Table 2.
Strength of evidence associating interventions with patient-related outcomes.
| Outcome | ACE Training | ACE Screening | ACE Response |
|---|---|---|---|
| Acceptability/Satisfaction | Low (n = 5): All studies found high levels of acceptability and satisfaction, including two RCTs; only five studies, inspecting different—albeit related—outcomes; studies had potential for social desirability bias. | Moderate (n = 14): Studies were predominately observational; outcomes were self-reported; respondents (patient, caregiver, provider) varied across studies; most studies recorded high levels of satisfaction and acceptability. | Very Low (n = 5): Four of five studies were observational; outcomes were self-reported; sample sizes were small; all findings indicated positive feedback from patients and caregivers. |
| Engagement in Referrals | Very Low (n = 2): Small number of studies on the topic, with only one RCT; acceptance of referrals was as low as 14% in one setting; both studies provided quantitative estimates for referral acceptance. | Very Low (n = 5): Small number of studies; sample sizes were modest; observed acceptance of referral rates ranged from 14% to 77%; one RCT and one quasi-experimental study both found a large increase in patients accessing community resources among those in intervention group. | Very Low (n = 4): Small number of studies; two studies were observational; small sample sizes; low acceptance rates (<40%) of referrals in both studies. |
| Health Outcomes | Very Low (n = 2): Only two studies; outcomes were self-reported and may be subject to social desirability bias. | Low (n = 3): Studies examined limited set of outcomes; two RCTs found an intervention (SEEK) reduced household violence, though outcome was self-reported; observational study found effects that largely dissipated within two months. | Very Low (n = 3): Small number of studies; outcomes were self-reported; improvements largely dissipated within two months. |
ACE, Adverse childhood experience. RCT, Randomized controlled trial. Options for strength of evidence were: very low, low, medium, and high, based on GRADE criteria.