{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:01:51Z","timestamp":1787022111596,"version":"build-2736575974"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2022,12,15]],"date-time":"2022-12-15T00:00:00Z","timestamp":1671062400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"TARA Health Foundation"},{"DOI":"10.13039\/100004328","name":"Genentech","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004328","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>While there is growing support for screening for Adverse Childhood Experiences (ACEs), rigorous evidence on the efficacy and preference of screening methods is needed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine caregiver: (1) rates of disclosure of their child\u2019s exposure to ACEs using item-level response (each item can be endorsed) versus aggregate-level response (only total score reported) screening format, (2) associations between family demographic factors and disclosure by screening format, and (3) emotional reaction and experience of screening formats in a diverse, low-income pediatric population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Caregiver participants (n = 367) were randomized to complete the Pediatric ACEs and Related Life Events Screener (PEARLS) tool, in an aggregate-level response vs item-level response format from 2016\u20132019. Select caregivers (n = 182) participated in debriefing interviews. T-test and chi-square analyses in 2019 compared PEARLS disclosure rates and reactions between the screening modalities. Regression models explored interactions with child characteristics. Thematic analysis of interview notes captured caregiver screening experience.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>PEARLS disclosure rates were significantly higher in the aggregate-level response compared to the item-level response screening arm (p &lt;0.05). This difference was accentuated for children identified as black and\/or male (p &lt;0.05). Caregiver reactions to PEARLS screening were rarely negative in either screening format. Qualitative data demonstrated strong caregiver preference for the item-level response format; additional themes include provider relationship, fear with disclosure, and screening outcome expectations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>While caregivers reported a preference for the item-level response format, the aggregate-level response screening format elicited higher disclosures rates particularly for children who are black or ma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec006\">\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>\n                      <jats:bold>Clinical trial registry:<\/jats:bold>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT04182906\" xlink:type=\"simple\">NCT04182906<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0273491","type":"journal-article","created":{"date-parts":[[2022,12,15]],"date-time":"2022-12-15T13:56:22Z","timestamp":1671112582000},"page":"e0273491","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":11,"title":["Screening for adverse childhood experiences in pediatrics: A randomized trial of aggregate-level versus item-level response screening formats"],"prefix":"10.1371","volume":"17","author":[{"given":"Dayna","family":"Long","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle","family":"Hessler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kadiatou","family":"Koita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7522-2810","authenticated-orcid":true,"given":"Monica","family":"Bucci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mindy","family":"Benson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1265-2925","authenticated-orcid":true,"given":"Rachel","family":"Gilgoff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neeta","family":"Thakur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadine","family":"Burke Harris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,12,15]]},"reference":[{"issue":"44","key":"pone.0273491.ref001","doi-asserted-by":"crossref","first-page":"999","DOI":"10.15585\/mmwr.mm6844e1","article-title":"Vital Signs: Estimated Proportion of Adult Health Problems Attributable to Adverse Childhood Experiences and Implications for Prevention 25 States, 2015\u20132017.","volume":"68","author":"MT Merrick","year":"2019","journal-title":"MMWR Morb Mortal Wkly Rep."