Comparison of ACEs reporting between clinic and telephone-based screening

Background: Whether screening for Adverse Childhood Experiences (ACEs) can improve health outcomes may depend in part on screening being acceptable and accurate. Screening modality and context may be important determinants of these characteristics. Objective: We compared telephone ACE screenings by 211LA (a health and human services information and referral center) to self-completed screenings during well-child visits and identified family factors associated with differences in ACEs reporting. Participants and Setting: This is a secondary analysis of data from the intervention arm (n = 51) of a pilot randomized trial of telephone ACE care coordination via 211LA versus usual care at three Federally Qualified Health Centers. Children who had ≥ 1 ACE on the Pediatric ACEs and Related Life-events Screener (PEARLS) administered during a well-child visit and were randomized to the intervention were connected to 211LA 1–2 weeks after their clinic visit. 211LA then administered a subsequent telephone PEARLS screening. Methods: A within-subjects design examined whether scores differed between clinic and 211LA screening. Linear regressions tested whether trust in healthcare providers, parent stress, financial security, education, income, child age/sex, Latine ethnicity, and English proficiency predicted higher 211LA than clinic scores. Results: In paired t-tests, mean ACE scores were higher (2.08 vs. 1.35, p = 0.002) through 211LA than through clinics. In linear regressions, greater trust in healthcare providers (β = 0.64, p = 0.049), more parental stress (β = 0.06, p = 0.028), and speaking English “Well” versus “Very well” (β = 1.85, p = 0.043) were associated with a greater difference in 211LA versus clinic scores. Conclusions: Telephone-based screening may be effective for sensitive questions. Specific family factors may affect which screening approaches are preferable.