Social work and adverse childhood experiences research: implications for practice and health policy

Measuring interpersonal trauma: Development and validation of the German version of the victimization experience schedule (VES)

OBJECTIVE

Interpersonal victimization experiences (VEs) significantly affect mental and physical health, particularly in disorders associated with life-time adversities, like fibromyalgia syndrome (FMS) and major depressive disorder (MDD). However, assessing VEs comprehensively remains challenging due to limited tools that encompass sub-traumatic events, such as bullying or discrimination, and contextual dimensions. We aimed to address this gap by validating the Victimization Experience Schedule (VES) in German, examining its reliability, and assessing VEs in clinical populations with FMS and MDD.

METHODS

We investigated the relationship between VEs and clinical symptoms in individuals with FMS, MDD and healthy controls (N = 105) in a case-control study. We also analyzed correlations between different types of VEs and categories of early childhood abuse and posttraumatic-stress-disorder instruments. Additionally, we validated our findings in an independent sample of individuals with FMS (N = 97) from a clinical study.

RESULTS

We observed excellent inter-rater reliability (Kw = 0.90-0.99), and VEs assessed using the VES were in alignment with subcategories of early childhood abuse. The prevalence of VEs extended beyond the categories covered by traditional survey instruments and was higher in individuals with MDD (4.0 ± 2.6) and FMS (5.9 ± 3.1) compared to controls (1.5 ± 1.7). We consistently identified a significant association between the number of VEs, the associated subjective distress, and clinical scores. Furthermore, distinct correlation patterns between VEs and clinical outcomes emerged across different cohorts.

CONCLUSION

Our study emphasizes the VES's value in understanding VEs within MDD and FMS. These experiences span from traumatic to sub-traumatic and correlate with posttraumatic-stress and clinical symptoms, underscoring the VES's importance as an assessment tool.

The long and winding road: Pathways from basic research to implementation and evaluation

In this article, we celebrate Dante Cicchetti's extensive contributions to the discipline of developmental psychopathology. In his seminal article, he articulated why developmental psychopathology was imperative to create research portfolios that could inform the causes, consequences, and trajectories for adults often initiated by early lived experiences (Cicchetti, 1984). In this three-part article, we share our transdisciplinary efforts to use developmental psychopathology as a foundational theory from which to develop, implement, and evaluate interventions for populations who experienced early adversity or who were at risk for child abuse and neglect. After describing interventions conducted at Mt. Hope Family Center that spanned over three decades, we highlight the criticality of disseminating results and address policy implications of this work. We conclude by discussing future directions to facilitate work in developmental psychopathology. Currently, one of three national National Institute of Child Health and Human Development-funded child abuse and neglect centers, we look forward to continuing to build upon Dante's efforts to disseminate this important work to improve society for our children, our nation's often most vulnerable and forgotten citizens.

Adverse Childhood Experiences, Coping and Resilience in Persons with Alcohol Use Disorder and Their Non-drinking Siblings in High-density Families: A Case-control Study

Background

Adverse childhood experiences (ACEs) increase the odds of alcohol use disorder (AUD).

Aim

To study the ACEs, coping, and resilience in persons with AUD and their non-drinking siblings from high-density families.

Methods

The study used a case-control study design. Using purposive sampling, 135 participants were selected; the sample consists of persons with AUD (n = 45), non-drinking siblings (n = 45), and healthy controls (n = 45), selected from out-patient and in-patient services from a government-run de-addiction centre in Bengaluru. Individuals were administered an ACEs questionnaire, Brief-COPE, and Connor-Davison Resilience scale. Descriptive statistics, Friedman's test, and Bonferroni's post-hoc test, Binary Logistic Regression were used for analysis.

Results

ACEs, coping, and resilience significantly differ across the three groups. Persons with AUD and their non-drinking siblings are comparable in terms of ACEs and having dysfunctional family members. Non-drinking siblings and healthy controls have similar coping and resilience. None of the healthy controls had dysfunctional family members.

Conclusion

ACEs are more prevalent and more frequent in persons with AUD. Individuals with AUD showed higher avoidant coping and lower resilience than their non-drinking siblings and healthy controls. Early identification of ACEs and interventions to build resilience and coping strategies could prevent individuals from developing AUD in high-density families.

Factors related to delayed disclosure among victims of child sexual abuse in Singapore

BACKGROUND

Delayed disclosure is a prevalent and serious issue among victims of child sexual abuse (CSA). Identifying the factors associated with delayed disclosure can identify the profile of children who are at risk of delaying disclosures and inform measures to facilitate timely disclosure.

OBJECTIVE

The current study represented a pioneering effort to investigate factors that are related to disclosure of CSA in Singapore. It examined the influence of various victim and abuse characteristics on the time taken for a victim to disclose CSA.

PARTICIPANTS AND SETTING

A total of 252 CSA cases that were referred to the psychology department of Singapore's Ministry of Social and Family Development (MSF) from 2017 to 2021 were analyzed.

METHODS

Cases were coded for the study variables and multivariate Cox regression was conducted to analyze the impact of each variable of interest on the time taken to disclose the abuse.

RESULTS

It was found that the following sub-populations of CSA victims were associated with delayed disclosure: younger victims, female victims (as compared to male victims), victims with higher severity of sexual abuse (e.g., forced intercourse), and victims who were abused by in-home caregivers (as compared to acquaintances).

CONCLUSIONS

The findings from the study generated practical implications to help reduce the time victims take to disclose CSA in the Singaporean context.

