The Recruit Assessment Program (RAP) Experience With Adverse Childhood Experiences (ACE) Questions

Abstract : The Recruit Assessment Program (RAP) study was begun in June 2001 to assess the feasibility of collecting computerized comprehensive baseline health information from new recruits, including data on demographics, medical history, psychosocial history, substance abuse, and family history. Past evaluations of from the Adverse Childhood Experiences (ACE) study have found a relationship between such experiences and adverse adult health outcomes, including substance abuse, attempted suicide, and depression. Thus, the ACE questions were added to the RAP questionnaire in June 2002. Focus group experiences with ACE questions on the RAP instrument, completed by Marine Corps recruits in San Diego and Army recruits in Fort Jackson, revealed no specific concerns. In extensive post-focus group implementation of RAP (>100,000 questionnaires completed overall), ACE questions also appeared well accepted and completed without problems. Reliability metrics, overall, indicate that ACE question were likely assessing what they were intended to assess among RAP respondents. Reasonably strong concordance was noted for internal reliability within the instrument. Test-retest results were robust, especially when the instrument was completed with only a short time interval between testing. Results from these, and other analyses, will be helpful to DoD policymakers considering the value of ACE questions in future military questionnaires.