The adverse childhood experiences checklist: Can it serve as a clinical and quality indicator?

Abstract

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.

Utility of screening for adverse childhood experiences (ACE) in children and young people attending clinical and healthcare settings: a systematic review

“…Twenty-four studies included in the review used a tool to assess for ACE as part of clinical enquiry. 4 5 7 8 38–57 Of these, 3 studies also assessed for SDH. 8 40 52 Fourteen studies were undertaken in the USA, 3 in Canada, 3 in Australia, 2 in Finland, 1 in Germany and 1 in France.…”

“… 1 Approximately 61% of adults report having experienced ACE, 2 with higher prevalence rates reported in priority populations. 3 In particular, First Nations people have been shown to experience higher rates of ACE 4 5 which has been attributed to collective, historic and intergenerational trauma and continued experiences of racism. 5 6 …”

Audit of paediatrician recognition of children's vulnerability to harm at the Royal Children's Hospital, Melbourne

“…The ROC curve suggests that eight risk factors offer the greatest sensitivity and lowest false positive rate for paediatrician recognition of vulnerability. An EMR‐generated checklist could be used to automatically identify vulnerability 29 …”

“…An EMR-generated checklist could be used to automatically identify vulnerability. 29 Referrals for those children identified as vulnerable were predominantly to mental health and child protective services, with few to social work. There is a large body of evidence for various therapeutic interventions 30 but paediatrician knowledge and limited access to services might have affected referral patterns in this cohort.…”

Adverse childhood experiences—household stressors and children’s mental health: a single centre retrospective review

“…Open access circumstances in Australia. [12][13][14] Whereas research into ACEs and adult mental health has necessarily been largely retrospective, there is increasing interest in behavioural and emotional problems in children whose ACEs may be ongoing. Much research on ACEs in childhood has looked at the combined effects of abuse, neglect and household stressors 1 10 11 15 ; instead, this paper focuses on possible associations between mental health symptomatology in childhood and household stressor ACEs in the absence of apparent abuse and neglect.…”