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Adverse Childhood Experience (ACE) Questionnaire and Resource Packet

What is the role of healthcare providers?
The healthcare system is a natural place to respond to ACEs and promote resilience in children,
youth and families. Guidelines for well childcare are extensive in the early years – 13 visits in
the first three years of lifei --, which is a crucial period of child development. Health systems,
and in particular pediatric providers, are in a unique position to identify issues for both children
and their families that contribute to either promoting or inhibiting healthy development. The
American Association of Pediatrics (AAP) issued a policy statement in 2012 that encourages,
among other things, pediatricians to take a more proactive role in educating patients and
families about the impact of toxic stress and in advocating for the development of interventions
that mitigate its impact. ii

What is trauma-informed care?
Trauma-informed care encompasses three levels of focus from a systems level: addressing
policy and procedures, creating approaches for organizing and delivering services and providing
specific programs or interventions for families.

The federal agency Substance Abuse and Mental Health Services Administration (SAMHSA) has
outlined six principles for trauma informed care: (1) creating a culture of physical and
psychological safety for staff and the people they serve; (2) building and maintaining
trustworthiness and transparency among staff, clients and others involved with the
organization; (3) utilizing peer support to promote healing and recovery; (4) leveling the power
differences between staff and clients and among staff to foster collaboration and mutuality; (5)
cultivating a culture of empowerment, voice and choice that recognizes individual strengths,
resilience and an ability to heal from past trauma; and (6) recognizing and responding to the
cultural, historical and gender roots of trauma.

Keywords 
ACE children child adverse childhood experience patient health questionnaire

Generalized Anxiety Disorder 7-Item Scale

Author/s: 
Spitzer, Robert L., Kroenke, Kurt, Williams, Janet B. W.

BACKGROUND:

Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity.

METHODS:

A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use.

RESULTS:

A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale.

CONCLUSION:

The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.

Keywords 
Self report depression mental health patient health questionnaire
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