Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Oct 24:65:102282.
doi: 10.1016/j.eclinm.2023.102282. eCollection 2023 Nov.

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

Ryan K McBain  1   2 , Jonathan S Levin  2 , Samantha Matthews  3 , Nabeel Qureshi  3 , Dayna Long  4 , Adam B Schickedanz  5 , Rachel Gilgoff  6 , Krista Kotz  6 , George M Slavich  7 , Nicole K Eberhart  3
Affiliations
Review

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

Ryan K McBain et al. EClinicalMedicine. .

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.

PubMed Disclaimer

Conflict of interest statement

RKM, NQ, DL, GMS, and NKE declare funding support from the California Department of Health Care Services over the prior 36 months, including since the initial planning of work. AS declares funding support from the Eunice Kennedy Shriver National Institute of Child Health & Human Development over the prior 36 months. RG declares funding support from UCLA-UCSF ACEs Aware and Family Resilience Network (UCAAN) over the prior 36 months, including since the initial planning of work, as well as consulting fees from UCAAN. RG also declares consulting fees from the Center for Youth Welnness and payment for expert testimony from Eglet Adams and Nevada State ACEs and Toxic Stress Abatement Plan. RG also declares participation in three data safety monitoring/advisee boards: for Pathways to Resilience Expert Advisory Committee–Aurrera Health, Expert Review Panel, Safe Spaces: Foundations of Trauma-Informed Practice for Educational and Care Settings–Office of the California Surgeon General, and National Early Relational Health Network. RG declares roles as the co-founder of the National Committee on Asthma and Toxic Stress and board membership of the Board Member, California American Professional Society on the Abuse of Children, as well as stock options in Stronger Brains Inc. KK declares support from California Department of Health Care Services and UCAAN since the initial planning of the work, as well as grants/contracts and consulting fees through Aurrera Health Group, Hillcrest Advisory, and the Population Health Innovation Lab in the prior 36 months.

Figures

Fig. 1
Fig. 1
Literature review flow diagram. ACEs, adverse childhood experiences. Reasons for exclusion were identified in sequential order: i.e., reviewers first identified whether the study related to ACEs, and only if the study related to ACEs would they proceed to inspecting whether the study was set in primary care, etc.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Centers for Disease Control and Prevention . 2022. Preventing adverse childhood experiences.https://www.cdc.gov/violenceprevention/aces/fastfact.html
    1. Felitti V.J., Anda R.F., Nordenberg D., et al. 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):245–258. doi: 10.1016/s0749-3797(98)00017-8. - DOI - PubMed
    1. About the CDC-Kaiser ACE study. Centers for Disease Control and Prevention; 2021. https://www.cdc.gov/violenceprevention/aces/about.html
    1. Franke H.A. Toxic stress: effects, prevention and treatment. Children. 2014;1(3):390–402. doi: 10.3390/children1030390. - DOI - PMC - PubMed
    1. Hughes K., Bellis M.A., Hardcastle K.A., et al. The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. Lancet Public Health. 2017;2(8):e356–e366. doi: 10.1016/S2468-2667(17)30118-4. - DOI - PubMed