Screening for adverse childhood experiences within paediatric patients in Rzeszów, Poland

Introduction
Adverse childhood experiences (ACEs) are stressful or potentially traumatic events correlated with negative, lasting effects on health.

Aim of the study
This study sought to assess: 1) prevalence of ACEs within a paediatric population in Rzeszow, Poland, 2) paediatrician screening practices for ACEs, and 3) physician experiences and opinions regarding ACE screening.

Material and methods
Caregivers (N = 110) of children aged 6 months to 18 years completed a translated Adverse Childhood Experiences Questionnaire (CYW ACE-Q), developed by the Centre for Youth Wellness, San Francisco. CYW ACE-Q scores were compared to physician perception of patient stress and need for intervention. Physicians (N = 18) provided additional opinions regarding ACE screening by completing a Physician Experiences in ACEs Questionnaire (PEA-Q).

Results
CYW ACE-Q responses revealed 27.3% of patients scored ≥ 4 ACEs, a positive screening reflecting increased concerns for toxic stress. An additional 30% of patients experienced 1–3 ACEs. In 14.5% of patients, screening was positive but physician perception of stress was negative. Of the patients with a positive screening, 53.3% had discordant positive physician perception of stress and only 46.6% were evaluated as in need of intervention. Physicians overestimated stress in patients with low parental education (p = 0.024) and from rural areas (p = 0.01) but underestimated stress in urban patients (p = 0.01). All surveyed physicians (N = 18) believed that ACEs were important in primary health; only 5% reported there was enough time to screen or resources to intervene and only 39% felt confident discussing ACEs with patients and families.

Conclusions
A significant prevalence of ACEs was noted within this paediatric sample in Rzeszow, Poland. Results highlight the incremental benefit of ACE screening to supplement physician perception of family stress. Further research is needed to guide implementation and education of physicians on the practical aspects of ACE screening and intervention strategies.