Screening for adverse childhood experiences in pediatrics: A randomized trial of aggregate-level versus item-level response screening formats.

Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE

Original Publication: San Francisco, CA : Public Library of Science

Adverse Childhood Experiences* ; Pediatrics*; Child ; Humans ; Male ; Caregivers/psychology ; Disclosure

Background: While there is growing support for screening for Adverse Childhood Experiences (ACEs), rigorous evidence on the efficacy and preference of screening methods is needed.
Objective: To examine caregiver: (1) rates of disclosure of their child's exposure to ACEs using item-level response (each item can be endorsed) versus aggregate-level response (only total score reported) screening format, (2) associations between family demographic factors and disclosure by screening format, and (3) emotional reaction and experience of screening formats in a diverse, low-income pediatric population.
Methods: Caregiver participants (n = 367) were randomized to complete the Pediatric ACEs and Related Life Events Screener (PEARLS) tool, in an aggregate-level response vs item-level response format from 2016-2019. Select caregivers (n = 182) participated in debriefing interviews. T-test and chi-square analyses in 2019 compared PEARLS disclosure rates and reactions between the screening modalities. Regression models explored interactions with child characteristics. Thematic analysis of interview notes captured caregiver screening experience.
Results: PEARLS disclosure rates were significantly higher in the aggregate-level response compared to the item-level response screening arm (p <0.05). This difference was accentuated for children identified as black and/or male (p <0.05). Caregiver reactions to PEARLS screening were rarely negative in either screening format. Qualitative data demonstrated strong caregiver preference for the item-level response format; additional themes include provider relationship, fear with disclosure, and screening outcome expectations.
Conclusion: While caregivers reported a preference for the item-level response format, the aggregate-level response screening format elicited higher disclosures rates particularly for children who are black or ma.
Trial Registration: Clinical trial registry: NCT04182906.
Competing Interests: : I have read the journal’s policy and the authors of this manuscript have the following competing interests: The selection of PEARLS as a recommended tool preceded Nadine Burke Harris in her appointment as Surgeon General and was done after careful review and selection by the AB340 workgroup. Dayna Long was a member of the AB340 workgroup, which recommended two tools to the California Department of Health Care Services for screening for childhood adversities, including the PEARLS tool. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
(Copyright: © 2022 Long et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

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ClinicalTrials.gov NCT04182906

Date Created: 20221215 Date Completed: 20221219 Latest Revision: 20230109

20240628

PMC9754205

10.1371/journal.pone.0273491

36520927