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Hello Colleagues:

The Institute for Safe Families is pursuing the advancement of an Urban ACEs questionnaire or group of questions to add to a household health survey that will be implemented by a local research organization in Philadelphia. We are wondering if any of you have experience in this area, including formulating questions or creating ACE-informed tools that target adults living within urban settings. A good example of a variation we have found is the World Health Organization’s International ACE Questionnaire (ACE-IQ):

Within this tool, the WHO added some questions that address other adverse or traumatic experiences that may occur globally. We are currently in the process of thinking through what our questions might be and we are considering issues of poverty, community violence, etc. Any examples, feedback, recommendations, resources, or discussions around this that you are willing to share would be most helpful to us in our process. Please feel free to engage with us here or contact me directly at

Thank you!

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Hi, Emily -- Here are two PDFs that Dr. Felitti used in the preventive medicine dept. that he ran at Kaiser. You'll see the questions about childhood adversity and trauma that he integrated after the results from the ACE Study convinced him they should be integrated into the patient history. This isn't necessarily urban-oriented, but if there's a lot of violence in a community, for example, it would be easy to add questions such as:

Have you experienced a friend, acquaintance or family member who was murdered?

Have you known a friend, acquaintance or family member who was injured in an assault?

I'm working with Dr. Felitti to craft a description of how this was used in the department. Β 

Another resource might be the CDC's National Violent Death Reporting System, which is used in 18 states.

Cheers, J.


I've started modifying and adding questions to the Felitti form. My intent is to create a digital format that can be answered in the office or waiting room, but eventually add in some automated responses to some of the answers. If someone responded with a significant history of abuse, the system might be prompted to "I'm sorry those things happened to you. They should not have happened and it is not your fault that you were hurt. But I'm glad you shared that with me. It helps me to know more about you. IT may not make sense to you now, but having these experiences can change the way your mind and Β body work together. I'll explain this more to you when I see you.

I've also used a folded sheet of paper in an envelope with colored circular stickers on it. The questions are very non-threateneing and do not use the words "violence" or "Abuse." The patient simply moves the color of sticker that fits their scenario best - green, yellow, or blue. There are categories of statements and the patient is asked to decide which set of statements most closely fits them. They move the colored stickers, give it back to the nurse in the envelope for the provider to see and decide about appropriate next steps and followup. I'm attaching the one that specifically deals with screening for domestic violence, but it can be modified many ways. It is gender neutral and relationship neutral.

Dave McCollum


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