Introducing Routine Assessment of Adverse Childhood Experiences For Looked-After Children: The Use and Properties of the Trauma and Adverse Life Events (TALE) Screening Tool

The present study aims to illustrate the process of developing, implementing, and clinically validating a new assessment measure, the Trauma and Adverse Life Events (TALE) screening tool, to assess Adverse Childhood Experiences (ACEs) among looked-after children. The TALE was developed by adapting existing ACEs measures to reflect the experiences of looked-after children. The TALE was completed by the local authority social worker for 218 children placed with Five Rivers Child Care (a UK fostering agency, residential, and educational care provider). Reliability was examined and exploratory factor analysis was conducted. Correlations between TALE scores, background variables, and psychosocial wellbeing using the carer-report Strengths and Difficulties Questionnaire (SDQ) and Child Dissociative Checklist (CDC) were also explored. The TALE was found to have acceptable reliability (α = .71). A three-factor solution was found which explained 46.24% of the variance, with factors labelled 'Direct Experience of Abuse', 'Witnessing Harm', and 'Household Dysfunction'. Exposure score was significantly associated with total difficulties score on the SDQ (rs = .24, p < .001) and Impact score was associated with the SDQ's impact score (rs = .33, p < .001). Exposure and Impact scores were both positively correlated with CDC scores (rs = .16, p = .021 and rs = .22, p = .002). This paper presents evidence of the importance of screening looked-after children for ACEs and demonstrates that the TALE is a valid and reliable tool for this purpose. Adverse and traumatic experiences were highly prevalent in this population and appeared to be closely related with children's psychosocial wellbeing. Results emphasise the importance of routine assessment of past experiences within trauma-informed psychological care and intervention planning for looked-after children.

Adverse childhood experience trajectories and individual high risk-behaviors of sexual offenders: A developmental victimology perspective

BACKGROUND

Developmental victimology theory suggests that developmental features of risk and impact stemming from various types of victimization depend on the age of the child or adolescent.

OBJECTIVE

A next step is studying the developmental victimization trajectories of individuals involved in sexual crimes by focusing on traumatic events occurring during childhood and adolescence respectively. Building on the developmental victimology perspective, the study's specific aims encompass two key objectives: 1) exploring the diverse trajectories of Adverse Childhood Experiences (ACEs) within a sample of individuals involved in sexual crimes, and 2) assessing whether these ACEs trajectories influence the emergence of distinct high-risk behaviors.

PARTICIPANTS AND SETTING

252 individuals convicted of sexual crimes were selected from a federal penitentiary in Quebec, Canada.

METHODS

Semi-structured interviews with a computerized questionnaire produced data on numerous aspects of the participant's life history, criminal career, and victimization experiences that were analyzed via latent class modeling.

RESULTS

Four classes (no ACEs trajectory, poly exposure and victimization trajectory, childhood exposure trajectory, and poly victimization trajectory) were identified.

CONCLUSIONS

Consistent with hypotheses, developmental ACEs trajectories are heterogeneous and associated with the criminal careers, adolescent problematic behaviors, substance use disorders, and violence history among individuals involved in sexual offending.

Employment of trauma informed principles in the Palabras Fuertes project: Implications for narrative research with older Latinx communities

In the US, there is a growing number of older Latinx communities. Qualitative approaches such as narrative inquiry may be fruitful endeavors to elucidate their lived experiences. However, older Latinx communities, including sexual minorities, are disproportionately exposed to social, health, and historical challenges that may result in exposure to potentially traumatic events (e.g. discrimination, illness, grief, etc.). The recognition of high rates of exposure to potentially traumatic events among participants has led to the recommended adoption of Trauma Informed (TI) principles for use in non-trauma specific research. At present, there are limited examples and discussions about the implementation of TI principles in qualitative research and our literature review yielded no discussion of the use of TI principles in narrative inquiry or with older Latinx communities. In this manuscript, we advocate for the adoption of TI principles when engaging in narrative inquiry with older Latinx adults. Second, we discuss examples of TI guided practices we employed while conducting the Palabras Fuertes study of life history narratives with older Latino immigrant gay men living in New York City. Finally, based on these experiences, we provide recommendations for incorporating TI into future narrative research with older Latinx communities.

Mediators of the Relationship Between Adverse Childhood Experiences (ACEs) and Symptoms of Anxiety, Depression, and Suicidality among Adults

Adverse childhood experiences (ACEs) are consistently found to be negatively associated with physical, psychological, and psychosocial well-being throughout the lifespan. While previous research has established risk factors and noxious outcomes arising post-ACEs, less attention has been given to factors such as resilience, perceived social support, and subjective well-being that may help explain the relationship between ACEs and psychopathology. Hence, the objectives of this study are to examine: (1) the relationships among ACEs and symptoms of anxiety, depression, and suicidality in adulthood, and (2) whether resilience, social support, and subjective well-being mediate the relationship between ACEs and psychopathological symptoms. Cross-sectional data on ACEs, psychological factors, potential mediating variables, and sociodemographic factors were collected from a community sample of adults aged 18-81 (N = 296) via an on-line survey. Endorsing ACEs was significantly and positively correlated with symptoms of anxiety, depression, and suicidality. Results of parallel mediation analyses showed that social support, negative affect, and life satisfaction statistically mediated the relationships between ACEs and psychopathological outcomes in adulthood. These results highlight the importance of identifying potential mediators of the ACEs-psychopathological symptoms relationship to aid in the development of screening and intervention practices that could bolster developmental outcomes following traumatic childhood experiences.

