Identifying and Assisting Burn Patients and Their Families With Needs Through Administration of an Assessment Tool on Admission.

Using a modified Safe Environment for Every Kid Questionnaire (Needs Survey), we previously showed a significant correlation between adverse childhood experiences (ACEs) and family needs. Herein, we retrospectively assessed whether patients' and their families' needs identified using the Needs Survey were addressed prior to discharge. We hypothesized that, without the knowledge gained by administering this tool, many basic needs may not have been fully addressed. Seventy-nine burn patients and families previously enrolled in our ACE studies were included. Answers to the Needs Surveys were reviewed to identify families with needs. Medical records were reviewed to determine if a social worker assessment (SWA) was completed per standard of care and if their needs were addressed prior to discharge. Of the 79 burn patients who received inpatient care and completed the Needs Survey, family needs were identified in 67 (84.8%); 42 (62.7%) received an SWA, and 25 (37.3%) did not. Those who did not receive a SWA had a shorter hospitalization and suffered less severe burns. Demographics, socioeconomics, ACEs, and identified needs were similar between the groups. Our study showed that SWA was performed on many patients with basic needs. However, with the focus of SWAs being on discharge arrangements, not all needs were addressed, and individualized resources were often not provided. Administering the Needs Survey on admission may help our social workers streamline and expedite this process to help support successful recovery for our burn patients and their families.

The Burden of Adverse Childhood Experiences in Children and Those of Their Parents in a Burn Population.

The aim of this study was to determine the prevalence, type, and associations of parental and child adverse childhood experiences (ACEs) in children presenting with burn injuries. Parents of burned children completed an ACE-18 survey, including questions on parent and child ACEs, needs, and resiliency. Demographics, burn injury, hospital course, and follow-up data were collected. Family needs and burn outcomes of children with and without ACEs' exposure (no ACE vs one to two ACEs vs three or more ACEs) were analyzed. P <.05 was considered significant. Seventy-five children were enrolled-58.7% were male, 69.3% white. The average age was 6.0 ± 5.2 years. The average total burn surface area was 4.4 ± 5.7% (0.1-27%). Parent ACE exposure correlated with child ACE exposure (r = .57; P = .001) and this intensified by increasing child age (P = .004). Child ACE exposure showed a graded response to family needs, including food and housing insecurity and childcare needs. Stress and psychosocial distress of the parents was significantly associated with their children's ACE burden. The ACE burden of parents of burned children can affect the ACE load of their children. Burned children with more ACEs tend to have significantly more needs and more family distress. Awareness of past trauma can help identify a vulnerable population to ensure successful burn recovery.

The Impact of Adverse Childhood Experiences on Burn Outcomes in Adult Burn Patients.

Adverse childhood experiences (ACEs), including child maltreatment and household dysfunction, define adverse events that occur before 18 years of age. National and state data show that between 12.5 and 14.5% of the adult population report ≥4 ACEs (HIGH-ACE), respectively. HIGH-ACEs are associated with more chronic health problems. To date, the interaction between ACEs and burn injuries has not been studied. Herein, we sought to define the ACE exposure in our burn patients and its impact on early outcomes. Inpatient and outpatient adult burn survivors (≥18 years of age) were enrolled. Subjects completed surveys assessing adverse experiences (ACEs-18), needs, strengths, and resiliency at consent, and pain, depression, post-traumatic stress disorder (PTSD), and social participation surveys at 2 weeks to 3 months postinjury. Demographics, burn, and hospital course data were also collected. Chi-square and student's t-tests were used for descriptive analysis and to compare the groups (HIGH-ACE vs LOW-ACE). The HIGH-ACE group (n = 24; 45.3%) reported more depressive symptoms (P < .04) than the LOW-ACE group (n = 29, 54.7%). HIGH-ACE patients were less resilient when facing stressful events (P ≤ .02) and more likely to screen positive for probable PTSD (P = .01) and to score lower on the Life Impact Burn Recovery Evaluation Profile (LIBRE Profile), which assesses for social participation, in the domain of Family and Friends (P = .015). Our exploratory study suggests that ACE screening may help detect burn patients at risk for a more complicated recovery, thereby promoting personalized assistance in recovery.