Adverse family environments

This domain includes indicators of adverse family environments (AFE), aligning with the original ACE domain "household challenges". We define an AFE as any clinically intervenable psychosocial risk factor or experience recorded in the child or the parent.

All indicators Child maltreatment Intimate partner violence High-risk presentation of child maltreatment Parental mental health problems Parental substance misuse Adverse family environments

• 1
  Overview
• 2
  Definition
• 3
  Clinical Codelist
• 4
  Implementation
• 5
  Publications

1 Overview

Domain / Phenotype

Adverse family environments (AFE)

Sex

Both

Age Range

Child (0-18y) Parent (Adults)

Individual

Parent Child

Coding System

READ SNOMED CT ICD-10 HES-AE speciality field HES-OP speciality field

Data Sources

CPRD Aurum CPRD GOLD HES-APC HES-AE HES-OP

2 Definition

The term "adverse family environments" refers to any clinically intervenable psychosocial risk factor or experience recorded in the child or the parent that met the pre-defined inclusion criteria.

The AFE domain broadly aligns with the original ACE domain titled "household challenges" from the CDC-Kaiser ACE Study, supplemented with clinically relevant definitions to select indicators consistent with the UK guidance for identifying families in need, and the US Preventive Services Task Force for social risk domains.

The AFE domain includes indicators from multiple social risk domains covering clinical concerns relating to housing instability (e.g., homelessness), “criminal behaviours in the household”, food insecurity, education and financial strains, transportation difficulties, utility needs, and aspects of interpersonal safety that are not already addressed by other ACE domains.

This domain also incorporates Royal College of General Practitioners recommended indicators for recordings that should raise a cause for concern (e.g., coded observations include various concerns in parent or child such as: "life crisis", "concerned about appearance", "history of other physical trauma", "anger or aggressive behaviours", etc.).

3 Clinical Codelist

Download AFE Codelist (2193 codes)

See the ACEsinEHRs Control documentation for code processing rules and release information.

Indicator Structure & Taxonomy

Domain	Indicator Code	Indicator Name
AFE	AFE1	High-risk antenatal presentation, social-risk specific
AFE	AFE2	High-risk antenatal presentation, psychosocial NOS
AFE	AFE3	Unwanted/concealed pregnancy incl. attempted abortion of the current child
AFE	AFE4	Psychosocial health problem with lower-level intervention
AFE	AFE5	Health visitor increasing concern
AFE	AFE6	Family disruptions and parental conflicts NOS
AFE	AFE7	Parental separations
AFE	AFE8	Parent with legal problems
AFE	AFE9	Family is cause for concern (incl. maternal FGM, current rec. historic event)
AFE	AFE10	Problems related to negative childhood events
AFE	AFE11	Parent assaulted NOS (GP record only)
AFE	AFE12	Housing problems, effects of deprivation and refugee (excl. homelessness)
AFE	AFE13	Homelessness (child/parent)
AFE	AFE14	Vulnerable family NOS (incl. CPA)
AFE	AFE15	Family/parental support referral
AFE	AFE16	Problems related to psychosocial circumstances
AFE	AFE17	Learning or intellectual disability
AFE	AFE18	Parent lack capacity, increased concerns
AFE	AFE19	Parental problems with daily living/limited capacity to work (incl. financial concerns)

Browse & Search Clinical Codelist (Preview)

Adverse family environments | ALL CODING SYSTEMS

Code	Description	Coding System	Indicator
SN160824009	Housing problems	SNOMED CT	AFE12
Z59.0	Homelessness	ICD-10	AFE13
1L10.	Problems related to family circumstances	READ	AFE6

4 Implementation

Standard Mapping Applied

No complex rule-based algorithms are currently required for the Adverse family environments domain beyond standard clinical code mapping.

5 Publications

Core research outputs associated with the Adverse family environments domain.

Family adversity and health characteristics associated with intimate partner violence in children and parents presenting to health care: a population-based birth cohort study in England.

Syed S, Gilbert R, Feder G, Howe LD, Powell C, Howarth E, Deighton J, Lacey RE. The Lancet Public Health. 2023.

Identifying adverse childhood experiences with electronic health records of linked mothers and children in England: a multistage development and validation study.

Syed S, Gonzalez-Izquierdo A, Allister J, Feder G, Li L, Gilbert R. The Lancet Digital Health. 2022.

Predictive value of indicators for identifying child maltreatment and intimate partner violence in coded electronic health records: a systematic review and meta-analysis.

Syed S, Ashwick R, Schlosser M, Gonzalez-Izquierdo A, Li L, Gilbert R. Archives of Disease in Childhood. 2021.

Notifications for child safeguarding from an acute hospital in response to presentations to healthcare by parents.

Gonzalez‐Izquierdo A, Ward A, Smith P, Walford C, Begent J, Ioannou Y, Gilbert R. Child: Care, Health and Development. 2015.

Relevant References

Responses to concerns about child maltreatment: a qualitative study of GPs in England.

Woodman J, Gilbert R, Allister J, Glaser D, Brandon M. BMJ Open. 2013.

A simple approach to improve recording of concerns about child maltreatment in primary care records: developing a quality improvement intervention.

Woodman J, Allister J, Rafi I, de Lusignan S, Belsey J, Petersen I, Gilbert R. British Journal of General Practice. 2012.

Screening and interventions for social risk factors: technical brief to support the US Preventive Services Task Force.

Eder M, Henninger M, Durbin S, Iacocca MO, Martin A, Gottlieb LM, Lin JS. JAMA. 2021.

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