Early Adverse Childhood Experiences and Positive Functioning during Adolescence

Adverse childhood experiences (ACEs) have been shown to have consequences for adolescent development, yet little is known about the association between ACEs and positive functioning. Positive functioning evaluates engagement, perseverance, optimism, connectedness, and happiness, which are intimately related to pro-social behavior. As skills associated with sociability in adolescence often carry on into adulthood, understanding the developmental origins in inequalities in pro-social behavior, as measured by positive functioning, is key to ensuring equitable life chances across the life course. Subsequently, the Fragile Families and Child Wellbeing Study (FFCWS; n = 3444) was used to examine how early exposure to cumulative ACEs, plus the timing and duration of those ACEs may be associated with positive functioning development in adolescence. The sample consisted of urban-born youth (49% female) with the mean age of 15. Racial/ethnic breakdown of the sample is 18% non-Hispanic White, 49% non-Hispanic Black, 25% Hispanic, and 8% "Other". Overall, estimates suggest that roughly 88% of these youth experienced at least one ACE by age five. The findings indicate that cumulation, timing, and duration of early ACEs are related to overall adolescent positive functioning and four out of the five domains (perseverance, optimism, connectedness, and happiness), even after controlling for more recent ACEs. This study highlights the critical impact of very early ACEs on youth positive functioning, which may confer further physical, mental, and social disadvantages into adulthood. Positive functioning can serve as a protective factor against some of the negative consequences of adversity, and ensuring that all families receive proper supports may limit the lifelong effects of adversity, and most importantly, prevent ACEs from occurring in the first place.

The Restorative Integral Support (RIS) Model: Community-Based Integration of Trauma-Informed Approaches to Advance Equity and Resilience for Boys and Men of Color

Mental health and health promotion research and practice have consistently revealed the social and structural inequities that boys and men of color (BMoC) face. Moreover, scholarship highlights the importance of gender, especially the concepts of masculinity and manhood, in understanding inequities that are experienced. Providers and community leaders are finding culturally relevant ways to foster healing and restoration while addressing racial trauma and the adverse community environments tied to adverse childhood experiences (ACEs). This article introduces the restorative integral support (RIS) model to promote connectivity through networks and to acknowledge the contextual differences BMoC experience when suffering from trauma and adversities. RIS is a framework used to address adversities and trauma while increasing societal awareness and advancing equity. This community-based, multidimensional approach is offered to enhance individual, agency, community, and policymaking leadership, raising awareness of mental health concerns and trauma while offering a flexible guide to developing safe spaces and support for recovery from ACEs and trauma. This article offers an in-depth appreciation of the real-life contexts within which BMoC overcome histories of adversity and trauma, demonstrating how the RIS model is applied to advance structural transformation while fostering community resilience.

Review: Universal mental health interventions for young students in adverse environments - a systematic review of evaluated interventions

BACKGROUND

Universal classroom-based interventions are a useful method to increase the mental health and resilience in children. Resilience describes the process that leads to a positive development despite adversities. It comprises the seven resources access to material resources, relationships, identity, power and control, cultural adherence, social justice and cohesion. Yet there is a paucity of studies evaluating interventions that enhance resilience in children exposed to adverse childhood experiences.

METHOD

This systematic review investigates whether universal classroom-based interventions can increase the seven resilience-related resources in children that live in adverse environments. Search strings were formulated based on an adapted version of the PICO criteria. The risk of bias of the individual studies was assessed using the ROBINS-I tool.

RESULTS

Seventeen studies were included in the review, of which 15 found an increase in resilience. The resource power and control was targeted in every intervention. Not one intervention included all seven resources. Intervention outcomes related mostly to just two of the resources (power and control and identity) and were rarely linked to what was being trained in the intervention.

CONCLUSION

The results of this review show that classroom-based interventions are suitable for promoting resilience in children living in adverse environments. Yet more high-quality studies are needed that evaluate the effectiveness of universal interventions on children living in adverse environments and specifically the effectiveness of training each of the seven resources. Future developments of school-based interventions should be careful to target and assess all resilience-related resources.

The effects of disability status and perceived neighbourhood cohesion and safety on adverse childhood experiences among college students

Adverse childhood experiences (ACEs) are early traumatic events that can have adverse long-term developmental effects on a person's health and well-being. Individuals with disabilities are at a greater risk of all types of ACEs. However, the impact of having a disability and neighbourhood context on ACEs is under-researched, and even less is known about whether neighbourhood cohesion and safety affect the relationship between disability status and ACEs. The purpose of this study is to examine the direct and indirect pathways between disability status, childhood neighbourhood environment and ACEs. The final study sample of this study was 2,049 college students, consisting of 494 students with disabilities and 1,555 students without disabilities from six universities in the U.S. and Canada between March 2016 and June 2017. Data analysis included Pearson correlations and structural equation modelling procedures using Stata 16 software to test a partial mediation model. Having a disability has both a direct effect and an indirect effect through the neighbourhood environment on ACEs after controlling for socio-demographic characteristics associated with neighbourhood environment or ACEs. The findings suggest that neighbourhood cohesion and safety can be a mediator between disability status and ACEs, and the potential cumulative risk and protective factors that can contribute to ACEs. To elucidate the relationship between disability status and a higher risk for ACEs fully and prevent ACEs that can negatively impact the long-term health outcomes, greater attention to environmental risk and protective factors is urgently needed.

