Journal
JOURNAL OF THE AMERICAN BOARD OF FAMILY MEDICINE
Volume 29, Issue 3, Pages 303-307Publisher
AMER BOARD FAMILY MEDICINE
DOI: 10.3122/jabfm.2016.03.150310
Keywords
Adult Survivors of Child Adverse Events; Child Abuse; Primary Health Care; Screening; Social Determinants of Health
Categories
Funding
- National Center for Advancing Translational Sciences of the National Institutes of Health [UL1TR001086]
Ask authors/readers for more resources
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. Conclusions: Incorporation of ACE screening during routine care is feasible and merits further study. ACE screening offers clinicians a more complete picture of important social determinants of health. Primary care-specific interventions that incorporate treatment of early life trauma are needed.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available