Screening for Adverse Childhood Experiences among Migrant Children
School of Nursing alumna Natasha Fevry’s quality improvement project supports migrant children and their access to mental health care.
Natasha Fevry, DNP’24, PMHNP-BC, recently published her DNP project, “Implementing an Adverse Childhood Experiences Screening Tool With Migrant Children: A Quality Improvement Project Using the PEARLS Screening Tool,” in the Journal of Pediatric Health Care with faculty members Sean Convoy and Melinda Teague and retired faculty member Julee Waldrop.
The aim of the project was to implement an adverse childhood experiences (ACE) screening questionnaire for all migrant children aged 19 years or younger in a community shelter.
ACEs are negative events that occur in a child’s life like abuse, neglect, and family dysfunction, which can affect them into adulthood. ACEs can also encompass the stress, vulnerability, and trauma experienced at various stages of migration, placing migrant children at an increased risk of poor mental health.
“Growing up as the child of migrant parents, I witnessed firsthand the challenges that come with displacement, cultural adjustment, and access to care,” said Fevry. “These experiences, coupled with the research linking ACEs to long-term mental and physical health outcomes, inspired me to focus on this vulnerable population.”
“I wanted to ensure that migrant children receive the early support they need to thrive, despite the challenges they face,” Fevry added.
According to the Centers for Disease Control and Prevention (CDC), ACEs are related to an increased risk of acquiring seven of 10 of the leading causes of death in the United States, such as cancer, diabetes, heart disease, suicide, and drug overdose. And despite facing increased mental risks, as Fevry and fellow authors pointed out, immigrants are 50% less likely to access mental health services than those born in the United States.
For the scope of her project, Fevry worked with a shelter in Massachusetts which houses approximately 162 migrant family from Haiti, Brazil and Chile; in coordination with their clinical team, she implemented the Pediatric ACEs and Related Life Events Screener over 10 weeks.
Ahead of screener implementation, educational sessions ensured that the clinical team had the necessary information about ACEs as well as the use of screening tools and algorithms. Once evaluated, migrant children who reported multiple ACEs participated in an educational session or were referred for further mental health services.
“Interdisciplinary collaboration ensured a holistic approach to care,” said Fevry. “By combining the expertise of social workers, mental health providers, and pediatric specialists, we were able to create comprehensive care plans that addressed both the emotional and physical well-being of the children.”
In addition, Fevry says that the team relied on feedback from community leaders and families, adapting the screening tool to be more accessible. They also incorporated trauma-informed care principles to reduce stigma and promote trust.
According to project findings, every child evaluated with the PEARLS questionnaire reported at least one adverse event, demonstrating the migrant population’s vulnerability to potential negative health outcomes. Fevry and her co-authors further concluded that future ACEs may be preventable with early detection and education.
“This project deepened my understanding of the importance of early intervention and the need for culturally sensitive care. It reinforced the idea that addressing mental health in vulnerable populations requires not just clinical care but also community engagement and policy advocacy,” said Fevry.