Pediatric ACEs and Related Life Events Screener (PEARLS v2): Adaptations and Acceptability

Due to a demonstrated relationship between Adverse Childhood Experiences (ACEs) and a range of psychological, physical, and social risks, there has been a growing movement to integrate routine ACEs screening in pediatric settings. As screenings have increased, there has also been a call for research to uncover areas for improvement in the implementation of these screenings. The Pediatric ACEs and Related Life Events Screener (PEARLS) is one common tool used for screening that has demonstrated construct validity in identifying three domains of adversity: maltreatment, household challenges, and social context. A second version of PEARLS (PEARLS v2) was adapted and refined in response to feedback collected from public health professionals, physicians, clinical psychologists, mental health specialists, and patients in a variety of settings, including clinics, state advisory boards, and health equity counsels. To ensure acceptability, this study examines caregiver feedback on PEARLS v2 through semi-structured interviews with 13 caregivers of child patients in Federally Qualified Health Centers. Using Rapid Qualitative Analysis, results highlight caregiver feedback on the addition of a written introduction to the screener and overall implementation preferences (i.e., location, length of time). Results also underscore caregiver feedback and suggestions on item clarity and acceptability, the addition of strength-based questions, perspectives on caregiver honesty in completing the screener, and preferences regarding provider response and resources. Findings support PEARLS v2 adaptations and provide caregiver-driven feedback to address acceptability and implementation of the screener in pediatric settings.