Primary Submission Category: Health systems
Building an Integrating Risk-level Tailored Clinic to Community Response to Prevent Child Maltreatment
Authors:Â Erin VanEnkevort, Lisa Bailey-Davis,
Presenting Author: Erin VanEnkevort*
Pennsylvania does not systematically collect risk factors related to child maltreatment despite having child abuse and neglect rates on par with the national average. The lack of systematic collection stifles the development of interventions to prevent child maltreatment. At Geisinger, a large integrated health system, we developed ALLIANCE with the goal of identifying families at risk for child maltreatment and connecting them to personalized resources that improve mental health, resilience, and prevent child maltreatment. We first captured demographic, health, and social factors through the electronic health record (EHR), and then assess childhood experience risk by implementing the Adverse Childhood Events (ACEs) questionnaire as a screener.
Methods. During the pre-implementation phase of ALLIANCE, we completed activities in 3 areas: Engagement, Consideration of Feasibility, and Readiness Planning. Example activities included engaging stakeholders, responding to problems and solutions, obtaining funding, identifying data assets and strategies to address gaps, understanding clinical workflow and referral pathways, developing a predictive risk model with existing EHR data, implementing patient-reported ACEs and integrating results with clinical decision support
Results. Stakeholders identified problems and potential solutions. Specifically, to address the lack of systematic tracking and develop a secondary prevention effort, ALLIANCE was developed, and funding was acquired from the Degenstein Foundation and Department of Health and Human Services. Geisinger EHR was identified as a data asset but there was a gap in ACEs collection. A review of literature informed variable selection to develop a predictive risk model using Geisinger’s EHR. Clinical decision support was built, and clinical staff will receive training about the model and the referral infrastructure.
Conclusion. ALLIANCE may serve as a model to prevent child maltreatment for other rural health systems.