6132 Assessing adverse childhood experiences in safeguarding medical reports in a busy district general hospital

Objectives Adverse Childhood Experiences (ACEs) are an integral part of paediatrics due to their effects on morbidity and mortality and their role within safeguarding. Understanding ACE's and their effects has recently been included in the national paediatric curriculum.1 Previous regional studies2 3 have found that there is poor paediatric trainee awareness and recognition of ACEs. ACEs should be explored routinely in Section 47 (S47) safeguarding medical assessments, therefore, a study in a busy district general was designed to assess whether ACEs were referenced in these reports and what the prevalence of ACEs were within the reports. Methods S47 reports were reviewed over a 1 year period (Dec 2020–2021). From these reports, data was collected on whether ACEs were referenced in the report, how many of the traditional 10 ACEs were found in the history and whether there were any other significant events that could be classified as ACEs. Results 77 reports were collected and analysed, the average age group for the S47 Medical assessment was 6 month- 1 year (22%) with the most common reason for assessment being bruising (40%). Only one report (1.3%) referenced ACE's. The average number of ACE's collected from the text in the report was 2.3; 64% had 1–3 ACEs, 3% had 9+ ACEs. The most frequently documented ACE was parental separation (59.7%). It was difficult to assess some ACEs as there were neither negative nor positive reports of many ACEs, for example sexual abuse was most commonly not documented/referenced (97.4%). Other examples of significant adversity in childhood found within the reports were; parental ACEs (6.5%), parent in different country (3.9%), death of sibling (1.3%) and significant racism (1.3%). When comparing documented ACEs to S47 outcomes- those felt to have injuries due to non-accidental injuries had an average of 2.9 ACEs, accidental injuries: 1.6 ACEs and those that were unable to determine had an average of 2.8. Conclusion This study shows that reference to adverse childhood experiences within the reports is poorly documented. There is a high prevalence of ACEs from the reports reviewed, even with the absence of documentation about certain ACEs. Following on from this project there is a redesign of the local S47 medical and report proformas to include a section on ACEs to prompt both positive and negative findings and documentation of ACEs in the final report. It is hoped that with further reference to ACEs this may help provide further support from social care for the family and greater understanding of the family that is affected. This study will be re-audited after the intervention to see if there has been an improvement whilst there is continual education about ACEs to paediatric trainees. References RCPCH. Level 2 Generic Syllabus Internet. 1.1. 2018 cited 2023 Aug 1. Available from: https://www.rcpch.ac.uk/sites/default/files/2023-07/ProgressPlus-core-syllabus-2023.pdf Netherton R, Presky J. Adverse childhood experiences- what do paediatric trainee's actually know? Arch Dis Child. 2022;107(Suppl 2):A265.1-A265. Netherton R. A non-academic trainee experience of paediatric research Internet. Royal College of Paediatrics & Child Health. 2022 cited 2023 Aug 2. Available from: https://www.rcpch.ac.uk/news-events/news/non-academic-trainee-experience-paediatric-research