» Articles » PMID: 38106557

The Effect of Adverse Childhood Experience Training, Screening, and Response in Primary Care: a Systematic Review

Overview
Specialty General Medicine
Date 2023 Dec 18
PMID 38106557
Authors
Affiliations
Soon will be listed here.
Abstract

Background: Adverse childhood experiences (ACEs) can have harmful, long-term health effects. Although primary care providers (PCPs) could help mitigate these effects, no studies have reviewed the impacts of ACE training, screening, and response in primary care.

Methods: This systematic review searched four electronic databases (PubMed, Web of Science, APA PsycInfo, CINAHL) for peer-reviewed articles on ACE training, screening, and/or response in primary care published between Jan 1, 1998, and May 31, 2023. Searches were limited to primary research articles in the primary care setting that reported provider-related outcomes (knowledge, confidence, screening behavior, clinical care) and/or patient-related outcomes (satisfaction, referral engagement, health outcomes). Summary data were extracted from published reports.

Findings: Of 6532 records, 58 met inclusion criteria. Fifty-two reported provider-related outcomes; 21 reported patient-related outcomes. 50 included pediatric populations, 12 included adults. A majority discussed screening interventions (n = 40). Equal numbers (n = 25) discussed training and clinical response interventions. Strength of evidence (SOE) was generally low, especially for adult studies. This was due to reliance on observational evidence, small samples, and self-report measures for heterogeneous outcomes. Exceptions with moderate SOE included the effect of training interventions on provider confidence/self-efficacy and the effect of screening interventions on screening uptake and patient satisfaction.

Interpretation: Primary care represents a potentially strategic setting for addressing ACEs, but evidence on patient- and provider-related outcomes remains scarce.

Funding: The California Department of Health Care Services and the Office of the California Surgeon General.

Citing Articles

Estimating the Prevalence of Child Abuse and Neglect Among Adolescents in Primary Care Through Diagnoses Codes and Free-Text EHR Clinical Notes.

Lee R, Landau A, Heider P, Hanson R, Espeleta H, Cato K J Pediatr Health Care. 2024; 39(2):189-197.

PMID: 39580745 PMC: 11807751. DOI: 10.1016/j.pedhc.2024.10.016.


Screening for Adverse Childhood Experiences: A Critical Appraisal.

Austin A, Anderson K, Goodson M, Niolon P, Swedo E, Terranella A Pediatrics. 2024; 154(6).

PMID: 39497538 PMC: 11891546. DOI: 10.1542/peds.2024-067307.


The effects of childhood adversity on twenty-five disease biomarkers and twenty health conditions in adulthood: Differences by sex and stressor type.

Alley J, Gassen J, Slavich G Brain Behav Immun. 2024; 123:164-176.

PMID: 39025418 PMC: 11624074. DOI: 10.1016/j.bbi.2024.07.019.

References
1.
Abatemarco D, Kairys S, Gubernick R, Kairys J . Expanding the pediatrician's black bag: a psychosocial care improvement model to address the "new morbidities". Jt Comm J Qual Patient Saf. 2008; 34(2):106-15. DOI: 10.1016/s1553-7250(08)34013-6. View

2.
A J Konijnendijk A, Boere-Boonekamp M, Haasnoot M, Need A . Effects of a computerised guideline support tool on child healthcare professionals' response to suspicions of child abuse and neglect: a community-based intervention trial. BMC Med Inform Decis Mak. 2019; 19(1):161. PMC: 6694693. DOI: 10.1186/s12911-019-0884-y. View

3.
Brennan L, Evans M, Michaeli G, Pandita P, Patel S, Powell K . Completion of Social Drivers of Health Screenings in Pediatric Practices Participating in a Quality Improvement Initiative. J Dev Behav Pediatr. 2022; 43(8):472-479. DOI: 10.1097/DBP.0000000000001114. View

4.
Felitti V, Anda R, Nordenberg D, Williamson D, Spitz A, Edwards V . Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998; 14(4):245-58. DOI: 10.1016/s0749-3797(98)00017-8. View

5.
Feigelman S, Dubowitz H, Lane W, Grube L, Kim J . Training pediatric residents in a primary care clinic to help address psychosocial problems and prevent child maltreatment. Acad Pediatr. 2011; 11(6):474-80. PMC: 5482713. DOI: 10.1016/j.acap.2011.07.005. View