Health Care Burden and Expenditure Associated with Adverse Childhood Experiences in Tennessee and Virginia

To estimate attributable burden and costs of conditions associated with exposure to Adverse Childhood Experiences (ACEs) in Tennessee (TN) and Virginia (VA) during 2017. This is a cross-sectional study of individuals aged 18+ having exposure to ACEs using Behavioral Risk Factor Surveillance System (BRFSS) data. Eight chronic diseases (asthma, obesity, hypertension, diabetes, chronic obstructive pulmonary disease (COPD), depression, cardiovascular disease, and arthritis) and two risk factors (smoking and drinking) associated with ACEs were analyzed. Pearson's chi-square tests analyzed the association between ACEs, risk factors and chronic diseases. The population attributable risks (PAR) were estimated for the ACEs related diseases and risk factors and combined with health care expenses and Disability Adjusted-Life-Years (DALYs). Among those who experienced at least 1 ACE in TN, 10% had COPD, 17% had diabetes, 36% had obesity, and 30% had depression. Individuals who experienced at least 1 ACE in VA had higher percentages for COPD, obesity and depression diseases compared to those who had no ACE (p< .0001). ACEs' exposure resulted in a burden of about 115,000 years and 127,000 years in terms of DALYs in TN and VA, respectively. The total health spending associated with ACEs based on PARs was about $647 million ($165 per adult) and $942 million ($292 per adult) in TN and VA respectively. The total costs associated with ACEs was about $15.5 billion ($3948) per person) and $20.2 billion ($6288 per person) in TN and VA, respectively. This study emphasizes the need to reduce ACEs due to high health and financial costs.

The Relationship between Adverse Family Experiences during Childhood and Self-rated Health Outcome in Adulthood

Although there is increasing evidence of a link between adverse family experiences (AFEs) and long-term health outcomes, few studies have investigated the role of educational attainment in the relationship between AFEs and adult health. The data of this study comes from the China Health and Retirement Longitudinal Study (CHARLS). Here, 15,359 samples were analyzed. Ordered logistic regression with interaction terms was used to explore the moderating effect of education on the relationship between AFEs in childhood and adult self-rated health. The self-rated health scores of people with childhood AFEs were significantly lower than of those without them, particularly in the categories of "parents divorced," "parent died," "physical abuse," "domestic conflict," "parental bias," "physical and emotional neglect," "parental physical illness," 'parental mental illness," "family economic hardship," "experience of starvation," "lived in an insecure neighborhood," and "lived in an unhygienic community." Increases in education level reduced the adverse effects of parental bias and neglect in childhood, but this did not eliminate the negative effect of community's environment on adult health. This study highlighted the role of the level of education in eliminating health disparities, which can reduce the adverse effects of AFEs on health in adulthood.

Exploring the knowledge base of trauma and trauma informed care of staff working in community residential accommodation for adults with an intellectual disability

Background

Taking a trauma informed care approach has demonstrated positive outcomes for services for people in the general population. Given the increased vulnerability to psychological trauma for adults with an intellectual disability, this study explores what residential staff know about trauma and trauma informed care.

Methods

Thirty‐two staffs representing three staff groups: direct care staff; managers; and specialist practitioners, were interviewed using semi‐structured interviews, which were analysed following a structured framework.

Findings

Each staff group held different perspectives in their knowledge of trauma and trauma informed care. Limitations were noted in staffs' knowledge of trauma, implementation of evidence‐based supports, and access to specialist services for adults with an intellectual disability. All participants highlighted their training needs regarding trauma.

Conclusion

Increased training on recognising and responding to trauma is needed among community staff supporting those with a trauma history if organisations are to move towards trauma informed care.

Early Adverse Childhood Experiences and Social Skills Among Youth in Fragile Families

Adverse childhood experiences (ACEs) are associated with negative health and behavioral outcomes across the life course, yet little is known about the association between early ACEs and social skills among youth. As social skills are often shaped by home environments, and social skills developed in adolescence often persist into adulthood, understanding the processes that drive inequalities in developmental outcomes, such as social skills, is imperative. The present study used data from the Fragile Families and Child Wellbeing Study (FFCW; n = 3245) and ordinary least squares regression analyses to explore the associations between early ACEs by age 5 (i.e., cumulative, timing, duration) and youth social skills (components include: emotional maturity, communication skills, intentionality, and social competence). The weighted sample consisted of urban-born youth (44% female) with a mean age of 15. Racial/ethnic breakdown of the sample is 37% non-Hispanic White, 25% non-Hispanic Black, 28% Hispanic, and 10% 'Other'. Overall, estimates suggest that nearly 79% of these youth experienced at least one ACE by age 5. Furthermore, the results indicated that as the number of early ACEs increased, deficits in social skills also increased. Moreover, the timing of exposure to early ACEs (i.e., high early, intermittent, chronic high) decreased social skills. The findings underscore the unique and robust links between early ACEs and youth social skills, underlining the importance of ACE exposure in social skill development.

“Hurt people hurt other people”: The link between past trauma and sexual offending

Background

A growing body of research documents the high rates of trauma among individuals who have sexually offended. Yet the relationship between prior victimization and subsequent sexual offending remained unclear. Objective: By including the voices and perspectives of individuals convicted of sexual offenses, we sought to strengthen professionals’ understanding of the connection between victimization and offending.

Method

This qualitative study used an online survey to collect data from individuals convicted of sexual offenses (n = 195) with the aims of understanding their perceptions of the link between trauma and offending and what they would like sex-offense treatment providers to know about this connection.

Results

Using grounded theory, five major themes emerged from the data analysis: Relationship between Trauma Offending (n = 91), Acknowledging the Connection (n = 57), Specific Effects of Trauma (n = 48), Individualized Treatment (n = 34), and Recognition of Humanity (n = 26).

