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

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. 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. 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.