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Adverse Childhood Experiences

NOMINATED TOPIC | January 31, 2019

1. Describe your topic: Our topic of interest is adverse childhood experiences (ACEs), and we are suggesting that the AHRQ Effective Health Care Program review the evidence surrounding the prevention, screening, and intervention for children and adults with high ACE scores. We are interested in all interventions (e.g., behavioral health, population-based approaches, etc) and both health and well-being outcomes (e.g., chronic disease, substance abuse, quality of life, etc). Our key questions are listed below.

  1. Is there evidence that adverse childhood experiences (ACEs) can be prevented?
    1. At the community level?
    2. At the individual level?
  2. Is there evidence that supports screening for ACEs?
    1. In children?
    2. In adults?
  3. Is there evidence for effective interventions for a variety of outcomes (e.g., health outcomes, well-being, quality of life, etc) in those with elevated ACE scores?
    1. In children?
    2. In adults?

==Importance of Suggested Topic==

 2. Describe why this topic is important: In 1998, Kaiser Permanente and the Centers for Disease Control and Prevention published the first paper on childhood abuse and neglect and later-life outcomes. Their investigation demonstrated that as the number of ACEs increased, so did the risk of negative health and well-being outcomes across the life course, such as substance abuse, chronic disease, and decreased life expectancy. Since 1998, a large body of evidence has developed which connects the biology of stress, as triggered by adverse childhood experiences, with the following: early childhood development; genetic and protein expression; neurologic and endocrine development; proinflammatory pathways; immune depression; negative psychological sequelae; educational, social and legal failure; workplace failure; epigenetics; and intergenerational transmission.

3. Tell us why you are suggesting this topic: Given the impact that ACEs can have on the health outcomes and well-being of an individual and the population, understanding and addressing them should be a national health priority. In addition, our country is currently amid an opioid outbreak, and there is a strong correlation between ACEs and opioid addiction. As such, recent opioid legislation passed by Congress includes the creation of an interagency task force to identify trauma-informed best practices and grants for trauma-informed practices in schools. Thus, having evidence that supports the development of these models of care is essential.

Target date: July 2020

==Impact of a New Evidence Report==

4. Describe what you are doing currently and what you are hoping will change because of a new evidence report.: Currently, there is a large body of evidence that supports various tools and interventions for screening for and addressing ACEs, however, no clinical recommendations for screening and interventions for high ACEs exist. As a result, there is tremendous variation in current practices, and some healthcare providers may not feel comfortable incorporating screening for ACEs into their normal care processes due to lack of knowledge of appropriate evidence-based follow-up interventions. Understanding of effective 1) prevention of ACEs 2) screening of ACEs and 3) interventions once high ACEs are identified is critical. 

5. How will you or your group use the information from a new evidence report? The American College of Preventive Medicine (ACPM) has approved the development of a practice statement that will provide specific recommendations to healthcare providers and health care systems for screening for and managing patients with high ACE scores. In addition, many state agencies and health systems are actively implementing Trauma Informed Care approaches and started to screen for ACEs. An AHRQ review would sythesize the available evidence and help to create a national understanding of what are the most effective preventive and treatment interventions.

6. How would you or your group plan to disseminate information from the report? Who would you plan to disseminate it to? The evidence report that will be drafted by AHRQ will serve as the foundation for our ACPM practice statement. Individuals in our group would also take this to our respective health systems and institutions to inform work on Trauma Informed Care and ACEs screening.

==Other Stakeholders Who Could Use a New Evidence Report==

7. Do you know of organizations that could use an evidence report to change clinical practice? Are you a part of, or have you been in contact with, any organizations that might implement the research findings of an evidence report? National agencies like the Substance Abuse and Mental Health Services Administration (SAMSHA) has prioritized Trauma Informed Interventions and this report would presumably be of interest. Other large medical organizations, such as the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Physicians, could use an evidence report to also develop position statements for their respective associations. Health care systems who are interested in implanting ACEs screening and trauma informed care could use this evidence review to guide interventions.  In addition, as local and state health departments and community organizations apply for funding opportunities to address ACEs and build trauma informed communities, they can leverage this information in their grant applications.

Page last reviewed September 2019
Page originally created January 2019

Internet Citation: Adverse Childhood Experiences. Content last reviewed September 2019. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD.

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