A Review of Randomized Controlled Trials Addressing Childhood Adversities in Pediatric Primary Care - Abstract
Pediatric providers play a critical role in the lives of developing children and are well-positioned to ameliorate the impacts of childhood adversity. Despite evidence-based recommendations and progress in drawing awareness to this issue, best practices have yet to be established. An investigation of the literature was conducted to understand how primary care pediatric providers have targeted childhood adversity through interventions evaluated using a randomized controlled trial (RCT) study design. Thirty-three articles describing 25 intervention programs were identified. Pediatric providers have largely participated in or implemented home visiting programs, parenting groups, parent trainings, or screening models. Engagement has ranged from referral to direct program implementation. Most RCTs addressed the prevention or reduction of childhood adversities, such as child maltreatment and parental mental health. Few studies evaluated mental/behavioral outcomes in adversity-exposed youth and none evaluated physical health impacts of adversity. Screening models implemented by pediatric providers, one-on-one parent trainings provided by diverse health professionals, and programs with an adversity-framework were overall effective at achieving favorable outcomes and should be emphasized for practice. Certain clinical practice gaps, including serving adolescent and rural populations, and involving paternal caregivers in intervention programs, should be addressed. Finally, ongoing research is needed to understand efficacy and translation of findings from randomized trials into clinical settings.