• Joshua P Mersky, Chien-Ti Plummer Lee, and Ross M Gilbert.
• Institute for Child and Family Well-being, Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin. Electronic address: mersky@uwm.edu.
• Am J Prev Med. 2019 Aug 1; 57 (2): e51-e58.

IntroductionMany service providers report concerns that questions about adverse events may upset clients. Studies indicate that most survey respondents answer sensitive questions without experiencing distress, although little is known about the prevalence or correlates of clients' discomfort when they are asked similar questions by direct care providers, such as home visitors.MethodsThis study used data collected between 2013 and 2018 from 1,678 clients and 161 providers in a network of home visiting programs in Wisconsin. Clients and home visitors completed an adverse childhood experience questionnaire that concludes by asking about discomfort with the questions. Analyses conducted in 2018 examined overall client discomfort and associations between discomfort and the endorsement of 10 distinct adverse childhood experiences. Multilevel regressions were performed to test whether client and provider factors were associated with client discomfort.ResultsMore than 80% of clients were not at all or slightly uncomfortable with the adverse childhood experience questionnaire, and 3% reported extreme discomfort. Bivariate results showed that each adverse childhood experience, except parental divorce, was associated with greater discomfort; sexual abuse was the only adverse childhood experience associated with discomfort in a multivariate analysis. Multiple client variables were linked to increased discomfort, including higher adverse childhood experience scores (b=0.06, 95% CI=0.04, 0.08) and depression scores (b=0.01, 95% CI=0.00, 0.02). Home visitor discomfort was positively associated with client discomfort (b=0.16, 95% CI=0.01, 0.31).ConclusionsResults indicated that most clients in home visiting programs tolerated an adverse childhood experience questionnaire well. The findings point to clients who may be more likely to report discomfort and highlight an important association between client and provider discomfort.Copyright © 2019. Published by Elsevier Inc.

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