Methods to Assess Adverse Childhood Experiences of Children and Families: Toward Approaches to Promote Child Well-being in Policy and Practice.
Methods to Assess Adverse Childhood Experiences of Children and Families: Toward Approaches to Promote Child Well-being in Policy and Practice.
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DOI：
10.1016/j.acap.2017.04.161
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发表时间：
2017-09
影响因子：
3.1
通讯作者：
Braveman P
中科院分区：
文献类型：
--
作者：
Bethell CD;Carle A;Hudziak J;Gombojav N;Powers K;Wade R;Braveman P
人类发展科学的进步指出，通过积极支持安全，稳定和养育家庭关系（SSNR），教授弹性，并及早干预以促进愈合与SSNR中断相关的创伤和压力，可以促进儿童健康发展和终身福祉。评估SSNR的潜在破坏，如不良童年经历（ACE），有助于评估创伤和慢性和毒性应激的风险。询问ACE有助于预防和减轻对儿童发展以及儿童和家庭福祉的负面影响。存在许多评估ACE的方法，但尚未进行比较。全国儿童健康调查（NSCH）现在测量儿童的ACE，但需要进一步的评估和验证。我们确定并比较了评估儿童和家庭ACE的方法，评估了新的NSCH-ACE措施的可接受性和有效性，并确定了评估ACE在研究和实践中的影响。在确定的14种ACE评估方法中，5种已用于临床环境（与公共卫生评估或研究相比），除1种外，所有方法均要求自我或父母报告（3种允许儿童报告）。在各种方法中，评估了6至20个结构，其中4个是共同的：父母监禁，家庭暴力，家庭精神疾病/自杀，家庭酒精或药物滥用。常见的其他内容包括评估暴露于邻里暴力，欺凌，歧视或父母死亡。所有方法都使用数字累积风险评分方法。的NSCH-ACE措施是可以接受的受访者作为证据的几个缺失值，并没有减少响应率归因于询问儿童的ACE。在NSCH中评估的9种ACE同时发生，大多数有1种ACE的儿童有额外的ACE。验证性因素分析和潜在类别分析支持累积风险评分方法。形成性和反射性测量模型进一步支持累积风险评分，并提供NSCH-ACE预测有效性的证据。ACE在家庭收入群体中的共同影响证实了与经济状况不同的信息，并建议使用全人群与高风险的方法来评估ACE。虽然存在重要的差异，可用的ACE测量方法是相似的，并显示出一致的关联，在缺乏保护因素和弹性较差的健康结果。所有的方法审查似乎符合更广泛的目标，以促进健康教育，促进健康，并在需要时，以减轻创伤，慢性压力，行为和情绪后遗症，可能会出现接触ACE。在基于人群和临床研究的背景下进行评估ACE似乎可以接受的个人和家庭。尽管迄今为止的研究和神经生物学发现迫使在临床环境中对ACE进行早期识别和健康教育，但需要进一步研究以指导儿科实践，特别是因为它涉及区分ACE评估与识别当前家庭心理社会风险和儿童虐待。在这项研究中进行的反射以及形成的心理测量分析证实使用累积风险评分的NSCH-ACE措施。即使儿童没有接触过ACE，评估ACE作为一种教育工具也具有价值，可以让家庭和儿童了解SSNR的重要性以及如何识别和管理压力并学习恢复力。
Advances in human development sciences point to tremendous possibilities to promote healthy child development and well-being across life by proactively supporting safe, stable and nurturing family relationships (SSNRs), teaching resilience, and intervening early to promote healing the trauma and stress associated with disruptions in SSNRs. Assessing potential disruptions in SSNRs, such as adverse childhood experiences (ACEs), can contribute to assessing risk for trauma and chronic and toxic stress. Asking about ACEs can help with efforts to prevent and attenuate negative impacts on child development and both child and family well-being. Many methods to assess ACEs exist but have not been compared. The National Survey of Children’s Health (NSCH) now measures ACEs for children, but requires further assessment and validation. We identified and compared methods to assess ACEs among children and families, evaluated the acceptability and validity of the new NSCH-ACEs measure, and identified implications for assessing ACEs in research and practice. Of 14 ACEs assessment methods identified, 5 have been used in clinical settings (vs public health assessment or research) and all but 1 require self or parent report (3 allow child report). Across methods, 6 to 20 constructs are assessed, 4 of which are common to all: parental incarceration, domestic violence, household mental illness/suicide, household alcohol or substance abuse. Common additional content includes assessing exposure to neighborhood violence, bullying, discrimination, or parental death. All methods use a numeric, cumulative risk scoring methodology. The NSCH-ACEs measure was acceptable to respondents as evidenced by few missing values and no reduction in response rate attributable to asking about children’s ACEs. The 9 ACEs assessed in the NSCH co-occur, with most children with 1 ACE having additional ACEs. This measure showed efficiency and confirmatory factor analysis as well as latent class analysis supported a cumulative risk scoring method. Formative as well as reflective measurement models further support cumulative risk scoring and provide evidence of predictive validity of the NSCH-ACEs. Common effects of ACEs across household income groups confirm information distinct from economic status is provided and suggest use of population-wide versus high-risk approaches to assessing ACEs. Although important variations exist, available ACEs measurement methods are similar and show consistent associations with poorer health outcomes in absence of protective factors and resilience. All 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. Assessing ACEs appears acceptable to individuals and families when conducted in population-based and clinical research contexts. Although research to date and neurobiological findings compel early identification and health education about ACEs in clinical settings, further research to guide use in pediatric practice is required, especially as it relates to distinguishing ACEs assessment from identifying current family psychosocial risks and child abuse. The reflective as well as formative psychometric analyses conducted in this study confirm use of cumulative risk scoring for the NSCH-ACEs measure. Even if children have not been exposed to ACEs, assessing ACEs has value as an educational tool for engaging and educating families and children about the importance of SSNRs and how to recognize and manage stress and learn resilience.
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影响因子：
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