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Feasibility of Assessing Parental ACEs in Pediatric Primary Care: Implications for Practice-Based Implementation

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R. J. Gillespie
R. J. Gillespie
R. J. Gillespie
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Alonzo Folger at Cincinnati Children's Hospital Medical Center
Alonzo Folger
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Abstract

To determine the feasibility and provider acceptability of implementing assessments for parental ACEs within the context of an outpatient pediatric clinic, and to compare parental ACE detection rates between an item-level response tool and an aggregate-level response tool. A convenience sample of parents completed one of two assessment tools during their child’s four month well visit. Detection of ACE scores ≥4 was compared between the two tools. Providers conducting the assessments completed a qualitative survey describing their experiences. Detection rates were significantly higher with the use of an aggregate-level reporting tool compared to item-level tool (11.2% versus 8.1%, p = 0.013). Provider feedback on the assessment process was positive; providers reported improved clinic visits without undue burden in terms of time constraints or parental resistance to ACE assessments. Implementing parental ACE assessments is feasible with limited resources in an outpatient setting. Providers and parents appear receptive to the conversations about past trauma, and find value in including this information in their counseling during well visits. Parents appear to be more likely to disclose ACEs when a degree of privacy is given through aggregate-level versus item-level reporting.
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ORIGINAL ARTICLE
Feasibility of Assessing Parental ACEs in Pediatric Primary
Care: Implications for Practice-Based Implementation
R. J. Gillespie
1
&Alonzo T. Folger
2
Published online: 11 March 2017
#Springer International Publishing 2017
Abstract To determine the feasibility and provider acceptabil-
ity of implementing assessments for parental ACEs within the
context of an outpatient pediatric clinic, and to compare paren-
tal ACE detection rates between an item-level response tool
and an aggregate-level response tool. A convenience sample
of parents completed one of two assessment tools during their
child’s four month well visit. Detection of ACE scores ≥4was
compared between the two tools. Providers conducting the as-
sessments completed a qualitative survey describing their ex-
periences. Detection rates were significantly higher with the
use of an aggregate-level reporting tool compared to item-
level tool (11.2% versus 8.1%, p= 0.013). Provider feedback
on the assessment process was positive; providers reported im-
proved clinic visits without undue burden in terms of time
constraints or parental resistance to ACE assessments.
Implementing parental ACE assessments is feasible with limit-
ed resources in an outpatient setting. Providers and parents
appear receptive to the conversations about past trauma, and
find value in including this information in their counseling
during well visits. Parents appear to be more likely to disclose
ACEs when a degree of privacy is given through aggregate-
level versus item-level reporting.
Keywords Adverse Childhood Experiences .Resilience .
Toxic Stress
Abbreviations
ACE Adverse Childhood Experience
TCC The Children’sClinic
CD-RISC Connor-Davidson Resilience Scale
BRFSS Behavioral Risk Factor Surveillance System
Introduction
The science of Adverse Childhood Experiences (ACEs) and
toxic stress has transformed our understanding of the role of
primary care in preventing lifelong health risks and promoting
wellness across the lifespan. The original ACE study was
groundbreaking in demonstrating a connection between a
child’s early experiences and lifelong health trajectories
(Felitti et al. 1998). This connection is instinctively known
by all seasoned primary care pediatricians–that healthy devel-
opment greatly depends on a nurturing and enriching social
environment, particularly in the critical early years of devel-
opment. Pediatricians are faced with translating the science of
toxic stress into actionable steps in protecting children from a
life of physical, mental and emotional damage. In 2012, a
policy statement disseminated by the American Academy of
Pediatrics endorsed this responsibility (Garner et al. 2011). In
describing the Bnew morbidities^of pediatric healthcare, the
pediatrician has a vital role in the early identification and
management of social-emotional disturbances, and is called
to innovate on how the science of toxic stress is incorporated
into practice.
