295 - Comparison of ACEs Reporting Between Clinic and Telephone-based Screening

Poster Number: 295
Publication Number: 295.1852

Background: Adverse Childhood Experiences (ACEs) are strongly associated with chronic disease, but the potential for ACEs screening to improve outcomes may depend in part on screening being acceptable and accurate. Screening modality and context may be an important determinant of these characteristics. 211LA, LA County’s largest health services referral and information provider, provides telephone-based ACEs screening and care coordination. We compared ACEs scores from screenings done over the phone by 211LA to self-completed screenings in clinics during well child visits.

Objective: First, to understand whether families report higher or lower ACEs scores in 211LA telephone-based screening than in clinic-based screening. Second, to identify family factors associated with differences in ACEs scores between 211LA and clinic-based screening.

Design/Methods: Study data were drawn from the intervention arm of a randomized trial of families with at least 1 ACE on the Pediatric ACEs and Related Life-events Screener (PEARLS) administered in well child visits at three Federally Qualified Health Centers. Families in this arm received clinic-based PEARLS screening, then a second phone-based PEARLS screening by 211LA 1-2 weeks later (n=51). A within-subjects design examined whether scores differed between 211LA and clinic-based screening. Bivariable linear regressions tested the amount by which trust in healthcare providers, parent stress, financial security, education, income, child age/sex, Latinx ethnicity, and English proficiency predicted higher 211LA scores relative to clinic ACEs scores.

Results: ACEs scores obtained by both clinic (mean=1.35, range=1-3) and 211LA (mean=2.08, range=0-6) showed unimodal, right-skewed distributions. In a paired t-test, 211LA ACEs scores were higher than clinic ACEs scores (difference=0.73, p=0.002).
In linear regressions, greater trust in providers (B = 0.64, p=0.049), more parental stress (B = 0.06, p=0.028), and speaking English “Well” versus “Very well” (B = 1.85, p=0.043) were associated with higher 211LA scores relative to clinic ACEs scores.

Conclusion(s): In this small pilot, 211LA telephone-based screening resulted in higher ACE scores than in-clinic screening. Findings suggest that, beyond screening modality (telephone vs. in-clinic, verbal vs. self-completed) and timing (e.g. repeated screening), family context, English proficiency, and relationship with providers may also influence ACEs screening results.