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

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.Copyright (c) 2023 RAND Corporation. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).