Screening for adverse childhood experiences in preventive medicine settings: a scoping review

Abstract

Aim Adverse childhood experiences (ACEs) are associated with numerous adverse mental and physical health outcomes. While interest in routine screening for ACEs is growing, there is still significant opposition to universal screening. This review explores the feasibility of implementing routine screening for ACEs in primary care settings. Subject and methods We searched PubMed, CINAHL, and PsycINFO, reference-mined relevant reviews, and consulted with key experts (June 2020). Studies from 1970 to date evaluating screening for childhood trauma, adversity, and ACEs in a routine healthcare setting, reporting quantitative or qualitative data were eligible. The project is registered in Open Science Framework (osf.io/5wef8) and reporting follows PRISMA-ScR guidelines. Results Searches retrieved 1402 citations. Of 246 publications screened as full text, 43 studies met inclusion criteria. Studies evaluated provider burden, familiarity with ACEs, practice characteristics, barriers to screening, frequency of ACE inquiry, reported or desired training, patient comfort, and referrals to support services. Conclusions This review found that the following factors increase the likelihood that ACE screenings can be successfully integrated into healthcare settings: staff trainings that increase provider confidence and competence in administering screenings, accessible and robust mental health resources, and organizational support. Further research should examine the scalability and sustainability of universal screening.

The Influence of Adverse Childhood Experiences in Pain Management: Mechanisms, Processes, and Trauma-Informed Care

“…Therefore, the utilization of preclinical ACEs screening would facilitate the early identification of critically vulnerable patients, potentially allowing for stratification of treatment and the formulation of trauma-informed pathways. Screening for ACEs in primary care is common and has not been linked to any added demand for other services (181)(182)(183). Rather, an ACE informed approach can reduce subsequent physician visits (184).…”

Screening for adverse childhood experiences in antenatal care settings: A scoping review

“…Also, the search was based upon previous studies on screening for ACEs in clinical settings. 21,25 The search of relevant literature was developed with the help of an experienced librarian along with input from other co-authors. The research strategy included key words related to ACEs, pregnant women and screening in clinical settings combined with the Boolean operators AND/OR.…”

“…These identified barriers are similar to those reported by healthcare providers in relation to ACE screening in general clinical settings. 21,25 Despite these concerns, healthcare providers realised the importance of asking about ACEs as it helped to raise issues that are otherwise unknown and unaddressed. Awareness of ACEs facilitates providers to support patients in new ways.…”

“…Further, there would need to be integration of supporting services with healthcare providers who are experiencing psychosocial adversity resulting from childhood trauma. 8,25 For pregnant women, privacy was one of the most important concerns when deciding whether to disclose their history of ACEs.…”

“…8,20 The screening for ACEs can itself be a therapeutic intervention that can help reduce traumatic shame that has roots in childhood adversity. 25 Screening for ACEs among pregnant women has not been widely implemented in antenatal care, but piloting of ACE screening practice has shown it to be implementable and well received by women and healthcare providers in both public and private clinic settings in the USA and UK. 20,27 Australia currently uses the Critical to screening is the provision of support to those who need additional services.…”