},{"issue":"4","key":"pone.0273491.ref002","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/S0749-3797(98)00017-8","article-title":"Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study.","volume":"14","author":"VJ Felitti","year":"1998","journal-title":"Am J Prev Med"},{"key":"pone.0273491.ref003","volume-title":"Vibrant and Healthy Kids: Aligning Science, Practice, and Policy to Advance Health Equity.","author":"National Academies of Sciences, Engineering, and Medicine","year":"2019"},{"issue":"1","key":"pone.0273491.ref004","article-title":"Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician: Translating Developmental Science Into Lifelong Health","volume":"129","author":"AS Garner","year":"2012","journal-title":"Pediatrics"},{"key":"pone.0273491.ref005","doi-asserted-by":"crossref","first-page":"16","DOI":"10.7812\/TPP\/16-055","article-title":"Patient Preferences for Discussing Childhood Trauma in Primary Care.","volume":"21","author":"E Goldstein","year":"2017","journal-title":"Perm J"},{"key":"pone.0273491.ref006","article-title":"Screening for Adverse Childhood Experiences and Trauma","author":"M. Schulman","year":"2019","journal-title":"Technical Assistance Tool. Center for Health Care Strategies, Inc. February"},{"issue":"1","key":"pone.0273491.ref007","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1177\/1524838013496335","article-title":"Disclosure of intimate partner violence to informal social support network members: A review of the literature.","volume":"15","author":"K. M. Sylaska","year":"2014","journal-title":"Trauma, Violence, & Abuse,"},{"issue":"1","key":"pone.0273491.ref008","doi-asserted-by":"crossref","first-page":"37","DOI":"10.5249\/jivr.v1i1.15","article-title":"Factors associated with disclosure of intimate partner violence among women in Lagos, Nigeria.","volume":"1","author":"L. Okenwa","year":"2009","journal-title":"Journal of injury and violence research"},{"key":"pone.0273491.ref009","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1007\/s40653-017-0138-z","article-title":"Feasibility of Assessing Parental ACEs in Pediatric Primary Care: Implications for Practice-Based Implementation.","volume":"10","author":"RJ Gillespie","year":"2017","journal-title":"Journ Child Adol Trauma"},{"issue":"12","key":"pone.0273491.ref010","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0208088","article-title":"Development and implementation of a pediatric adverse childhood experiences (ACEs) and other determinants of health questionnaire in the pediatric medical home: A pilot study.","volume":"13","author":"K Koita","year":"2018","journal-title":"PLoS One."},{"key":"pone.0273491.ref011","volume-title":"Center for Youth Wellness ACE-Questionnaire User Guide.","author":"M Bucci","year":"2015"},{"issue":"12","key":"pone.0273491.ref012","doi-asserted-by":"crossref","first-page":"2831","DOI":"10.1093\/jn\/135.12.2831","article-title":"Food Insecurity Affects School Childrens Academic Performance, Weight Gain, and Social Skills","volume":"135","author":"DF Jyoti","year":"2005","journal-title":"J Nutr"},{"issue":"11","key":"pone.0273491.ref013","doi-asserted-by":"crossref","first-page":"1830","DOI":"10.1377\/hlthaff.2015.0645","article-title":"Food Insecurity And Health Outcomes.","volume":"34","author":"C Gundersen","year":"2015","journal-title":"Health Aff (Milwood)."},{"issue":"12","key":"pone.0273491.ref014","doi-asserted-by":"crossref","first-page":"1293","DOI":"10.1016\/j.jaac.2012.09.009","article-title":"Food Insecurity and Mental Disorders in a National Sample of U.S. Adolescents.","volume":"51","author":"KA Mclaughlin","year":"2012","journal-title":"J Am Acad Child Adolesc 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Psychol"},{"key":"pone.0273491.ref018","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.chiabu.2015.06.002","article-title":"Housing Mobility and Cognitive Development: Change in Verbal and Nonverbal Abilities.","volume":"48","author":"PJ Fowler","year":"2015","journal-title":"Child Abuse Negl"},{"issue":"2","key":"pone.0273491.ref019","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1086\/682162","article-title":"The Cost of Color: Skin Color, Discrimination, and Health among African-Americans.","volume":"121","author":"EJ Monk","year":"2015","journal-title":"Am J Sociol."},{"key":"pone.0273491.ref020","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.psyneuen.2015.08.018","article-title":"Developmental histories of perceived racial discrimination and diurnal cortisol profiles in adulthood: A 20-year prospective study.","volume":"62","author":"EK Adam","year":"2015","journal-title":"Psychoneuroendocrinology."