Validation of the Traumatic Events Screening Inventory for ACEs

Abstract

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.

A Review of Suicide Risk Assessment Tools and Their Measured Psychometric Properties in Korea

“…For instance, although there have been previous studies on the relationship between unemployment and depression ( 50 – 52 ), the process of screening participants' employment status stems from either self-structured questionnaires or datasets from third parties such as the Korea Employment Information Service. There have also been studies to assess the validity of childhood adversity questionnaires, such as the Traumatic Event Screening Inventory and the Childhood Trauma Questionnaire, to identify childhood trauma ( 53 , 54 ). Although the Childhood Trauma Questionnaire has been validated in Korean, these tools are administered via interview or self-report.…”

Introducing ACEs (Adverse Childhood Experiences) and Resilience to First-Year Medical Students

“… 40 Nevertheless, ACE-based screenings and referrals are becoming increasingly used in adult and pediatric primary care. 41 , 42 …”

“…40 Nevertheless, ACE-based screenings and referrals are becoming increasingly used in adult and pediatric primary care. 41,42 A positive outcome to highlight is that learners' ability to describe resilience, a protective factor in an individual's development, increased. This is important because significant attention is paid to the adversity associated with ACEs, but the strengths and resilience in individuals with ACEs, which enable them to overcome and succeed in life, are often overlooked.…”

Guardians at the Gate: Early Adversity, Neurocognitive Development, and the Role of the Pediatrician in the Era of COVID-19

“…A number of well-validated inventories, based on the original ACE Study (14), have proven feasible to screen for ACEs at each well-child visit (12). Among the most promising are the Traumatic Events Screening Inventory-Child Report Form Revised (TESI-CRF-R) (13,15), a screening tool aimed at assessing children and teens from ages 6-18 in the pediatric primary care setting, the Center for Youth Wellness ACE-Questionnaire (CYW ACE-Q Child, Teen, Teen SR) (16), and the Survey of Well-being of Young Children (SWYC) (17,18). In order for such screening tools to be broadly useful, pediatricians must be made aware of their existence and be willing to incorporate one of these ACE questionnaires into each child's clinic visit.…”