Date of Award

January 2025

Document Type

Open Access Thesis

Degree Name

Doctor of Nursing Practice (DNP)

Department

Yale University School of Nursing

First Advisor

Monica Ordway

Abstract

Children and adolescents exposed to adverse childhood experiences (ACEs) and negative social determinants of health (SDoH) have an increased risk of developing pediatric obesity. The American Academy of Pediatrics Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents with Obesity (2023) recommends assessing these factors in children with obesity. At a School-Based Health Center (SBHC), the standard of care for pediatric obesity did not include ACEs and SDoH screening, highlighting a gap in practice. This Doctor of Nursing Practice project developed, implemented, and evaluated a patient-centered pediatric obesity protocol incorporating ACEs, SDoH screening, and referrals to patient-centered medical home (PCMH) services during SBHC nutrition visits. A quality improvement design was used. The project was implemented in an urban K-8 SBHC. A chart review of 20 pre-implementation and 33 post-implementation visits for children aged 10–15 years was conducted. Fisher’s exact test assessed changes in referral rates, and descriptive statistics evaluated acceptability, appropriateness, and feasibility. Post-implementation, 76% (n=25) of patients screened positive for at least one ACE or SDoH risk factor, compared to none pre-implementation. There was an increase in referrals to Nutrition (p<0.05), Care Coordination (p=0.25), and Behavioral Health (p=0.33) Departments. Staff reported the protocol as acceptable, appropriate, and feasible. Findings suggest that implementing a site-specific, guideline-aligned protocol can effectively identify ACEs and SDoH risk factors associated with pediatric obesity and increase referrals to supportive services within a PCMH. Identifying these risks is crucial for comprehensive obesity care and for mitigating long-term obesity-related health outcomes in children.

Comments

This is an Open Access Thesis.

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