Much attention has been given to the role of mitigating the
effects of toxic stress once they have occurred; the greater
challenge lies in prevention of these life-altering and health-
altering events. Very early adversity leads to disrupted attach-
ment patterns between children and their caregivers, and this
disrupted attachment can result in disturbances in the child’s
*R. J. Gillespie
rgillespie@childrens-clinic.com
1
The Children’s Clinic, 9555 SW Barnes Road, Suite 301,
Portland, OR 97225, USA
2
Cincinnati Children’s Hospital Medical Center, College of Medicine
Department of Pediatrics, University of Cincinnati, Cincinnati, OH,
USA
Journ Child Adol Trauma (2017) 10:249–256
DOI 10.1007/s40653-017-0138-z
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... 14 Numerous studies have argued for the importance of integrating caregiver and child's ACEs screening into pediatric primary care clinic settings, given the known negative intergenerational effects and the value of early screening. [15][16][17][18][19] However, only 4% of surveyed pediatricians actively screened for ACEs. 20 Potential barriers to widespread ACEs screening implementation include limited data supporting improved outcomes for children screened for ACEs, provider concerns over potential retraumatization or overdiagnosing patients through ACEs screening, 21,22 and many health system performance factors that may be influencing a screening decision upon the whole population. ...
... Case series conducted in non-Hispanic populations have provided initial evidence that discussions regarding caregiver ACEs have positive effects on mental and physical health for the caregiver and child. 16 Providing education to caregivers about how their own ACEs can impact parenting behavior and psychological health may positively alter behavior and promote help-seeking, although this remains untested. Gaps in research exist on whether screening and discussion of ACEs can negatively impact caregiver health by increasing symptoms related to traumatic memories. ...
... Moreover, screening and discussions did not cause significant delays in clinic flow, something that has already been demonstrated in a variety of settings. 16,18,29,32 While this study focused on addressing provider hesitancy, training, and feasibility, ensuring appropriate clinical resources is key for successful ACEs screening. It is essential to establish close collaboration with organizational leadership to ensure adequate referral processes and resource guidance for positive ACEs screenings. ...
Investigating the Impact of Caregiver Adverse Childhood Experiences Screening and Pediatrician-Led Discussions on Posttraumatic Stress Disorder Symptoms in a Majority-Hispanic Pediatric Primary Care Clinic Setting
Article
Full-text available
  • Oct 2024
  • MED CARE
Background Evidence suggests that screening and provider-led discussions of parental adverse childhood experiences (ACEs) may help identify at-risk families and be linked to positive health outcomes in caregivers and their children. However, the direct effect of ACEs screening and discussions on posttraumatic stress disorder (PTSD) has yet to be studied. Objectives To determine if screening or provider-led discussions of parental ACEs are associated with inadvertent worsening of PTSD symptoms 1 week after screening. Research Design Data was obtained as part of a cluster randomized controlled trial to examine the effects of ACEs screening and provider-led discussions on child health care utilization outcomes. Baseline surveys were completed before scheduled infant well child checks (WCCs). Providers were randomized into the standard of care or intervention (discussion) conditions. Intervention providers were trained in delivering brief trauma-informed discussions about the impact of ACEs on parenting during WCCs. Subjects Caregivers in a pediatric primary care clinic serving predominantly Hispanic and low socioeconomically resourced families (N=179, 93% female, 87% Hispanic). Measures The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5), Brief Resilience Scale (BRS), and ACEs screening were completed at baseline. PC-PTSD-5 was repeated 1-week after screening. Results Mixed-effects ordinal logistic regression analysis of PTSD scores from baseline to 1-week postscreening with the full sample showed no significant effect of time [odds ratio (OR)=1.21, P =0.68], group (OR=1.68, P =0.33), or their interaction (OR=0.48, P =0.21). Conclusions Screening or brief discussion of ACEs with providers trained in trauma-informed care were not associated with worsening PTSD symptoms.
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... ACEs. The 14-item ACE Questionnaire (Felitti et al., 1998;Finkelhor et al., 2013;Gillespie & Folger, 2017) was used to assess parents' exposure to ACEs during childhood, including abuse/neglect, household dysfunction, and community violence. This questionnaire has been modified from its original version to include questions on community violence and aggregate-level responding (i.e., asking for respondents to include a total ACE score as opposed to including scores for individual ACE items), which has demonstrated increased privacy in responding and more accurate reports of ACEs (Finkelhor et al., 2013;Gillespie & Folger, 2017). ...
... The 14-item ACE Questionnaire (Felitti et al., 1998;Finkelhor et al., 2013;Gillespie & Folger, 2017) was used to assess parents' exposure to ACEs during childhood, including abuse/neglect, household dysfunction, and community violence. This questionnaire has been modified from its original version to include questions on community violence and aggregate-level responding (i.e., asking for respondents to include a total ACE score as opposed to including scores for individual ACE items), which has demonstrated increased privacy in responding and more accurate reports of ACEs (Finkelhor et al., 2013;Gillespie & Folger, 2017). Higher scores indicate higher ACE exposure. ...
