BRD 7552 In the U S surveillance of ACEs

In the U.S., surveillance of ACEs has garnered traction at the state level through administration of the ACE Optional Module in CDC’s Behavioral Risk Factor Surveillance System (BRFSS) (Centers for Disease Control & Prevention, 2003). Since 2009, select states have implemented the ACEs optional module to gather population-level data. The BRFSS includes multiple chronic disease indicators, which can help states understand the association of ACEs with outcomes that are of public health priorities, as demonstrated in the original ACE Study (Felitti et al., 1998). It should be noted, that as early as 2002, states such as Texas, administered ACE questionnaire as part of their specific state mandate (Dube, Cook, & Edwards, 2010). These state-level data inform child welfare programs for policy and planning purposes, as well as for tracking the burden of ACEs in adults across the population. Oklahoma is state highlighted by the CDC as utilizing ACE data to inform child welfare programs (Centers for Disease Control and Prevention, 2018). Obtaining data from adult survivors is as critical as monitoring the children because we now know that a large percent of the adult BRD 7552 survive early childhood adversities and ACE exposures can be intergenerational (Dube & Rishi, 2017; Dube, Felitti, & Rishi, 2013). As early as 2005, the Army was interested in exploring universal screening for ACEs in military recruits (Robinson et al., 2008). The first step taken was to hold an expert panel with key stakeholders to solicit input about ACEs screening among military recruits, given the sensitive nature of the topic. The expert panel proposed and conducted a feasibility and acceptability study among active duty military personnel and their spouses. The study utilized the emic perspective to understand attitudes about being asked about ACEs on military recruit health assessments. The study found that participants were hesitant about the inclusion of ACE questions on the new recruit health assessments as they were unsure what services and interventions were available. While they were not in favor of ACEs screening, they were in favor of mental health screening. The research conducted at that point in time indicated that from the perspective of military personnel, it was too early for universal ACEs screening within the Army. Although carried out almost 10 years ago, the study supports the cautions that Finkelhor raises: military personnel voiced concern about providing information about ACEs. Moreover, the study also underscores the importance of conducting formative research using a community-engaged emic approach to assess costs and benefits to the population that is to undergo the routine and systematic universal screening. In an attempt to untangle the various methodological issues related to ACEs screening, Bethell et al. (2017) examined 14 separate ACEs instruments to evaluate how they might vary with respect to assessment (Bethell et al., 2017). The authors concluded that in the absence of protective factors, the instruments demonstrated consistent associations with negative health outcomes, although there were observed variations across the instruments. The ACE assessments methods reviewed appear to coincide with broader goals to facilitate health education, promote health and, where needed, to mitigate the trauma, chronic stress, and behavioral and emotional sequelae that can arise with exposure to ACEs. In their study, they found that assessing ACEs appears acceptable to individuals and families when conducted in population-based and clinical contexts. This study along with Robinson et al emphasize that the field is aware of the need to systematically investigate the feasibility of ACEs screening across a variety of target populations and settings (Bethell et al., 2017; Robinson et al., 2008).
Recognition of a public health crisis In 2012, the American Academy of Pediatrics, 2018 (AAP) released a Technical Report and Policy Statement on Childhood Toxic Stress (American Academy of Pediatrics, 2012a, 2012b). The documents guide ethical action to address and prevent childhood adversities and includes language about the importance of screening for ACEs and trauma. In fact, the AAP includes on their website an ACEs Questionnaire as a Promising Screening Tool (American Academy of Pediatrics, https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Screening/Pages/Screening-Tools.aspx).