Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, 140 Decatur Street, Urban Life Building, Suite 465, Atlanta, GA 30303, United States.
Child Abuse Negl. 2018 Nov;85:180-184. doi: 10.1016/j.chiabu.2018.03.007. Epub 2018 Mar 17.
Currently, in the U.S. and worldwide, childhood trauma is a public health crisis. Childhood adversities, such as abuse, neglect, and related household stressors, are common, interrelated and contribute to multiple adverse social, behavioral and health outcomes throughout the lifespan. The present article provides further discussion regarding adverse childhood experiences (ACEs) screening in healthcare utilizing the etic and emic perspectives. Screening in the healthcare system leans toward the etic view: objective observations of symptoms, which may then lead to intervention delivery. Whereas the emic view provides the subjective perspective as experienced by participants of a system, culture, or common group. Finkelhor's argument about cautions regarding widespread screening is relevant in the current allopathic healthcare system, which utilizes an etic perspective and where evidence-based ACEs interventions within a biomedical-centric model are lacking. Therefore, in healthcare settings, universal ACEs screening may serve the clinicians with a surveillance tool to inform and guide medical practice and policy as they relate to delivering trauma-informed care. The Public Health Code of Ethics and Basis for Action reminds us about the values approach for collecting and using data ethically to protect population health. Practitioners and researchers across the globe are beginning to take community-engaged action, with an emic view of all community members involved.
目前，在美国和全球范围内，儿童期创伤是一个公共卫生危机。儿童期逆境，如虐待、忽视和相关的家庭压力源，是常见的、相互关联的，并导致整个生命周期中多种不良的社会、行为和健康结果。本文从他者和本土视角进一步讨论了医疗保健中的不良儿童经历（ACEs）筛查。医疗保健系统中的筛查倾向于他者视角：对症状的客观观察，这可能导致干预措施的实施。而本土视角则提供了系统、文化或共同群体参与者所经历的主观视角。芬克尔霍关于广泛筛查的警告在当前的对抗疗法医疗保健系统中是相关的，该系统采用他者视角，并且缺乏基于生物医学为中心的模型的循证 ACEs 干预措施。因此，在医疗保健环境中，普遍的 ACEs 筛查可以为临床医生提供一个监测工具，以便在提供创伤知情护理方面为医疗实践和政策提供信息和指导。《公共卫生道德规范和行动基础》提醒我们要注意以价值观为导向，以保护人群健康为目的，在收集和使用数据方面做到合乎道德。全球的从业者和研究人员开始采取以社区为中心的行动，以所有参与社区成员的本土视角进行。