Pain and Mental Health Variables for Youth With Chronic Pain: The Role of Caregiver Stress, Pain, and Resilience
Article
Full-text available
  • Mar 2025
Introduction: The primary aim of this study was to examine the way in which parent stress, including adverse childhood experiences (ACEs) and emotional distress, pain, and resilience, relates to child pain and mental health variables when families are establishing pediatric pain management care. Method: Participants included 50 parent/patient dyads who were recruited from an outpatient pediatric pain clinic. The study utilized an observational design, including self-report questionnaires (parents, youth) and chart review. Questionnaires gathered information on parent ACEs, recent emotional distress, pain, and resilience, as well as child pain, anxiety, depression, and global health. The area deprivation index was used to assess family socioeconomic disadvantage, and all data were collected in 2021. Results: Results indicated that higher levels of parent pain severity, disability, and generalized pain were associated with child pain and mental health variables, including higher levels of child generalized pain, anxiety, depression, and worse child global health. Results also indicated that high parent pain disability coupled with higher levels of ACEs increased the risk for child generalized pain. Discussion: Parent factors may impact child pain and mental health variables for youth with chronic pain. Improved understanding of the way in which these parent variables relate to child variables may provide opportunities for improved assessment and care for youth and their families.
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... Table 1 shows the demographic composition of the cohort at each of the three time periods. Across years, the majority of participants were in the oldest age category [11][12][13][14][15][16][17][18] (41.6%, 41.2%, and 40% for intervention clinics in years 2020, 2021, and 2022, respectively), followed by age 2-5 in 2020 (32.5% for intervention clinics), and 6-10 (25.9% in intervention clinics in year 2020). More children were in the 6-10 age group than 2-5 in years 2021 and 2022 (31.2% and 27.5% for intervention clinics in 2021 for age 6-10 and 2-5, respectively and 31.3% and 28.7% for intervention clinics in 2022 for age 6-10 and 2-5, respectively). ...
... While some argue that there is little evidence of the clinical utility of particular ACE scores and without evidence-based interventions that link directly to specific ACE scores there will be minimal benefit of screening [14,15]. Advocates for ACEs screening point to the importance of the screening for prompting conversations with parents about how early experiences can affect the health of their child and an avenue for gaining better information about their needs [16,17]. Although the current study does not address these issues, it does provide critical data regarding other concerns related to the capacity of behavioral health services after ACEs screening. ...
Adverse childhood experiences screening in pediatric primary care and changes in the rate of visits to social work and behavioral health
Article
Full-text available
  • Feb 2025
  • BMC Pediatr
Background There is increasing interest in screening for adverse childhood experiences in pediatric primary care, but no evidence of the actual consequences on behavioral/mental health services. This study tested the association between initiation of ACEs screening in pediatric primary care and changes in the rate of referrals to social work and visits to social work and behavioral health. Methods Data came from the electronic health records of children and adolescents between 2 and 18 years old who were members of a large integrated healthcare system serving Southern California (N = 513,812). Poisson regression was used to compare the rate of referrals and visits to social work and behavioral health visits for clinics doing standardized ACEs screening (i.e., intervention clinics; n = 28) versus clinics not screening (i.e., control clinics; n = 64) during June 1-December 31 2022 as well as for these same months in 2020 and 2021. Results Intervention clinics had an average screening rate of 57% (range 26.8 to 91.9%) and an average positive screen rate of 11% (range 1.6–25.1%). The difference in the adjusted rate from 2021 to 2022 was significantly different between intervention and control clinics for referrals to social work (RR 1.48, 95% CI 1.25, 1.74), but was not statistically different for visits to social work or behavioral health. Conclusions The findings suggest that ACEs screening does not significantly increase the rates of social work and behavioral health visits, although it did increase referrals to social work. We acknowledge that this may vary based on geographic areas and populations served by different healthcare systems.
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... Some clinicians and practices screen only for the ACEs score because some research suggests that patients are more likely to disclose ACEs when asked only to report the total number of ACEs and not information on specific types of ACEs. [15][16][17] In addition, screening only for the ACEs score among child and adolescent populations can prevent the need for mandated reporting to child protective services (CPS), which would be required if some types of ACEs were identified (eg, child abuse and neglect, children witnessing intimate partner violence in the home). Some clinicians and practices use a threshold or cutoff ACEs score (eg, $4 vs 0-3 ACEs) to identify patients they consider to be at "high risk" for poor health outcomes. ...
