Recommendations for Population-Based Applications of the Adverse Childhood Experiences Study: Position Statement by the American College of Preventive Medicine

Kevin M Sherin; Audrey J Stillerman; Laxmipradha Chandrasekar; Nils S Went; David W Niebuhr

doi:10.1016/j.focus.2022.100039

Recommendations for Population-Based Applications of the Adverse Childhood Experiences Study: Position Statement by the American College of Preventive Medicine

AJPM Focus. 2022 Oct 8;1(2):100039. doi: 10.1016/j.focus.2022.100039. eCollection 2022 Dec.

Authors

Kevin M Sherin^{1

2}, Audrey J Stillerman³, Laxmipradha Chandrasekar^{4

5}, Nils S Went^{6

7}, David W Niebuhr⁸

Affiliations

¹ Department of Family Medicine & Rural Health, Florida State University College of Medicine, Orlando, Florida.
² Department of Medicine, University of Central Florida College of Medicine, Orlando, Florida.
³ Department of Family and Community Medicine, School Health Centers, Office of Community Engagement and Neighborhood Health Partnerships, University of Illinois Chicago, Chicago, Illinois.
⁴ Family Medicine Residency, AdventHealth Sebring, Sebring, Florida.
⁵ Clinical Operations, Clinica Mi Salud, Orlando, Florida.
⁶ Collaborative Care Clinician, Clinica Mi Salud, Orlando, Florida.
⁷ Department of Psychiatry, Brookdale University Hospital Medical Center, Brooklyn, New York.
⁸ Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Abstract

Introduction: Childhood adversity profoundly influences health, well-being, and longevity. Prevention and interventions to mitigate its harmful effects are essential. The American College of Preventive Medicine reviewed the research literature and other professional and governmental statements about adverse childhood experiences to support the development of evidence-based and population-focused recommendations about prevention, screening, and mitigation interventions for childhood adversity.

Methods: We performed an umbrella review to find, assess and synthesize the evidence from systematic reviews focused on 3 key questions: the prevention or mitigation of the effects of adverse childhood experiences; the association of screening for adverse childhood experiences with various benefits, including health outcomes; and the effectiveness and harms of interventions in individuals with elevated adverse childhood experience scores. Adverse childhood experience‒related recommendations from 6 professional and governmental organizations were also reviewed. On the basis of these reviews, the American College of Preventive Medicine developed a position statement through consensus.

Results: A total of 8 systematic reviews, including 260 studies in total, were identified and combined with adverse childhood experiences‒related recommendations from 6 professional organizations to support the American College of Preventive Medicine recommendations. The American College of Preventive Medicine offers 7 adverse childhood experiences‒related recommendations focused on screening, education/training, policy/practice, and research: 2 are evidence-based, and 5 are based on expert opinion. Notably, regarding secondary prevention of adverse childhood experiences, the American College of Preventive Medicine endorses population-level surveillance and research around childhood adversity but not adverse childhood experience screening in individual clinical encounters.

Conclusions: Despite limitations in the heterogeneity and quality of the published systematic reviews, the extant literature supports the American College of Preventive Medicine recommendations. Interventions to enhance protective factors and prevent and mitigate the consequences of adverse childhood experiences and other childhood adversity are promising and require further implementation and research.

Keywords: ACEs; childhood adversity; position statement; prevention recommendations; protective factors; umbrella review.