},{"key":"pone.0273491.ref021","first-page":"119","article-title":"Multiple forms of discrimination, social status, and telomere length:Psychoneuroendocrinology.","volume":"98","author":"EJ Pantesco","year":"2018"},{"issue":"2","key":"pone.0273491.ref022","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1093\/eurpub\/cki105","article-title":"Bullying and symptoms among school-aged children: international comparative cross sectional study in 28 countries.","volume":"15","author":"P Due","year":"2005","journal-title":"Eur J Public Health"},{"issue":"10","key":"pone.0273491.ref023","doi-asserted-by":"crossref","first-page":"1544","DOI":"10.1002\/ejp.689","article-title":"Bullying, abuse and family conflict as risk factors for chronic pain among Dutch adolescents","volume":"19","author":"J Voerman","year":"2015","journal-title":"Eur J Pain"},{"issue":"16","key":"pone.0273491.ref024","doi-asserted-by":"crossref","first-page":"2094","DOI":"10.1001\/jama.285.16.2094","article-title":"Bullying behaviors among us youth: Prevalence and association with psychosocial adjustment","volume":"285","author":"TR Nansel","year":"2001","journal-title":"JAMA"},{"issue":"2","key":"pone.0273491.ref025","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1111\/j.1943-278X.1999.tb01050.x","article-title":"Suicidal Ideation among Adolescent School Children, Involvement in Bully\u2014Victim Problems, and Perceived Social Support.","volume":"29","author":"K Rigby","year":"1999","journal-title":"Suicide Life Threat Behav."},{"issue":"4","key":"pone.0273491.ref026","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1016\/j.chest.2016.11.027","article-title":"Perceived Discrimination Associated With Asthma and Related Outcomes in Minority Youth: The GALA II and SAGE II Studies.","volume":"151","author":"N Thakur","year":"2017","journal-title":"Chest"},{"issue":"1","key":"pone.0273491.ref027","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1606\/1044-3894.2017.10","article-title":"Exposure to Community Violence as a New Adverse Childhood Experience Category: Promising Results and Future Considerations.","volume":"98","author":"E Lee","year":"2017","journal-title":"Fam Soc"},{"issue":"6","key":"pone.0273491.ref028","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1037\/0022-3514.54.6.1063","article-title":"Development and validation of brief measures of positive and negative affect: the PANAS scales","volume":"54","author":"D Watson","year":"1988","journal-title":"J Pers Soc Psychol"},{"key":"pone.0273491.ref029","volume-title":"Dedoose Version 7.0.23, web application for managing, analyzing, and presenting qualitative and mixed method research data","year":"2016"},{"key":"pone.0273491.ref030","first-page":"222","article-title":"Thematic analysis.","author":"V. Clarke","year":"2015","journal-title":"Qualitative psychology: A practical guide to research methods"},{"key":"pone.0273491.ref031","article-title":"A Process and feasibility evaluation of the pilot Adverse Childhood Experience (ACE) Informed Approach to Policing Vulnerability Training.","author":"K Ford","year":"2017","journal-title":"Public Health Wales."},{"key":"pone.0273491.ref032","first-page":"181","article-title":"Primary healthcare practitioners\u2019 screening practices and attitudes towards women survivors of child abuse.","volume":"9","author":"A. Lee","year":"2012","journal-title":"Ment Health Fam Med"},{"issue":"467","key":"pone.0273491.ref033","first-page":"468","article-title":"Women who experience domestic violence and women survivors of childhood sexual abuse: A survey of health professionals attitudes and clinical practice.","volume":"51","author":"J Richardson","year":"2001","journal-title":"Br J Gen Pract"},{"issue":"1","key":"pone.0273491.ref034","doi-asserted-by":"crossref","first-page":"e13","DOI":"10.1542\/peds.2013-2475","article-title":"Adverse Childhood Experiences of Low-Income Urban Youth","volume":"134","author":"R Wade","year":"2014","journal-title":"Pediatrics"},{"issue":"3","key":"pone.0273491.ref035","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1177\/0022146512455804","article-title":"Miles to go before we sleep: racial inequities in health.","volume":"53","author":"DR Williams","year":"2012","journal-title":"J Health Soc Behav"},{"key":"pone.0273491.ref036","unstructured":"White Coat 4 Black Lives Racial Justice Report Card 2019. https:\/\/whitecoats4blacklives.org\/wp-content\/uploads\/2019\/08\/RJRC-2019-Full-Report-Final-8.28.19.pdf"},{"key":"pone.0273491.ref037","unstructured":"Pediatric Inegrated Care Collaborative. Implementing Trauma-Informed Integrated Care. https:\/\/picc.jhu.edu\/the-toolkit.html"},{"issue":"2","key":"pone.0273491.ref038","first-page":"e20191765","article-title":"AAP Section on Adolescent Health, AAP Council on Community Pediatrics, AAP Committee on Adolescence. 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