... 29 ACEs screening may help promote supportive and empathetic relationships between clinicians and patients. 16 ACEs screening also has the potential to facilitate earlier detection of children and adolescents exposed to ACEs, perhaps offering an opportunity to prevent additional ACEs. Last, results from ACEs screening can potentially be used to inform care, referrals, and follow-up for children, adolescents, and adults exposed to ACEs to mitigate potential negative impacts on health and well-being and to treat current health challenges possibly resulting from ACEs. ...
Screening for Adverse Childhood Experiences: A Critical Appraisal
Article
Full-text available
Adverse childhood experiences (ACEs) are common and can impact health across the life course. Thus, it is essential for professionals in child- and family-serving roles, including pediatric and adult primary care clinicians, to understand the health implications of childhood adversity and trauma and respond appropriately. Screening for ACEs in health care settings has received attention as a potential approach to ACEs identification and response. Careful examination of the existing evidence on ACEs screening and consideration, from a clinical and ethical perspective, of the potential benefits, challenges, and harms is critical to ensuring evidence-informed practice. In this critical appraisal, we synthesize existing systematic and scoping reviews on ACEs screening, summarize recent studies on the ability of ACEs to predict health outcomes at the individual level, and provide a comprehensive overview of potential benefits, challenges, and harms of ACEs screening. We identify gaps in the existing evidence base and specify directions for future research. We also describe trauma-informed, relational care as an orientation and perspective that can help pediatric and primary care clinicians to sensitively assess for and respond to ACEs and other potentially traumatic experiences. Overall, we do not yet have sufficient evidence regarding the potential benefits, challenges, and harms of ACEs screening in health care and other settings. In the absence of this evidence, we cannot assume that screening will not cause harm and that potential benefits outweigh potential harms.
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... However, the review concluded that incorporating this enquiry was not time-intensive or resource-heavy (Mishra et al., 2023). One study reported that conversations about ACEs with patients lasted between 3 and 5 min on average (Gillespie & Folger, 2017). ...
ACE Enquiry in Primary care: A Qualitative Exploration of the Perspective of General Practitioners in Northern Ireland
Article
Full-text available
  • Sep 2024
  • J Child Adolesc Trauma
This study sought to identify gaps in the current literature base by exploring the perspectives of General Practitioners (GPs) in Northern Ireland in relation to the significance, relevance, and feasibility of conducting a comprehensive inquiry into Adverse Childhood Experiences (ACEs) with patients. Semi-structured, in-depth interviews were conducted with 10 qualified GPs using Zoom Videoconferencing technology. Interviews were audio recorded and transcribed verbatim. Qualitative data was analysed using Theoretical Thematic Analysis (Braun & Clarke Qualitative Research in Psychology 3(2):77-101, 2006). Analysis revealed nine key superordinate themes. These themes encompassed various aspects such as the role of a GP, trauma-informed training, the advantages and barriers associated with conducting an ACE assessment, and the impact of childhood adversity on subsequent physical and mental health. This study provides valuable primary care professional insights that contribute to the existing evidence base. It highlights the importance of recognising, discussing, and screening for ACEs in primary care settings. Furthermore, this study explores a range of practical adjustments that could support the implementation of routine ACE enquiry within the primary healthcare system in Northern Ireland.
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A Chronic Stress and Wellbeing Screening Implementation Initiative in Pediatric Primary Care
Article
  • Apr 2025
Chronic childhood stress – adverse childhood experiences (ACEs), social drivers of health (SDOH), and trauma – is associated with negative health outcomes across the lifespan. Early identification supports whole-child wellbeing and enables families to connect to resources. Pediatric primary care represents an ideal avenue for these efforts given its wide reach and the trusting relationships providers form with families. This paper reports on the chronic stress portion of a quality improvement initiative to implement a comprehensive screening tool for children ages 0-5 at well-child checks (WCCs) in a rural academic medical center. Between June 2023 and April 2024, caregivers of 1,754 unique patients (89.0% White; 49.7% female) completed the screener at 2,787 of 3,470 total WCCs (80%). Overall, 14% of caregivers reported on their child’s experience of early adversity (14%), unmet SDOH needs (20%), and potential trauma (14% of children ages 3-5). Parents only skipped 0.4-5.8% of early adversity, SDOH, and trauma questions. Early adversity and SDOH were significantly weakly correlated, suggesting that these constructs capture related yet unique variance describing chronic stress. After implementation, average monthly pediatric resource team referrals did not change, but the percentage of referrals for young children significantly increased. The first year of data supports the potential for screening initiatives to identify social and material needs, improve health equity, and increase access to community resources.