Conclusions

The participants perceived a strong connection between one’s own victimization and subsequent sexual offending. In addition, they offered specific recommendations for treatment providers, including individualizing treatment with an emphasis on humanity and compassion. Implications for trauma-informed practice and policy are discussed.

An Association of Adverse Childhood Experiences with Binge Drinking in Adulthood: Findings from a Population-Based Study

Background: Adverse childhood experiences (ACEs) are a major public health issue linked to negative health outcomes. Yet, few recent studies drawing on national data have examined the association between ACEs and binge drinking. Objective: The objective of this study was to examine the association between ACEs and binge drinking among adults in the United States and whether this association is dependent on sex. Methods: Data for this study were obtained from the 2019 Behavioral Risk Factor Surveillance System survey. An analytic sample of 41,322 adults aged 18-64 years (50.7% male) from 17 states was analyzed using binary logistic regression. The outcome variable was binge drinking, and the main explanatory variable was ACEs. Results: Of the 41,322 respondents, 21.3% engaged in binge drinking. About 30% of the respondents had no ACEs and 23.9% had four or more ACEs. In the multivariable logistic regression, we observed that sex moderated the association between ACEs and binge drinking. Odds were 1.36 times higher for females who experienced two ACEs (aOR = 1.36 p < .05, 95% CI = 1.04-1.77) and 1.58 times higher for females who experienced three ACEs (aOR = 1.58 p < .01, 95% CI = 1.17-2.12) to engage in binge drinking. Other factors associated with binge drinking include younger age, non-Hispanic White, higher income level, higher education, not being married, being overweight, and history of cigarette smoking. Conclusion: The findings of this study underscore the importance of developing sex-appropriate screening and intervention strategies to support individuals exposed to ACEs and potentially mitigate negative health outcomes later in life.

Adverse Childhood Experiences Distinguish Violent Juvenile Sexual Offenders' Victim Typologies

Juvenile perpetrators account for over 25% of all sexual offenses, and over one-third of such offenses are against victims under the age of 18. Given empirical connections between adverse childhood experience (ACE) exposure and perpetration of violence, we create victim typologies based on the juveniles’ relationship to their victims among 5539 justice-involved adolescents who have committed violent against-person sexual felonies. Multinomial logistic regression is used to assess which covariates, including individual ACE exposures and cumulative traumatic exposures, are associated with victim typologies. This approach allows for better targeting of violence prevention efforts, as a more nuanced understanding of the increased likelihood to victimize specific victim groups lends to potential differences in treatment provision, beyond simplistic findings regarding ACE exposure increasing offending. Results indicate five classes of victim types, ranging from a low of 6.4%, with primarily strangers as victims, to 31.3%, with predominately acquaintances as victims, and only 12.9% with a diverse array of relationships to victims. Importantly, many demographic and individual risk factors, and specific traumatic exposures were related to victimizing one’s sibling, while cumulative trauma as measured by an ACE score decreased the likelihood of victimizing classmates, while increasing the likelihood of victimizing siblings and other relatives compared to victimizing acquaintances.

The Impact of Adverse Childhood Experiences on Cognition in African American Older Adults: An Integrated Literature Review

The current integrative literature review examined the existing evidence on the connection between adverse childhood experiences (ACEs) and cognitive changes in African American older adults. Using the Covidence platform, several databases were searched, resulting in 266 publications dated 2008-2020. Ten articles met inclusion criteria and were reviewed. Findings indicate that four ACEs (physical, sexual, and verbal abuse, and low socioeconomic status) are associated with impaired cognition in African American older adults. Four gaps were identified: lack of (a) older adult participants in research investigating original and expanded ACEs; (b) exclusively African American samples of participants in studies examining the relationship between ACEs and cognition; (c) consensus about what specific ACEs contribute to changes in cognition in older adults; and (d) information about successful interventions created to prevent and mitigate the effects of ACEs in older adults. This review provides a synthesis of the limited evidence on the effects of ACEs on cognition among other outcomes. Findings on the effects of ACEs on African American older adults' cognition are limited, thus making a compelling case for further investigating the role of childhood adversity in the disparity of cognitive changes in African American communities. [Research in Gerontological Nursing, 14(5), 265-272.].

Neighborhood structural characteristics, perceived neighborhood environment, and problem behaviors among at-risk adolescents

Neighborhood environment has been linked to behavioral outcomes in adolescence. The current study examined two potential mediators (i.e., perceived social capital, perceived neighborhood disorder) in the association between neighborhood structural characteristics (i.e., neighborhood disorganization) and problem behaviors (i.e., externalizing behavior, substance use) among at-risk adolescents with prenatal substance exposure. The study sample included 350 15-year-old adolescents recruited at birth. Adolescents' addresses were linked to census tract data. Neighborhood structural characteristics were not directly associated with adolescent problem behaviors in the presence of perceived social capital and neighborhood disorder. Greater neighborhood disorganization was associated with lower levels of perceived social capital, which was related to greater perceived neighborhood disorder, and then problem behaviors. The findings suggest that community practice needs to focus on subjective perceptions of neighborhoods when developing intervention programs on problem behaviors among at-risk adolescents.

