Engaging with History Taking for Adverse Childhood Experiences in Care: A Rapid Qualitative Review

Key Message

Participants in the five included primary studies and the one included literature synthesis noted a general acceptance of history taking for childhood trauma or adverse experiences in primary care. That being said, there was a dearth of literature exploring the perspectives and experiences of individuals within typically marginalized populations. While one included study focused specifically on refugees living in the United States,9 the remainder engaged with a broader North American population who had experienced childhood trauma or adverse experiences. As such, though the findings within this report do offer space for reflection regarding any clinical encounter, particular emphasis on typically marginalized populations is largely absent. Furthermore, participant acceptance of history taking while generally accepted by those represented in this review, was not without bounds. The following descriptive themes emerged from the included studies as the form these bounds may take. The importance of developing and demonstrating clarity regarding the purpose of history taking was spoken to across all six studies. A need for clarity was articulated in terms of a perceived need for provider awareness of the context surrounding conversations of childhood trauma or adverse experiences. Clinical languages of abuse and trauma may not always be understood or perceived as appropriate and dependent upon the purpose of the clinical visit (e.g., a prenatal obstetrics visit), emphasis could be placed on different forms of childhood trauma (e.g., perhaps a particular focus on sexual abuse). Assurance that the conversation was not standing in for any ulterior motives and that it would be completely confidential were also important to study participants particularly among expectant or recent parents and members of the military. The importance of developing and demonstrating commitment to building a trusting patient-provider relationship was also noted. Rather than treating history taking as a singular performance or rapid exercise, patients expressed that they need their health care providers to foster a safe and trusting environment for the conversation. While some participants noted this was a temporal issue, where each visit added to the strength of the relationship, trust could also be built through the intensity and patience of a singular clinical interaction. Similar to an expressed need for clarity, the importance of taking action or providing resources, if required, once the conversation had taken place was noted across studies. This could take the form of referring patients onto professional or peer support groups, but it could also be done by the provider themselves. Knowing how to hold and work with the traumatic pasts of their patients, from the patient perspective, comes hand-in-hand with asking about those pasts.