Screening for adverse childhood experiences increases visits to behavioral health services


A recent study found that children were 7.5 times more likely to visit behavioral health services after positive screening for adverse childhood experiences.

New screenings for adverse childhood experiences (ACEs) increase the rate of positive screenings and reception of behavioral health services among children and adolescents, according to a recent study.

ACEs have been associated with physical and mental health complications, but there have been challenges when attempting to implement wide-scale screening and appropriate action following positive screenings. The lack of guidelines for referrals and the slow uptake of ACE screening in pediatric primary care led to these challenges.

Most states prioritize education programs related to trauma rather than considering how the need for these services could be identified in children. There are also few studies on how the implementation of ACEs screening impacts treatment response among pediatric patients in primary care.

To determine the association between ACEs screening and completed visits to behavioral health services, investigators conducted a study in an integrated health care system. About 1.5 million children were served in the system, and data for the study was collected from the electronic records of pediatric patients from July 1, 2018, to November 30, 2021.

Participants were members of the health care system who had completed ACEs screening at the pilot clinic. Data was divided into preintervention and postintervention periods to determine the outcome, with the assumption that no intervention would lead to a continuation of preintervention trends.

A questionnaire was completed by participants prior to intervention, with participants aged 13 years and older answering for themselves while participants aged 2 to 12 years had their questionnaires completed by their parents. Referral scores were consistent with results from ACEs screenings.

Changes implemented during intervention include change in screener, referral from a pediatrician to a medical social worker in cases of positive screenings, and a direct connection from a social worker to behavioral health services after assessment. These changes were based on the screening progress, feedback from parents and professionals, and policy changes.

The new screening tool was the Pediatric ACEs and Related Life-Events Screener (PEARLS). PEARLS contained 10 common screening questions, along with 7 questions on community violence exposure, housing inability, discrimination, food insecurity, separation from parent, parent or guardian death, and parental severe physical illness or disability.

The primary outcome of the study was the rate of completed visits to behavioral health services within 90 days of a positive health screening. Covariates included age at screening, race and ethnicity, and Medicaid status.

There were 4030 children with positive ACEs screenings, with a mean age of 9.94. The gender of participants was closely split, 73% were Hispanic, and 33% had Medicaid status. Of the positive screenings, 1383 took place during the preintervention period and 2949 during the postintervention period.

Children with positive screenings were 7.5 times more likely to complete a behavioral health visit, with health visits more likely among girls and older participants. Investigators concluded that changes to health care systems should be implemented to screen children for ACEs and provide them with care.


Negriff S, DiGangi MJ, Sidell M, Liu J, Coleman KJ. Assessment of screening for adverse childhood experiences and receipt of behavioral health services among children and adolescents. JAMA Netw Open. 2022;5(12):e2247421. doi:10.1001/jamanetworkopen.2022.47421

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