Adverse Childhood Experiences & mental health - the urgent need for public health intervention in India

Global evidence has demonstrated that Adverse Childhood Experiences (ACEs) up to age 18 significantly increases the risk of mental and physical health for an adult. The research linking ACE with health and well-being has confirmed a dose-response relationship between the number of ACEs experienced and the extent of the impact on wellbeing. The source of ACE is the family, community, and the immediate environment, and it causes long-term risk for mental health with the potential to carry it over beyond the present generation. The findings are consistent across the developed and developing countries, and the evidence highlights the need for new elements beyond the 10 ACE elements in the pathbreaking original study. India needs urgent intervention on ACE prevention and management with 0.4 billion children and adolescents, with one out of seven Indians with mental health issues. Firstly, this commentary reviews global research and summarizes the limited evidence available in India on ACE elements' impact on mental health. And, secondly, it proposes a multi-pronged approach to identify, manage and prevent the mental health implications of ACE in India to preempt a significant public health challenge.

Comparison of smoking reduction with improvement of social conditions in early life: simulation in a British cohort

BACKGROUND

Health care evaluation models can be useful to assign different levels of priority to interventions or policies targeting different age groups or different determinants of health. We aimed to assess early mortality in counterfactual scenarios implying reduced adverse childhood experience (ACE) and/or improved educational attainment (childhood and early life characteristics), compared with a counterfactual scenario implying reduced smoking in adulthood.

METHODS

We used data from the 1958 National Child Development Study British birth cohort, which initially included 18 558 subjects. Applying a potential outcome approach, scenarios were simulated to estimate the expected mortality between ages 16 and 55 under a counterfactual decrease by half of the observed level of exposure to (i) ACE, (ii) low educational attainment (at age 22), (iii) ACE and low educational attainment (a combined exposure) and (iv) smoking at age 33. Estimations were obtained using g-computation, separately for men and women. Analyses were further stratified according to the parental level of education, to assess social inequalities.

RESULTS

The study population included 12 164 members. The estimated decrease in mortality in the counterfactual scenarios with reduced ACE and improved educational attainment was close to the decreased mortality in the counterfactual scenario with reduced smoking, showing a relative difference in mortality of respectively -7.2% [95% CI (confidence interval) = (-12.2% to 1.2%)] versus -7.0% (-13.1% to +1.2%) for women, and -9.9% (-15.6% to -6.2%) versus -12.3% (-17.0% to -5.9%) for men.

CONCLUSIONS

Our results highlight the potential value of targeting early social characteristics such as ACE and education, compared with well-recognized interventions on smoking.

Cumulative risk of compromised physical, mental and social health in adulthood due to family conflict and financial strain during childhood: a retrospective analysis based on survey data representative of 19 European countries

Background

Childhood adversity (CA) has previously been linked to various health problems in adulthood. Investigations into the differential impact of distinct types of CA on a wide range of outcomes are scarce. This study aimed to assess the impact of self-reported childhood family conflict and/or financial strain on health and social functioning in adulthood among Europeans, while taking into account the mediating role of adulthood socioeconomic disadvantage (SED) in these associations.

Methods

Using the European Social Survey (ESS) collected in 2014, nationally representative cross-sectional data from 35 475 participants aged 15 years and older in 19 European countries were analysed. Logistic regressions were conducted to assess associations of retrospectively reported family conflict and/or financial strain in childhood with physical and mental health as well as health behaviours and social functioning in adulthood.

Results

A quarter of the European population reported having experienced family conflict, financial strain or both in childhood. Financial strain was reported more among older age groups and conflict more among younger age groups. A dose-response pattern with increased risk was demonstrated for almost all physical, behavioral, mental and social outcomes for these aspects of CA compared with no CA, with the highest risk observed in those who experienced both financial strain and family conflict. Adulthood SED mediated a significant proportion of the associations with financial strain (ranging from 5.4% to 72.4%), but did not mediate the associations with conflict.

Conclusion

Individuals reporting family conflict or financial strain during childhood are at increased risk of developing a wide range of health and social problems. Those who report financial strain in childhood are more likely to experience SED in adulthood, which in turn increases their risk of experiencing health and social problems. Reported family conflict during childhood conferred increased risk of health and social problems, but adulthood SED did not appear to operate as an indirect pathway.

Race and sex differences in adverse childhood experiences among Asian/Pacific Islander college students

Adverse childhood experiences (ACEs) may be detrimental to health, yet are understudied in Asians/Pacific Islanders (API). We described the prevalence of individual ACEs among API college students compared to White college students. Participants: College students (n = 8,472) from 17 Minnesota postsecondary institutions completed the College Student Health Survey in spring 2015. Methods: Students self-reported on 11 ACEs. We assessed differences in prevalence of individual ACEs between APIs and Whites. Results: APIs were more likely to report having been physically abused (adj. OR = 2.04), verbally abused (adj. OR = 1.25), and raped (adj. OR = 1.75) relative to Whites. Stratification by sex showed API males were more likely to have been sexually abused relative to White males, with additional ACEs differing significantly by sex and race. Conclusions: Individual ACE prevalence differed between APIs and Whites and is often sex-specific. Additional research is needed to estimate ACE prevalence in other racial/ethnic groups and their health impacts.

Racial/ethnic disproportionality in reunification across U.S. child welfare systems

BACKGROUND

Racial/ethnic disparities are persistent in referrals and removals of children into child welfare systems. Yet, less is known about disparities in reunification, and how system factors may contribute to more equitable outcomes for families of color.

OBJECTIVE

This study examined racial/ethnic disparities in reunification rates across U.S. child welfare systems controlling for child- and system-factors.

PARTICIPANTS AND SETTING

Data for this study came from the 2017 Adoption and Foster Care Analysis and Reporting System (AFCARS). We utilized a subsample of n = 284,382 children ages 0-5.

