Assessing adverse childhood experiences in young refugees – development of the BRACE questionnaire

BACKGROUND: With the persistence of ongoing crises and subsequent displacement of individuals, including children, knowledge about adversities experienced in this context is crucial, given the harmful effects of adverse childhood experiences (ACE) on mental and physical health. With the tools currently available, a comprehensive assessment of adversity exposure faced by refugee children is not possible. The BRACE (beyond refugee ACE) project set out to develop a core set of screening items that are refugee children specific and measure exposure and severity at all stages of migration. Here, the development of the Arabic (one of the majority languages of asylum seekers in Europe) parent report version is described. METHODS: The BRACE questionnaire was developed based on results of 1) a qualitative study involving semi-structured interviews with 47 refugee parents and 11 children (Germany, 2018-2020), and 2) a systematic review of relevant measures. Categories and associated adverse/protective experiences derived in 1) built the foundation of the BRACE. Whenever possible, items of validated ACE tools identified in 2) were used to assess exposure. The item set was finalized after translation into Arabic and cognitive pre-testing with 12 participants from the target population. RESULTS: The developed BRACE consisted of 52 items for 48 categories covering 8 adverse (e.g. disruption, violence) and 2 protective themes (e.g., connections). 19 items were developed by the study team (e.g., police brutality), 33 items were adopted from existing ACE tools (e.g. family member arrest). A binary response format expanding into a 4-point Likert scale was employed. Minor difficulties regarding respondent interpretation and answering ability could be resolved resulting in a final 50 item set. CONCLUSIONS: This item set provides a starting point for field trials of a measure needed to facilitate the identification of at-risk individuals for targeted interventions. KEY MESSAGES: • Adverse childhood experiences (ACE) can harm mental/physical health. Adequate tools assessing ACE exposure in flight contexts are needed in order to develop mitigation strategies for those at risk. • The BRACE project has developed a core set of screening items specific to refugee children's experiences to measure adversity exposure and severity at all stages of migration.