Adolescents' and parents' perspectives on addressing adverse childhood experiences in school-based health centers.

BACKGROUND

School-based health centers (SBHCs) serve many children impacted by adverse childhood experiences (ACEs), but little is known about addressing ACEs in these settings. This study explored the barriers and facilitators to addressing ACEs in SBHCs from the perspectives of adolescents and parents/caregivers in the community.

METHODS

We conducted semi-structured interviews with adolescents (ages 16-22) and parents/caregivers of school-aged youth (ages 3-17) recruited from patient and family advisory groups, primary care clinic waiting rooms, and snowball sampling. We used a thematic analysis approach and continued until reaching saturation.

RESULTS

Twenty interviews were conducted (10 adolescents, 10 parents/caregivers). Four themes emerged, emphasizing the importance of relational context: (1) Participants expect trust between the patient and the provider addressing ACEs, (2) The school's social environment influences comfort with addressing ACEs, (3) Relationships and contexts outside school impact perceptions of addressing ACEs, and (4) Addressing ACEs in SBHCs can promote the health of the school community.

CONCLUSION

SBHCs can play a vital role in educating about the management and impacts of ACEs. Addressing ACEs in SBHCs requires attention to the relational ecosystem. Policies and practices may consider addressing patient-provider relationships, the school environment, and broader social ecological contexts.

IMPACT: School-based health centers (SBHCs) are understudied settings that may hold promise for addressing adverse childhood experiences (ACEs). This study is the first to explore barriers and facilitators to addressing ACEs in SBHCs from the perspectives of adolescents and parents/caregivers in the community. Relational context, including the patient-provider relationship, the school's social environment, and broader community influences, informed participants' attitudes toward addressing ACEs in SBHCs. SBHCs have several advantages that may promote the health and well-being of youth with ACEs. These findings may inform the development of family-centered strategies to support youth with ACEs in SBHCs.