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

Dayna Long; Danielle Hessler; Kadiatou Koita; Monica Bucci; Mindy Benson; Rachel Gilgoff; Neeta Thakur; Nadine Burke Harris

doi:10.1371/journal.pone.0273491

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

PLoS One. 2022 Dec 15;17(12):e0273491. doi: 10.1371/journal.pone.0273491. eCollection 2022.

Authors

Dayna Long¹, Danielle Hessler², Kadiatou Koita³, Monica Bucci³, Mindy Benson¹, Rachel Gilgoff³, Neeta Thakur², Nadine Burke Harris³

Affiliations

¹ Center for Child and Community Health, Benioff Children's Hospital Oakland, University of California, San Francisco, San Francisco, California, United States of America.
² Department of Medicine and Family and Community Medicine, University of California, San Francisco, San Francisco, California, United States of America.
³ Center for Youth Wellness, San Francisco, California, United States of America.

Abstract

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.

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.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

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

Associated data

ClinicalTrials.gov/NCT04182906

Grants and funding

The PEARLS study was supported by the TARA Health Foundation and in part by Genentech Corporate Giving. https://tarahealthfoundation.org/https://www.gene.com/good/giving/corporate-giving The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors have no financial relationships relevant to this article to disclose.