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Adverse Childhood Experiences in Mental Health Outcomes
Chapter
  • Oct 2024
Research over the last two decades has established Adverse Childhood Experiences (ACEs) as one of the most important determinants of mental and physical health outcomes over the lifespan. Despite compelling evidence, the integration of Adverse Childhood Experiences (ACEs) or trauma-informed approaches into public health policies and healthcare services has been slow, underscoring the urgent need for heightened awareness and advocacy. This chapter provides an in-depth exploration of ACE studies, beginning with their origins, followed by discussions on defining ACEs and exploring various types. Subsequently, the chapter scrutinizes the evidence linking ACE exposure to prevalent mental health conditions, with a special focus on recent evidence from Asian and African countries. Finally, it synthesizes potential biological and psychological mechanisms through which ACEs get “under the skin.”
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Parent Perspectives on Social Risk Screening in the PICU
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  • PEDIATR CRIT CARE ME
Objective Health inequities are widespread and associated with avoidable poor health outcomes. In the PICU, we are increasingly understanding how health inequities relate to critical illness and health outcomes. Experts recommend assessing for health inequities by screening for social determinants of health (SDOH) and adverse childhood experiences (ACEs); however, guidance on screening is limited and screening has not been universally implemented. Our study aimed to understand parent perspectives on screening for SDOH/ACEs in the PICU, with the primary objective of determining whether screening would be acceptable in this setting. Design We conducted a qualitative study using semistructured interviews with a convenience sample of eleven PICU parents between November 2021 and January 2022. Setting Urban, quaternary free-standing children’s hospital. Subjects Parents of children with a PICU hospitalization between November 2020 and October 2021. Interventions None. Measurements and Main Results Domains of interest included experience with and attitudes toward SDOH/ACEs screening, perspectives on addressing needs with/without resources and their relationship to health, and recommendations for screening. Interviews were transcribed verbatim and coded with an inductive approach using thematic analysis and constant comparative methods. Ann & Robert H. Lurie Children’s Institutional Review Board approved this study (2021- 4781, Approved September 13, 2021). Ten participants found SDOH/ACEs screening to be acceptable and valuable in the PICU, even for topics without a readily available resource. Participants did not have broad experience with ACEs screening, though all believed this provided the medical team with valuable context regarding their child. Ten participants recommended screening occur after their child has been stabilized and that they are notified that screening is universal. Conclusions Participants found screening for SDOH/ACES to be acceptable and valuable in the PICU. Families have important insight that should be leveraged to improve the support of unmet needs through the development of strengths-based, parent-informed screening initiatives.
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Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician: Translating Developmental Science Into Lifelong Health
Article
Full-text available
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This Policy Statement was revised. See https://doi.org/10.1542/peds.2021-052582 Advances in a wide range of biological, behavioral, and social sciences are expanding our understanding of how early environmental influences (the ecology) and genetic predispositions (the biologic program) affect learning capacities, adaptive behaviors, lifelong physical and mental health, and adult productivity. A supporting technical report from the American Academy of Pediatrics (AAP) presents an integrated ecobiodevelopmental framework to assist in translating these dramatic advances in developmental science into improved health across the life span. Pediatricians are now armed with new information about the adverse effects of toxic stress on brain development, as well as a deeper understanding of the early life origins of many adult diseases. As trusted authorities in child health and development, pediatric providers must now complement the early identification of developmental concerns with a greater focus on those interventions and community investments that reduce external threats to healthy brain growth. To this end, AAP endorses a developing leadership role for the entire pediatric community—one that mobilizes the scientific expertise of both basic and clinical researchers, the family-centered care of the pediatric medical home, and the public influence of AAP and its state chapters—to catalyze fundamental change in early childhood policy and services. AAP is committed to leveraging science to inform the development of innovative strategies to reduce the precipitants of toxic stress in young children and to mitigate their negative effects on the course of development and health across the life span.
