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Screening for childhood adversity among adult primary care patients

Kalmakis, Karen A. PhD, MPH, FNP-BC, FAANP (Associate Professor)1; Shafer, Mary B. DNP, FNP-BC, CPN (Family Nurse Practitioner)2; Chandler, Genevieve E. PhD, RN (Associate Professor)1; Aponte, Elizabeth V. DNP, FNP (Family Nurse Practitioner)1; Roberts, Susan J. DNSc, ANP-BC, FAAN (Professor)3

Journal of the American Association of Nurse Practitioners: April 2018 - Volume 30 - Issue 4 - p 193–200
doi: 10.1097/JXX.0000000000000033
Research - Quantitative

Background and purpose: Over half of Americans reports a history of adverse childhood experiences (ACEs), which have been associated with many chronic health conditions. Yet primary care providers infrequently screen patients for ACEs and fail to consider the relationship between ACEs and adult health. Therefore, the purposes of this study were to test the effectiveness and feasibility of a screening interview for ACEs and to confirm the prevalence of ACEs among individuals with chronic health conditions.

Methods: Screening interviews were conducted with 71 adults in a primary care setting. Patients' ACE history, nurse practitioner comfort with screening, time to screen, and patient follow-up care recommendations were gathered through questionnaires. Adverse childhood experience prevalence was analyzed by descriptive statistics. Relationships between ACEs, number of clinic visits, time to screen, and follow-up care recommendations were analyzed by bivariate statistics.

Conclusions: Over half of participants reported more than four ACEs, with ACEs common among participants with chronic health conditions (93%). Adverse childhood experience scores were positively correlated with number of clinic visits, time to screen, and recommendations for follow-up care. Findings support screening primary care patients for ACEs.

Implications for practice: Adverse childhood experiences are prevalent among primary care patients with chronic conditions. Using interviews to screen for ACEs in primary care settings is effective and feasible.

1Department of Nursing, University of Massachusetts Amherst, Amherst, Massachusetts,

2First Choice Health Centers, Inc, Manchester, CT,

3Department of Nursing, Northeastern University, Boston, Massachusetts

Correspondence: Karen A. Kalmakis, PhD, MPH, FNP-BC, FAANP, University of Massachusetts Amherst, Amherst, Massachusetts 01003; Tel: 413-577-4763; Fax: 413-577-2550; E-mail:

Competing interests: The authors report no conflicts of interest.

Authors' contributions: Karen Kalmakis assumed a leadership role in the writing of the manuscript and in all phases of the research project and data analysis. Mary Shafer assisted in the writing of the manuscript, data collection, data entry, and data analysis. Genevieve Chandler assisted with all aspects of the research project, student supervision, and the writing of the manuscript. Elizabeth Aponte participated in data collection, data entry, and editing of the manuscript. Susan Roberts assisted with research design and editing of the manuscript.

Received November 29, 2017

Accepted February 07, 2018

© 2018 American Association of Nurse Practitioners
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