OBJECTIVES: Our purpose in this study was to adapt and validate the Traumatic Events Screening Inventory (TESI) as a primary-care childhood adversity screening tool for children living in vulnerable neighborhoods using a community-partnered approach.METHODS: In this cross-sectional, descriptive study, we used a sample of 261 children (3-16 years old) who were seeking services at a Federally Qualified Health Center with colocated behavioral health services in Chicago and had a positive Pediatric Symptom Checklist screen result or received a referral for behavioral health evaluation. The TESI was adapted as a screening tool to be sensitive to adverse childhood experiences (ACEs) unique to the clinic communities. ACEs were mapped by zip code with objective neighborhood crime data, and latent class analysis was performed to identify ACE subgroups. RESULTS:The mapping validation suggested face validity for geographic overlap between participant ACEs and objective violent-crime occurrence. With latent class analysis, we identified 3 ACE subgroups: (1) high ACE (18.0% of the sample; polyvictimization and/or maltreatment), (2) moderate ACE (52.1%; violent environments), and (3) low ACE (29.9%; few adverse experiences). Membership in the high-ACE subgroup was associated with higher odds of a clinically significant Pediatric Symptom Checklist score (odds ratio = 3.83) and clinical-level attention problems (odds ratio = 3.58) even after accounting for child resilience and parent depression.CONCLUSIONS: ACEs play a significant role in predicting a need for behavioral health services among children seeking primary-care services. The community-adapted TESI is a valid ACE screening tool.WHAT'S KNOWN ON THIS SUBJECT: Adverse childhood experiences (ACEs) are harmful to child health, but there is disagreement about the role of ACE screening in primary care. Adapting trauma assessment tools and colocating behavioral services may help identify high-ACE youth for connection to trauma-informed services.WHAT THIS STUDY ADDS: The adapted Traumatic Events Screening Inventory has validity as an ACE screener in primary care and predicts behavioral dysfunction, particularly among polyvictimized youth. ACEs can be indicative of a need for behavioral health referral and trauma-informed intervention.Drs Choi and Zima conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript; Mr McCreary designed the data-collection system and reviewed and revised the manuscript; Ms Rahmanian Koushkaki conducted a review of the measurement literature and reviewed and revised the manuscript; Drs Ford and Kenan reviewed and revised the manuscript for important intellectual content; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Across three formative evaluation stages, the foundation, clinic, and academic partners continued to reach beyond their respective traditional roles of project oversight, clinical service, and research as adjustments were collectively made to accommodate barriers and unanticipated events. Together, an innovative shared data collection approach was developed that extends partnered research to include data collection being led by the clinic partners and supported by the technical resources of a university-based research center.

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