Screening for Adverse Childhood Exposures

Abstract

<p>Introduction:<br> Adverse Childhood Exposures (ACEs) were first identified by Felitti et al. through surveys sent to 9,508 respondents. More than half of the respondents had exposure to at least one ACE. Furthermore, there was a graded relationship between the number of ACEs experienced and the odds ratio for experiencing adverse health outcomes such as severe obesity, ischemic heart disease, any cancer, stroke, etc.<p/>

<p>Objectives:<br> Increase community awareness about the significance of ACEs<br> Increase provider engagement in administering ACE screening questionnaires and providing appropriate interventions<br> Increase patient engagement in completing ACE screening questionnaires<p/> <p>Methods:<br> When Kaiser Permanente West Oahu Medical Office at Kapolei began screening for ACEs, all the screening questionnaires were completely negative. The Pediatric ACEs and Related Life Events Screener (PEARLS) questionnaires were being given at the front desk attached to the routine one year questionnaire without any explanation or cover letter. We hypothesized that the inclusion of a cover letter and re-ordering the items on the PEARLS would improve patient engagement and comfort with responding.<p/>

<p>Results:<br> De-identified responses to ACEs screening questionnaires were recorded from the beginning of administration throughout the implementation of both the cover sheet and the re-orderd PEARLS. The average total scores for the original PEARLS, cover sheet with the original PEARLS, and cover sheet with revised PEARLS was recorded. The re-ordered PEARLS given with a cover sheet had the highest average total score, followed by PEARLs given with a cover sheet, then PEARLS given without a cover sheet.<p/>

<p>Conclusion:<br> The implementation of a cover sheet and re-ordering the items on the PEARLS seemed to improve patient engagement with the questionnaires, suggesting that these alterations may increase patient comfort in disclosing ACEs. For patients who responded to the questionnaires, appropriate referrals and resources were provided.<p/>

<p>Desired impact:<br> This project was created to encourage health professionals to consider the relationship between ACEs and pediatric patient health and how questionnaires addressing sensitive topics may be administered for optimal patient engagement.<p/>

<p>Vincent J Felitti, Robert F Anda, Dale Nordenberg, David F Williamson, Alison M Spitz, Valerie Edwards, Mary P Koss, James S Marks, Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study, American Journal of Preventive Medicine, Volume 14, Issue 4, 1998, Pages 245-258, ISSN 0749-3797, https://doi.org/10.1016/S0749-3797(98)00017-8.<br> Petruccelli K, Davis J, Berman T. Adverse childhood experiences and associated health outcomes: A systematic review and meta-analysis. Child Abuse Negl. 2019;97:104127. doi:10.1016/j.chiabu.2019.104127<br> Zhang X, Monnat SM. Racial/ethnic differences in clusters of adverse childhood experiences and associations with adolescent mental health. SSM - population health. 2022;17:100997-100997. doi:10.1016/j.ssmph.2021.100997<p/>