Barriers and facilitators to behavioral health follow-up in children screened and referred for Adverse Childhood Experiences (ACEs)

Sep 30, 2026

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Semi-structured phone interviews with caregivers of children referred to behavioral health after positive Adverse Childhood Experiences (ACEs) screening were analyzed using inductive coding and thematic analysis. The study identified three main barriers to completing referrals: difficulty communicating with behavioral health and navigating the healthcare system, limited appointment availability and access, and medication concerns. Four facilitator themes were also found: healthcare system support, family and friend support, prior positive experience with behavioral health, and the child or caregiver requesting therapy.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Abstract

Introduction

Adverse Childhood Experiences (ACEs)

Screening and early intervention

Caregiver and patient perceptions

Study context and prior evidence

Ticknor et al. BMC Health Services Research (2026) 26:36 BMC Health Services Research [https://doi.org/10.1186/s12913-025-13928-7](https://doi.org/10.1186/s12913-025-13928-7) RESEARCH Open Access Barriers and facilitators to behavioral health follow-up in children screened and referred for Adverse Childhood Experiences (ACEs) Iesha L. Ticknor 1, Mercie J. Digangi 1,2, Laurel D. Sarfan3 and Sonya Negriff1,3* Abstract We conducted 20 semi-structured phone interviews with caregivers of children referred to behavioral health after positive ACEs screening. We analyzed the transcripts using inductive coding and thematic analysis. Results Three themes regarding barriers to completing behavioral health referrals after ACEs screening were identified: (1) difficulty communicating with behavioral health and navigating the healthcare system,(2) appointment availability and access, and (3) medication concerns. Additionally, four themes regarding facilitators were identified: (1) healthcare system support,(2) family and friend support,(3) previous positive experience with behavioral health,(4) child or caregiver requesting therapy. Conclusions Most caregivers reported positive views of the referral process. However, the identified barriers indicate next steps to improve acceptability of the referral process from pediatric ACEs screening to behavioral health. Keywords Adverse childhood experiences, ACEs, Pediatrics, Social work Introduction Adverse Childhood Experiences (ACEs) are potentially traumatic events that occur during childhood, such as physical, emotional, and sexual abuse; neglect; and household dysfunction such as substance use and mental illness [1, 2]. It is estimated that at least 42% of the pediatric population has experienced at least one ACE [3]. ACEs and their long-term consequences were first described in a study conducted in 1998 by Kaiser Permanente and the Centers for Disease Control and *Correspondence: Sonya Negriff [sonya.x.negriff@kp.org](sonya.x.negriff@kp.org) 1Kaiser Permanente Bernard J. Tyson School of Medicine, 98 S Los Robles Ave, Pasadena, CA 91101, USA 2Southern California Permanente Medical Group, 9353 Imperial , Hwy. Downey, CA 90242, USA 3Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA 91101, USA Prevention (CDC) [2]. Numerous studies have shown that ACEs are associated with widespread health sequela later in life including increased health risk behaviors, developmental disruption, high risk of diabetes, heart disease, substance abuse, and overall all-cause mortality [1, 4]. Given this evidence, recent discussion ofACEs has centered around how to mitigate and prevent these effects [5]. There has been growing interest in implementing screening programs for ACEs in medical settings to identify children who are at risk, as it is suspected that potential interventions may be more effective in early childhood [6], highlighting the need for early intervention. Screening has been shown to increase identification of adversities, relative to controls, and may lead to increased referrals in those who screen positive [7]. Emerging research has investigated caregiver and patient perceptions of ACEs screening. Current literature shows that integrating ACEs screening into patient’s © The Author(s) 2026. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is

FAQs

What was the study’s main focus?

The study examined barriers and facilitators affecting whether caregivers completed behavioral health referrals for children after positive ACEs screening.

How were the interview data analyzed?

Researchers conducted 20 semi-structured phone interviews and analyzed transcripts using inductive coding and thematic analysis.

What barriers and facilitators were identified for completing referrals?

Barriers included communication and healthcare navigation difficulties, appointment availability/access issues, and medication concerns. Facilitators included healthcare system support, support from family and friends, previous positive experiences, and children or caregivers requesting therapy.

Sep 30, 2026

Uploaded by Đào