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

Sara Cibralic; Mafruha Alam; Antonio Mendoza Diaz; Susan Woolfenden; Ilan Katz; Dimitra Tzioumi; Elisabeth Murphy; April Deering; Lorna McNamara; Shanti Raman; Valsamma Eapen

doi:10.1136/bmjopen-2021-060395

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

BMJ Open. 2022 Aug 25;12(8):e060395. doi: 10.1136/bmjopen-2021-060395.

Authors

Sara Cibralic¹, Mafruha Alam², Antonio Mendoza Diaz³, Susan Woolfenden^{4

5}, Ilan Katz⁶, Dimitra Tzioumi^{7

8}, Elisabeth Murphy⁸, April Deering⁸, Lorna McNamara⁸, Shanti Raman⁹, Valsamma Eapen^{3

10}

Affiliations

¹ Ingham Institute, Liverpool, New South Wales, Australia s.cibralic@unsw.edu.au.
² Ingham Institute, Liverpool, New South Wales, Australia.
³ Department of Psychiatry, University of South Wales, Sydney, New South Wales, Australia.
⁴ Sydney Local Health District, Camperdown, New South Wales, Australia.
⁵ Department of Paediatrics, University of New South Wales, Sydney, New South Wales, Australia.
⁶ Department of Social Policy Research Centre, University of New South Wales, Sydney, New South Wales, Australia.
⁷ University of New South Wales, Sydney, New South Wales, Australia.
⁸ New South Wales Ministry of Health, St Leonards, New South Wales, Australia.
⁹ South Western Sydney Local Health District, Liverpool, New South Wales, Australia.
¹⁰ ICAMHS, South Western Sydney Local Health District, Liverpool, New South Wales, Australia.

Abstract

Objective: To 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).

Design: A systematic review of literature was undertaken.

Data source: PsycInfo, Web of Science, Embase, PubMed and CINAHL were searched through June 2021. Additional searches were also undertaken.

Eligibility criteria: English 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 synthesis: Two independent reviewers extracted data and assessed for risk of bias using the Mixed Methods Appraisal Tool. Results were synthesised qualitatively.

Results: Initial 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.

Conclusion: As 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 number: University of York Centre for Reviews and Dissemination (CRD42021260420).

Keywords: child & adolescent psychiatry; paediatric pathology; quality in health care.

Publication types

Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Adverse Childhood Experiences*
Caregivers
Child
Child, Preschool
Delivery of Health Care
Family
Humans
Infant
Infant, Newborn
Parents
Young Adult