Title Adversity Screening for Underserved Trauma-Impacted Children
AAP Grant ID 2679
Project Year 2021
City & State Boca Raton, FL
Program Name CATCH Planning
Topic Child Abuse & Neglect
Program Description

​This grant proposes to identify and address barriers to practice-relevant pediatric adversity screening by planning community partnerships that support sustainable pediatric adversity screening in PBC.   In 2012, the AAP issued a Policy Statement recommending that pediatric medical homes actively screen for “practice-relevant” toxic stresses. Fourteen years earlier, a landmark study discovered that ten ACEs, or childhood traumas, led to lifelong poor health and well-being. ACEs are examples of toxic stress - severe, chronic, and unbuffered stress - which damages a child’s developing brain and body through excessive or prolonged activation of the stress response system. Other examples of toxic stress include extreme poverty and food insecurity.   Further studies demonstrate that resilient children can thrive in the face of adversity, especially with the support of stable, committed adults. Pediatricians can foster childhood resilience in the 68% of American children exposed to ACEs by screening and managing trauma-related physical and mental health problems. However, a 2021 University of Florida study noted, “Pediatricians have not yet implemented widespread ACE screening.”   Pediatric adversity screening has been largely elusive due to significant barriers. A 2013 National Periodic Survey conducted by the AAP found that only 4% of pediatrician respondents were familiar with the concept of childhood trauma. Additionally, many foster children’s caregivers and adolescents fail to disclose trauma or adversity. Failure to identify childhood adversity leads to systemic inequities for vulnerable children and subsequent long-term poor health, well-being, and opportunities.   The risk of poor adult outcomes increases with the number of ACE exposures (or ACE score). Foster care children, by definition, are exposed to at least one ACE. A 2014 study found that children in foster care are far more likely to experience at least four ACEs (42%) compared to the general population (12.5%).   On September 30, 2018, the United States Department of Health and Human Services estimated that 437,283 children were in foster care nationwide. On November 30th, 2020, the Florida Department of Children and Families estimated that 1003 children were in foster care in Palm Beach County (PBC). Friends of Foster Children (FOFC), located in the low-income section of PBC, estimates that they served 960 children in 2020. FOFC provides family-centered services to foster families across PBC and is considered a safe and trusted space for trauma-impacted foster children. This year, FOFC will open an on-site medical clinic in partnership with Least Of These (LOT) Medical Services. LOT clinics operate in the rural areas of opportunity and medically underserved areas of PBC. Currently, FOFC and LOT clinics do not screen for ACEs.   I will partner with FOFC and LOT Medical Services in PBC to identify gaps in referral networks and supportive resources; conduct focus groups with key stakeholders (pediatricians, foster children’s caregivers, and adolescent foster children) to identify the barriers to pediatric adversity screening in an underserved trauma-impacted community; obtain stakeholder feedback on two commonly used pediatric adversity screening tools [Pediatric ACEs and Related Life-events Screener “PEARLS,” and the Whole Child Assessment (WCA)]; and explore potential solutions to overcome identified barriers. 


​1) By November 30th, 2021, identify the two most common barriers to pediatric adversity screening in each stakeholder group (pediatricians,  foster children’s caregivers, and foster care adolescents) at Friends of Foster Children.

2) By February 28th, 2022, determine which pediatric adversity screening tool (PEARLS or WCA) is preferred by each stakeholder group (pediatricians,  foster children’s caregivers, and foster care adolescents) at Friends of Foster Children.

3) By June 30th, 2022, engage with at least three community partners in Palm Beach County to discuss the implementation and sustainability of this initiative.

AAP District District X
Institutional Name Friends of Foster Children
Contact 1 Rosemary Martoma, MD, FAAP
Contact 2
ID 889