METHODS

We used a bottom-up model building-approach to examine child- and system-factors associated with reunification. A series of multilevel models were run.

RESULTS

Less than 3% of the variance in reunification occurred between state child welfare systems. Native American children had lower odds of reunification than White children (AOR = 0.87, p < .001), while Hispanic children had higher odds of reunification (AOR = 1.08, p < .001). Random effects were present for race/ethnicity and interaction terms between race/ethnicity and parental drug use were significant.

CONCLUSIONS

Racial/ethnic disparities are present in reunification, though these may vary across child welfare systems. Thus, future research could examine state systems that have better outcomes for families of color and examine factors that might explain these relationships.

Trauma experiences of people with an intellectual disability and their implications: A scoping review

BACKGROUND

People with an intellectual disability are more vulnerable to psychological trauma compared with the general population. The aim of this scoping review was to identify the current status of the literature on trauma that is specific to the experiences of adults with an intellectual disability, living in community settings.

METHODS

A scoping review was conducted using the Arksey and O'Malley (International Journal of Social Research Methodology, 2005, 8, 19) framework. Forty-one international papers were reviewed spanning 2000-2020, and their quality assessed using the MMAT.

FINDINGS

(1) Aggressive behaviours can be symptoms of trauma, (2) there are appropriate assessment tools for the impact of trauma, (3) evidence-based interventions for trauma may be effective, and (4) factors associated with disability can be experienced as traumatic.

CONCLUSION

There is a growing body of literature highlighting assessment needs and potential interventions for people with an intellectual disability who have experienced psychological trauma. Further research is needed to develop trauma-informed pathways.

Can Early Life Stress Engender Biological Resilience?: Commentary

Early life is a sensitive period in which social experience provides essential information for normal development (Johnson and Blasco Pediatrics in Review, 18(7), 224-242, 1997). Studies have shown that having a loving, primary caregiver early in life acts as a protective factor against social and emotional maladjustments later in life (Egeland and Hiester Child Development, 66(2), 474-485, 1995), while the exposure to childhood adversities, such as child abuse and neglect, have been associated with increased risk of developing diseases later in life (Felitti et al. American Journal of Preventive Medicine, 14(4), 245-258, 1998). Data based on reports by American child protective service agencies estimated that with little change over the last four years, more than 700,000 children were victims of child abuse and neglect in the US alone every year (Child Trends Data Bank 2019). The biological mechanisms involved in the associations between childhood adversities and disease development are not known, but it is likely that child abuse and neglect do influence fundamental biological processes (Mehta et al. Proceedings of the National Academy of Sciences of the United States of America, 110(20), 8302-8307, 2013) and epigenetic alteration has been suggested as one such biological mechanism regulating these interactions (Tammen et al. Molecular Aspects of Medicine, 34(4), 753-764, 2013).

Translating the neuroscience of adverse childhood experiences to inform policy and foster population-level resilience

Imaging methods have elucidated several neurobiological correlates of traumatic and adverse experiences in childhood. This knowledge base may foster the development of programs and policies that aim to build resilience and adaptation in children and youth facing adversity. Translation of this research requires both effective and accurate communication of the science. This review begins with a discussion of integrating the language used to describe and identify childhood adversity and their outcomes to clarify the translation of neurodevelopmental findings. An integrative term, Traumatic and Adverse Childhood Experiences (TRACEs+) is proposed, alongside a revised adverse childhood experiences (ACEs) pyramid that emphasizes that a diversity of adverse experiences may lead to a common outcome and that a diversity of outcomes may result from a common adverse experience. This term facilitates linkages between the ACEs literature and the emerging neurodevelopmental knowledge surrounding the effect of traumatic adverse childhood experiences on youth in terms of the knowns and unknowns about neural connectivity in youth samples. How neuroscience findings may lead directly or indirectly to specific techniques or targets for intervention and the reciprocal nature of these relationships is addressed. Potential implications of the neuroscience for policy and intervention at multiple levels are illustrated using existing policy programs that may be informed by (and inform) neuroscience. The need for transdisciplinary models to continue to move the science to action closes the article. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Adverse childhood experiences: Mechanisms of risk and resilience in a longitudinal urban cohort

There is an extensive literature describing the detrimental effects of adverse childhood experiences (ACE; e.g., abuse, neglect, and household dysfunction) on physical and mental health. However, few large-scale studies have explored these associations longitudinally in urban minority cohorts or assessed links to broader measures of well-being such as educational attainment, occupation, and crime. Although adversity and resilience have long been of interest in developmental psychology, protective and promotive factors have been understudied in the ACE literature. This paper investigates the psychosocial processes through which ACEs contribute to outcomes, in addition to exploring ways to promote resilience to ACEs in vulnerable populations. Follow-up data were analyzed for 87% of the original 1,539 participants in the Chicago Longitudinal Study (N = 1,341), a prospective investigation of the impact of an Early Childhood Education program and early experiences on life-course well-being. Findings suggest that ACEs impact well-being in low-socioeconomic status participants above and beyond the effects of demographic risk and poverty, and point to possible mechanisms of transmission of ACE effects. Results also identify key areas across the ecological system that may promote resilience to ACEs, and speak to the need to continue to support underserved communities in active ways.

What Do Survivors of Child Sexual Abuse Believe Will Facilitate Early Disclosure of Sexual Abuse?

