Screening for Adverse Childhood Experiences in a Family Medicine Setting: A Feasibility Study

Abstract

Introduction:The role of adverse childhood experiences (ACEs) in predicting later adverse adult health outcomes is being widely recognized by makers of public policy. ACE questionnaires have the potential to identify in clinical practice unaddressed key social issues that can influence current health risks, morbidity, and early mortality. This study seeks to explore the feasibility of implementing the ACE screening of adults during routine family medicine office visits.Methods: At 3 rural clinical practices, the 10-question ACE screen was used before visits with 111 consecutive patients of 7 clinicians. Clinician surveys about the use of the results and the effect on the visits were completed immediately after the visits. The presence of any ACE risk and "high-risk" ACE scores (>4) were compared with clinician survey responses.Results: A risk of ACEs was present in 62% of patients; 22% had scores >4. Clinicians were more likely to have discussed ACE issues for high-risk patients (score 0 -3, 36.8%; score >4, 83.3%; P ‫.؍‬ 00). Clinicians also perceived that they gained new information (score 0 -3, 35.6%; score >4, 83.3%; P ‫؍‬ .00). Clinical care changed for a small proportion of high-risk patients, with no change in immediate referrals or plan for follow-up. In 91% of visits where a risk of ACEs was present, visit length increased by <5 minutes.

Physicians’ knowledge and practices regarding screening adult patients for adverse childhood experiences: a survey

“…The most frequently endorsed perceived barriers were consistent with those that have been reported previously [28,29]. This suggests another potential target for education, since available evidence suggests that screening ACEs requires less than 5 min and does not necessarily lead to new needs for mental health resources [30].…”

Adult health burden and costs in California during 2013 associated with prior adverse childhood experiences

“…Upstream efforts at screening for ACEs should begin in childhood as an approach to reduce exposure and continue into adult primary care to assure that disease prevention and management activities are cognizant of early life trauma. Numerous studies have explored the effectiveness of screening of childhood adversities in primary care, and have seen promising findings overall in improved outcomes related to healthcare costs, quality of care, feasibility, and reduced maltreatment prevalence [40][41][42][43]. However, careful consideration of clinical integration of screening for early life adversity is also important and requires ongoing research [44][45][46].…”

Parents' adverse childhood experiences and mental health screening using home visiting programs: A pilot study

“…Our home visitors used written questionnaires completed by the parents either in coordination with the home visitor or in private. The same questionnaires can be used in a clinical practice setting (Glowa, Olson, & Johnson, ) to retrieve either an isolated ACE score or to record specific items screening positive. Whether one focuses on the total number of ACEs or the specific items screening positive may depend in part on whether the goal of screening is to identify the level of risk for development of mental or physical health conditions, or to intervene immediately with resources and referral.…”