COMMUNITY PRACTICE PATTERNS: LINKING TO COMMUNITY VIOLENCE PREVENTION RESOURCES
Shari Barkin, Edward H. Ip, Stacia Finch, Jennifer Steffes, Richard Wasserman.. Pediatrics, WFUHS, W-S, NC; Public Health Sciences, WFUHS, W-S, NC; PROS, Department of Research, CCHR, AAP, Elk Grove Village, IL; Pediatrics, University of Vermont, Burlington, VT.

BACKGROUND: Linking parents of aggressive children to community resources is one component of office-based violence prevention. Evidence is lacking regarding the effect of training clinicians to make these referrals and families' responses to them.

OBJECTIVE: To determine how often and to whom trained providers make community referrals for parental concerns of childhood aggression and to ascertain how often parents acknowledge receipt of such a referral.

DESIGN/METHODS: Clinicians were trained to complete and use a local agency resource worksheet to provide local agency referrals for childhood aggression as part of routine care for children ages 2-11 years. Clinicians (n=47) and parents (1,093) were queried on the provision of referrals immediately after the visit.

RESULTS: The community resource worksheet was completed most often by the clinician themselves (65%), with nurses or front office staff completing the worksheet almost a third of the time (28%). About a third of providers reported difficulty in identifying resources. Twelve percent (133/1,093) of parents reported that they worry that their child is more aggressive than other children their age. Twenty-one of 47 clinicians (45%) reported making referrals to 40 of 1,093 patients (3.7% of patients received a referral). Logistic regression examining associations local agency referral provision indicated that parental concern about childhood aggression (OR: 7.74, p <0.001) and being in solo practice (OR: 3.79, p=0.02) were positively associated with providing a referral. The age of the provider, years out from training, difficulty identifying local resources, child's age and ethnicity were not associated.

Referrals were made to: mental health professionals (35.5%), local agency resources such as the YMCA (35.5%), developmental professionals (24%), and parenting classes (6%). Immediately post-visit, only half of parents reported receiving the referral that the provider indicated was given.

CONCLUSIONS: Training clinicians to utilize local agency resources for childhood aggression is necessary, but not sufficient for creating community links for this purpose. Parents and providers have limited agreement that a referral has been provided.