P3A164: Utility of Aces Screening Tool vs. Traditional Interview in a Specialty Pediatrics Clinic

Background: Growing evidence shows experiencing Adverse Childhood Experiences (ACEs) increases likelihood of behavioral health diagnoses in a dose-dependent manner. Information about ACEs could be valuable for formation of correct diagnoses in a specialty health setting. This study compares results of ACEs disclosed in traditional 90-minute initial interviews in Developmental Behavioral Pediatrics (DBP) clinic to results of a validated ACEs screening tool, hypothesizing that a standardized screening tool will provide more information on ACEs endorsements than in-depth interview alone.

Methods: In an academic center DBP clinic, caregivers participated in traditional interviews at their initial visit. Later, five providers were trained to use a validated screening tool, the PEdiatric ACEs and Related Life Events Screener (PEARLS) and provide Resilience education. Following this intervention, all patients visiting the DBP clinic for a 2nd or 3rd visit were consented and administered the PEARLS. After enrollment, each patient’s clinic note from their initial visit interview was coded for all disclosed ACEs, and results of both were compared.

Results: Using paired t-test analysis, the results suggest that there was a significant difference in the total scores between PEARLS tool (mean = 3.41, SD = 3.93) and interview (mean = 2.08, SD = 2.01), t(36) = 2.636, p=0.012, for the 19 total ACEs included on the PEARLS. Overall, more ACEs were endorsed by caregivers using the PEARLS tool than in the initial interview alone. Discrepancies by item number are shown in Table 1.

Results from multiple linear regression indicated that larger differences between PEARLS and interview were observed in older children (in months) (β = 0.06, p = < 0.001), Hispanic ethnicity (β = 3.3, p = 0.009, vs. Non-Hispanic), and those who were in non-kinship foster/adoptive homes (β = 4.6, p = 0.02, vs. bio child), controlling the impact of other covariates such as provider, location, changes in caregiver, income, days between interview and PEARLS, and diagnosis, as shown in Table 2.

Conclusion: Use of an ACEs screening tool provided more information than a traditional interview in a DBP clinic. Potential limitations include time between interview and PEARLS tool at 2nd or 3rd visit (no significant discrepancy using multiple linear regression) and possible lack of documentation of ACEs in initial notes, despite provider knowledge of them (not reported by providers on follow up surveys). This study suggests that a tool such as the PEARLS may help providers elicit more uniform and comprehensive ACEs information or may prompt more tailored interviews to better ascertain a history of ACEs. However, ACEs screening tools are not recommended to be used without a protocol for positive results and corresponding Resilience education.