The California Surgeon General's Clinical Advisory Committee developed several screening questionnaires to determine adverse childhood experiences.
Patient selection: adult, English as primary language
Experiences during childhood:
(1) experienced lack of care and protection (deprivation: not enough to eat, wearing dirty clothes, etc)
(2) experienced loss of a parent
(3) experienced verbal abuse from an adult or parent
(4) experienced physical abuse from an adult or parent
(5) experienced sexual abuse
(6) experienced neither love nor a sense of being special to someone (emotional abuse)
(7) lived with someone with mental health issues (depression, suicide, etc)
(8) lived with someone abusing drugs and/or alcohol
(9) lived with physical abuse between parents or adults in the home
(10) lived with someone who went to jail or prison
total score =
= SUM(number of experiences)
Interpretation:
• minimum number of experiences: 0
• maximum number of experiences: 10
• The higher the score the greater the adversity.
The adult is also asked if these experiences affected health with responses:
(1) not much
(2) some
(3) a lot