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Trauma-Focused Child-parent Psychotherapy in a Community Pediatric Clinic: A Cross-Disciplinary Collaboration
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  • Dec 2013
The present chapter presents an innovative model of community-based, multi-disciplinary collaboration among pediatricians, social workers, and clinical psychologists working together to address the impact of trauma on the physical and mental health of their patients. Early childhood traumatic experiences are profoundly disruptive to the attachment–caregiving system that regulates the Child-parent relationship and that has the function of providing protection and the sense of safety needed to facilitate normal development. Such disruptions, especially those experienced by both caregiver and child, can lead to profound changes in the developmental functioning of the child and result in poor outcomes later in life. There is growing research evidence that trauma-focused psychotherapy addressing the mental health sequelae of early trauma can lead to significant improvements in the child, the caregiver, and the caregiver–child relationship. This chapter includes a brief review of the impact of trauma on the parent–child relationship as well as a discussion of the importance of using a treatment approach informed by attachment theory, psychoanalysis, knowledge about the impact of trauma, and cultural and contextual considerations. A clinical illustration is provided to highlight the advantages of this integrative approach in the unique setting of a community pediatric clinic. The collaboration is dedicated to the trauma-informed integration of physical and psychological care of children and families living in a neighborhood affected by historical trauma as well as current, community and intergenerational violence, poverty, and scarcity of supportive resources. Specific approaches to engaging hard to reach families are explored.
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Exploring Parents’ Adversities in Pediatric Primary Care
Article
  • Feb 2016
The Viewpoint explores the benefits and risks of screening parents for adverse childhood experiences.Recent attention focused on the effect of adverse childhood experiences (ACEs) provides important support for a life course perspective to health. However, the growing popularity of screening parents for ACEs requires consideration of its benefits and consequences. This Viewpoint explores potential issues associated with parental ACE screening. Although the focus of this Viewpoint is on parental ACE screening, similar and additional concerns (eg, possible need to involve child protective services) arise for child ACE screening. We also offer an alternative approach, grounded in evidence. Specifically, parents should be screened for current psychosocial issues like intimate partner violence, mental health problems, and substance use, all of which are common distal consequences of ACEs. Each has effective interventions. Education should be provided to all parents about how a prior adversity can affect their health, parenting behaviors, and relationships with their children. These discussions should occur in the context of trusting parent-clinician relationships; recognizing parents’ strengths; and encouraging safe, stable, and nurturing relationships with their children.
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Adverse Experiences in Early Childhood and Kindergarten Outcomes
Article
Objective: To examine associations between adverse childhood experiences (ACEs) in early childhood and teacher-reported academic and behavioral problems in kindergarten. Methods: We conducted a secondary analysis of data from the Fragile Families and Child Wellbeing Study, a national urban birth cohort. Subjects with primary caregiver-reported information on ACE exposures ascertained at 5 years and teacher-reported outcomes at the end of the child's kindergarten year were included. Outcomes included teacher ratings of academic skills, emergent literacy skills, and behavior. We included 8 ACE exposures on the basis of the original Centers for Disease Control and Prevention Kaiser study and created an ACE score by summing individual adversities. We examined the associations between teacher-reported academic and behavioral outcomes and ACE scores by using logistic regression. Results: In the study sample, 1007 children were included. Fifty-five percent had experienced 1 ACE and 12% had experienced ≥ 3. Adjusting for potential confounders, experiencing ≥ 3 ACEs was associated with below-average language and literacy skills (adjusted odds ratio [AORs]: 1.8; 95% confidence interval [CI]: 1.1-2.9) and math skills (AOR: 1.8, 95% CI: 1.1-2.9), poor emergent literacy skills, attention problems (AOR: 3.5, 95% CI: 1.8-6.5), social problems (AOR: 2.7, 95% CI: 1.4-5.0), and aggression (AOR: 2.3, 95% CI: 1.2-4.6). Conclusions: In this study of urban children, experiencing ACEs in early childhood was associated with below-average, teacher-reported academic and literacy skills and behavior problems in kindergarten. These findings underscore the importance of integrated approaches that promote optimal development among vulnerable children.
