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The problem
Intervention: Screening for adverse childhood experiences (ACEs) and related life events using the PEARLS tool, with randomization to item-level screening, aggregate-level screening, or control (no screening)
Who it was tested with: Children aged 0-11 years (n=367) attending a safety-net primary care clinic in Oakland, California.
Children or communities are compared with a group that did not receive the intervention, or followed over years. This is the design that best separates what the intervention did from everything else that changed.
"Participants were randomized 1:1:1 to item-level (item response), aggregate-level (total number of exposures), or no screening for ACEs (control arm)" with multivariable regression models examining associations between PEARLS scores and health outcomes. The randomized design with comparison groups and statistical adjustment for confounders provides experimental-level evidence for the associations between ACEs and health outcomes, though the primary finding concerns the relationship between adversities and health rather than the efficacy of the screening intervention itself.
The study design is primarily observational; screening group assignment did not substantially change disclosure patterns or outcomes. Cross-sectional design cannot establish causality. No long-term follow-up to assess whether screening led to improved health outcomes or interventions.
Across countries and designs
1 study · 1 country
