Indeed, although combined in this study, there may be a qualitative difference between screening for a need for resources (broader social determinant of health screening) and for exposure to adversity within the caregiving relationship (eg, abuse, neglect, exposure to intimate partner violence). 12 Having only 4 studies of this systematic review that meet moderate criteria speaks to the limited evidence for the value of ACEs screening and a lack of evidence that screening improves access or receipt of necessary services. We know from our previous work that there is an intergenerational effect of ACEs 11 and also a possible hesitancy to answer questions that are sensitive and potentially retraumatizing. In their systematic review, Loveday et al 6 identified a dearth of studies relevant to child ACEs screening and point out that none of the studies reported on child or parent mental health outcomes.
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