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Primary Care Interventions to Prevent or Treat Traumatic Stress in Childhood: A Systematic Review
Article
  • Sep 2015
Objectives: To systematically assess the evidence base for prevention and treatment of child traumatic stress in primary care settings. Data sources: PubMed, Embase, PsycINFO, Scopus, Academic Search Complete, CINAHL, Web of Science, Cochrane Library, the National Registry of Evidence-based Programs and Practices, the National Child Traumatic Stress Network website, Google search. Study eligibility criteria, participants, and interventions: Studies were eligible for inclusion if they described the results of intervention studies in a primary care setting addressing child traumatic stress. Study participants could include primary care providers, pediatric patients, and their parents or other caregivers. Study appraisal and synthesis methods: Each study was assessed for inclusion, and each included study was assessed for risk of bias by 2 reviewers. Results: We found 12 articles describing 10 different studies that met the inclusion criteria. The intervention approaches taken in the studies were diverse and included the implementation of screening programs or tools, training clinicians to recognize and discuss psychosocial issues with patients and their families, and providing primary care professionals with community resource lists. Nine out of 10 studies included in the review reported favorable results. Limitations: Studies included in the review had relatively short follow-up periods, and the diversity of studies identified precluded the possibility of conducting a meta-analysis. Conclusions and implications of key findings: Findings suggest that interventions in pediatric primary care settings are feasible and can favorably affect clinical practices and families' outcomes.
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Pediatric Adverse Childhood Experiences: Implications for Life Course Health Trajectories
Article
  • Sep 2015
lems have their origins early in life. 1 The timing, intensity, and cumulative burden of adversities, especially in the relative absence of protective factors, can affect gene expression, the conditioning of stress responses, and the development of immune system function. Individuals affected by a high burden of adverse experiences may adopt compensatory high-risk behaviors that can further erode their health and mental health. Not all adversity occurs in childhood(eg,military combat),but a highburden of cumulative intrafamilial (child maltreatment, domestic violence, impaired caregiving) and other adversities (income and food insecurity) in childhood can have profound lifelong effects unless mitigated by protective factors within the family or the community, or through specific interventions. Two of the articles in this issue indicate that the impact of intrafamilial adverse childhood experiences (ACEs) on health and mental health begin to manifest in childhood. Kerker et al 2 used the nationally representative longitudinal National Survey of Child and Adolescent Well-Being study toassessthe ACEscoresofchildrenunder theageof6years who remained at home after child protective investigation and found they were similar to those of children who were removed and placed in foster/kinship care. The authors also reported that higher ACE scores in this population were associated with more mental health (Child Behavior Checklist score >64) and chronic medical problems, and, for preschool children, lower social scores. Earlier studies of children informally placed with kinship caregivers after child welfare investigation showed a high prevalence of health problems, although fewer mental health problems, compared to children in nonrelative foster care, indicating that almost all children involved with child welfare are at high risk for poor outcomes that may be rooted in cumulative childhood trauma. 3 In a second article in this issue, Thompson et al 4 used LONGSCAN longitudinal data to
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Association of Parental Adverse Childhood Experiences and Current Child Adversity
Article
  • Jun 2015
This research letter discusses the importance of screening for parental adverse childhood experiences on child adversity. Prompted by a growing body of evidence demonstrating the significant lifelong effect of adverse childhood experiences (ACEs) and toxic stress, health care professionals have begun to address these issues more directly.¹- 3 The parental history of ACE may serve as a marker of risk for child adversity, thus offering opportunities for early intervention to prevent ACE or ameliorate the negative outcomes associated with ACE. However, associations between parental ACE and child adversity are not well described. Previous studies primarily examine associations between maternal childhood maltreatment and child behavioral health. This study examined associations between parental ACE and child current adversity.
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Intergenerational transmission of child abuse and neglect: Real or detection bias?
Article
  • Mar 2015
  • SCIENCE
The literature has been contradictory regarding whether parents who were abused as children have a greater tendency to abuse their own children. A prospective 30-year follow-up study interviewed individuals with documented histories of childhood abuse and neglect and matched comparisons and a subset of their children. The study assessed maltreatment based on child protective service (CPS) agency records and reports by parents, nonparents, and offspring. The extent of the intergenerational transmission of abuse and neglect depended in large part on the source of the information used. Individuals with histories of childhood abuse and neglect have higher rates of being reported to CPS for child maltreatment but do not self-report more physical and sexual abuse than matched comparisons. Offspring of parents with histories of childhood abuse and neglect are more likely to report sexual abuse and neglect and that CPS was concerned about them at some point in their lives. The strongest evidence for the intergenerational transmission of maltreatment indicates that offspring are at risk for childhood neglect and sexual abuse, but detection or surveillance bias may account for the greater likelihood of CPS reports. Copyright © 2015, American Association for the Advancement of Science.
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