet families’ comprehensive care needs.

“Sometimes a medicine is not the best treatment for a child’s health issue — in fact a referral to a community resource or ‘prescribing community’ may be the best treatment,” Dr. Pendleton said. “A critical part of providing comprehensive care includes addressing the needs of parents and caregivers. Clinics should work with the communities where families live to build a village to support a child’s health.”