Utility of screening for adverse childhood experiences (ACE) in children and young people attending clinical and healthcare settings: a systematic review

Abstract

ObjectiveTo examine and synthesise the literature on adverse childhood experience (ACE) screening in clinical and healthcare settings servicing children (0–11) and young people (12–25).DesignA systematic review of literature was undertaken.Data sourcePsycInfo, Web of Science, Embase, PubMed and CINAHL were searched through June 2021. Additional searches were also undertaken.Eligibility criteriaEnglish language studies were included if they reported results of an ACE tool being used in a clinical or healthcare setting, participants were aged between 0 and 25 years and the ACE tool was completed by children/young people or by parents/caregivers/clinicians on behalf of the child/young person. Studies assessing clinicians’ views on ACE screening in children/young people attending health settings were also included.Data extraction and synthesisTwo independent reviewers extracted data and assessed for risk of bias using the Mixed Methods Appraisal Tool. Results were synthesised qualitatively.ResultsInitial searches identified 5231 articles, of which 36 were included in the final review. Findings showed that the most commonly used tool for assessing ACE was the ACE questionnaire; administering ACE tools was found to be feasible and acceptable; there were limited studies looking at the utility, feasibility and acceptability of assessing for ACE in First Nations people; and while four studies provided information on actions taken following ACE screening, no follow-up data were collected to determine whether participants accessed services and/or the impact of accessing services.ConclusionAs the evidence stands, widespread ACE screening is not recommended for routine clinical use. More research is needed on how and what specific ACE to screen for and the impact of screening on well-being.PROSPERO registration numberUniversity of York Centre for Reviews and Dissemination (CRD42021260420).

Evolving Our Understanding: Housing Instability as an ACE for Young Children

“…With children, we look forward at the associations and mechanisms that impact ongoing development. With children, its use is clearly different and has the potential to increase providers' understanding of children's needs and identify early risks to development (Cibralic et al, 2022;Cronholm et al, 2015;Finklehor et al, 2013) allowing for a more holistic approach. Focused intervention on mediating variables across a child's ecology, if targeted, might right a developmental trajectory gone askew.…”

“…Concerns about the use of ACE notwithstanding and acknowledging that the evidence base for is still being built (Cibralic et al, 2022), these studies and the science of child development challenge the notion that ACE scores should never be used for individual assessment. At least for young children, the impacts appear to be immediate, moderated by a variety of sociocultural factors, embedded within the caregiving system, and amenable to intervention if identified.…”

Child-Reported Family Violence: A Systematic Review of Available Instruments

“…For example, there is evidence that screening is not always fruitful for detecting exposure to inter-parental violence in healthcare settings ( O’Doherty et al, 2015 ). While there is robust evidence that adverse childhood experiences (ACEs) including maltreatment and exposure to FV are associated with increased risk of poor health outcomes across the population ( Kalmakis & Chandler, 2015 ), more research is needed on the utility of ACEs screening, including when, where, and how to screen, and which ACEs to screen for in which settings ( Cibralic et al, 2022 ; Finkelhor, 2018 ; Meehan et al, 2022 ). Results from recent systematic reviews ( Cibralic et al, 2022 ; Loveday et al, 2022 ) suggest that screening for ACEs can increase the identification of adversity which may in turn increase referrals to services, but there are limited data to indicate whether this then results in increased referral uptake or improved mental health outcomes.…”

“…While there is robust evidence that adverse childhood experiences (ACEs) including maltreatment and exposure to FV are associated with increased risk of poor health outcomes across the population ( Kalmakis & Chandler, 2015 ), more research is needed on the utility of ACEs screening, including when, where, and how to screen, and which ACEs to screen for in which settings ( Cibralic et al, 2022 ; Finkelhor, 2018 ; Meehan et al, 2022 ). Results from recent systematic reviews ( Cibralic et al, 2022 ; Loveday et al, 2022 ) suggest that screening for ACEs can increase the identification of adversity which may in turn increase referrals to services, but there are limited data to indicate whether this then results in increased referral uptake or improved mental health outcomes. There are recent arguments that general ACEs screening is not appropriate for routine or widespread clinical use, as this approach may fail to accurately identify those at highest risk and fail to lead to the most appropriate intervention ( Cibralic et al, 2022 ; Finkelhor, 2018 ).…”

From Hard Knocks to Headache

“…The authors support routine screening for ACEs in children and young adults, a stance in keeping with the American Academy of Neurology position statement on abuse and violence, 11 which goes a few steps further by advocating that all patients be asked about past and ongoing violence and by providing assessment questions, strategies, and resources for patients and physicians. There remains some controversy regarding ACEs screening given a paucity of rigorous research on its benefits and risks, 12 but the body of evidence supporting ACEs as important social determinants of health is undeniably robust.…”