The effect of adverse childhood experience training, screening, and response in primary care: a systematic review

Ryan K McBain; Jonathan S Levin; Samantha Matthews; Nabeel Qureshi; Dayna Long; Adam B Schickedanz; Rachel Gilgoff; Krista Kotz; George M Slavich; Nicole K Eberhart

doi:10.1016/j.eclinm.2023.102282

The effect of adverse childhood experience training, screening, and response in primary care: a systematic review

EClinicalMedicine. 2023 Oct 24:65:102282. doi: 10.1016/j.eclinm.2023.102282. eCollection 2023 Nov.

Authors

Affiliations

¹ Department of Medicine, Brigham & Women's Hospital, Boston, MA, USA.
² Division of Healthcare Delivery, RAND Corporation, Washington, DC, USA.
³ Division of Healthcare Delivery, RAND Corporation, Santa Monica, CA, USA.
⁴ Department of Medicine, University of California, San Francisco, CA, USA.
⁵ Department of Pediatrics, David Geffen School of Medicine and Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA, USA.
⁶ UCLA-UCSF ACEs Aware Family Resilience Network, Los Angeles, CA, USA.
⁷ Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA.

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.

Keywords: Adverse childhood experiences; Life stressors; Pediatrics; Primary care; Traumatic stress.

Publication types

Review