ObjectivesAdverse childhood experiences (ACE) are associated with poor short, medium and long-term health outcomes. South Western Sydney (SWS) has a large culturally diverse population, including many disadvantaged population groups. Our aims were to determine the burden of ACE in children attending community paediatric (CP) clinics using a purposefully developed ACE checklist, and explore any association with developmental health of children.MethodsWe trialled the ACE checklist in all CP clinics including child development (CD) and vulnerable child (VC) clinics between February 2017 and August 2017. Data were collated from completed ACE checklists and relevant clinical information from CP clinics. Statistical analysis was performed using SPSS and MedCalc software.ResultsOf 279 children seen in CP clinics with checklists completed for the period, 167 (60%) attended CD clinics and 112 (40%) attended VC clinics. Seventy-eight (28%) had ACE ≥4 and 178 (64%) had ACE ≥1. Of those attending CD clinics, 8 (5%) had ACE ≥4 compared with 70 (63%) attending VC clinics (p<0.001). Of all age groups, children ≥10 years of age had the highest proportion of children with ACE ≥4 (65%); significant association between age group and ACE ≥4 (p<0.001). There was a significant association between cultural background and ACE ≥4 (p<0.001); indigenous children had the highest proportion of ACE ≥4 (n=21; 64%), followed by Anglo-Australian children (55%). On logistic regression analysis, only attending VC clinics was significantly associated with ACE ≥4. There was no significant association between ACE ≥4 and developmental health.ConclusionAmong children attending CP clinics in SWS, more than a quarter had a significant burden of ACE; those attending specialised clinics for vulnerable children, those from particular ethnic groups and from older age groups, had the highest burden of ACE. Our findings support the need for specialised pathways for paediatric assessment for vulnerable, at-risk children.
Aim There is strong evidence that adverse childhood experiences (ACE) are associated with poor short‐, medium‐ and long‐term health outcomes. In South Western Sydney, we trialled a modified ACE checklist in community paediatric clinics. Our aim was to design the best version of the ACE checklist for routine clinical use to serve as both a clinical and quality indicator. Methods We trialled two versions of the modified ACE checklist based on a pre‐existing tool in child development (CD) and vulnerable child (VC) clinics over a 6‐month period in 2012 (V1) and 7‐month period in 2017 (V2). We analysed clinical and demographic data and correlated with ACE scores. We asked clinicians about the use of the ACE checklist and modified the checklist based on clinicians' recommendations. Results In phase 1, V1 was trialled in CD clinics only; 77 children were assessed, of whom 38 children (49%) had ACE score of ≥1, and 8 (10%) had a score of ≥4. In phase 2, of 279 children assessed, 178 (64%) had ACE ≥1, and 78 (28%) had ACE ≥4. In both phases, clinicians found the checklist simple to use and helpful in identifying especially vulnerable children. Conclusions The ACE checklist helps clinicians and managers identify the burden of exposure to trauma, violence and abuse of children attending paediatric clinics, both to facilitate intervention and aid service development. This version of the ACE checklist has the potential to be used across a variety of populations and settings as a clinical and quality indicator.
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