The purpose of this study was to explore what adult survivors of child sexual abuse (CSA) believe will facilitate early disclosure of sexual abuse. We conducted semi-structured interviews with 12 adult survivors of CSA aged 18-57 years, and analyzed the transcripts using reflexive thematic analysis. Our analysis resulted in three main themes: Adults making it possible to tell; Adults daring to consider the unthinkable; and Conveying knowledge of CSA that facilitates understanding. The findings highlighted the importance of adults facilitating disclosure and making it possible for survivors to tell about their experiences, but also the responsibility adults have to dare to consider the possibility of CSA when children struggle. Another important finding was the significance of enhancing the general population's understanding of the complexity of CSA, including why disclosure is difficult, so adults are given the tools needed to understand and know what to do when they suspect CSA. The findings also have important implications for the planning and implementation of interventions to facilitate early disclosure of CSA.

Intersections of Adverse Childhood Experiences, Race and Ethnicity and Asthma Outcomes: Findings from the Behavioral Risk Factor Surveillance System

Racial and ethnic minority subpopulations experience a disproportionate burden of asthma and adverse childhood experiences (ACEs). These disparities result from systematic differences in risk exposure, opportunity access, and return on resources, but we know little about how accumulated differentials in ACEs may be associated with adult asthma by racial/ethnic groups. We used Behavioral Risk Factor Surveillance System data (N = 114,015) from 2009 through 2012 and logistic regression to examine the relationship between ACEs and adult asthma using an intersectional lens, investigating potential differences for women and men aged 18 and older across seven racial/ethnic groups. ACEs were significantly related to asthma, adjusting for race/ethnicity and other covariates. Compared to the reference group (Asians), asthma risk was significantly greater for Black/African American, American Indian and Alaska Native (AIAN), White, and multiracial respondents. In sex-stratified interactional models, ACEs were significantly related to asthma among women. The relationship between ACEs and asthma was significantly weaker for Black/African American and AIAN women compared to the reference group (Asian women). The findings merit attention for the prevention and early detection of ACEs to mitigate long-term health disparities, supporting standardized screening and referrals in clinical settings, evidence-based prevention in communities, and the exploration of strategies to buffer the influence of adversities in health.

"We're Talking About You, Not to You": Methodological Reflections on Public Health Research With Families With Young Children

In this article, we critically reflect upon the experience of public health research involving children and contribute to existing conversations about the methodological and ethical facets of research in this field. Drawing on two phases of a study that sought to explore the lived experiences of families with young children who have had a recent common childhood illness (gastrointestinal infection), we address the research process, from inception of the studies, to fieldwork and the resultant material obtained. We argue that when researching with families about a child-centered experience, it is important to look beyond the individual adult as "participant" and to conceptualize dependents either as, or "like" participants-what we suggest as a "family-centered approach." Theoretically, this strategy best addresses the lived reality of relationality and responsibility of parent/carers for dependent children; while improving the ease and safety of data collection for the researcher and participants alike.

Introducing ACEs (Adverse Childhood Experiences) and Resilience to First-Year Medical Students

INTRODUCTION

Adverse childhood experiences (ACEs) are associated with negative mental and physical health outcomes and predictive of higher sociodemographic risk. Introducing ACEs into undergraduate medical education is key to prevention, early recognition, and intervention.

METHODS

In a 1-hour lecture, held live and viewed online, we delivered a condensed introduction to ACEs to first-year medical students. Live-classroom participants completed pre-/postsession questionnaires self-assessing their knowledge of 10 content areas on a 5-point Likert scale. We analyzed quantitative data to determine mean scores and differences. We synthesized qualitative data obtained from feedback.

RESULTS

One hundred twenty-four students, including 32 live-classroom attendees and 92 online viewers, participated in this activity. Self-assessment scores increased in all content areas measured, with a mean increase of 1.5 (p < .0001). The most significant increases occurred in identifying household dysfunction as ACEs (increase of 2.3), calculating an ACE score (increase of 2.2), differentiating between child abuse acts of commission and omission (increase of 1.9), describing resilience (increase of 1.7), and recognizing the link between ACEs and chronic medical conditions (increase of 1.4). Participants found the lecture informative, appreciating the use of the case illustrating how ACEs impact health and an interactive slide on the risks conferred by cumulative ACEs. Learners welcomed the positive message of resilience.

DISCUSSION

Introducing ACEs in medical student education is feasible. Educating the next generation of health providers on ACEs while highlighting prevention and resilience and teaching trauma-informed care is crucial. This lecture can be readily incorporated into medical student curricula.

Adverse childhood experiences and household food insecurity among children aged 0–5 years in the USA

Objective:

Although studies have examined the association between adverse childhood experiences (ACE) and health and mental health outcomes, few studies have investigated the association between ACE and household food insecurity among children aged 0–5 years in the USA. The objective of this study is to investigate the association between ACE and household food insecurity among children aged 0–5 years.

Design:

The data used in this study came from the 2016–2017 National Survey of Children’s Health. Data were analysed using multinomial logistic regression with household food insecurity as the outcome variable.

Setting:

United States.

Participants:

An analytic sample of 17 543 children aged 0–5 years (51·4% boys).

Results:

Of the 17 543 respondents, 83·7% experienced no childhood adversity. About one in twenty (4·8%) children experienced moderate-to-severe food insecurity. Controlling for other factors, children with one adverse childhood experience had 1·43 times the risk of mild food insecurity (95 % CI 1·25, 1·63) and 2·33 times the risk of moderate-to-severe food insecurity (95 % CI 1·84, 2·95). The risk of mild food insecurity among children with two or more ACE was 1·5 times higher (95 % CI 1·24, 1·81) and that of moderate-to-severe food insecurity was 3·96 times higher (95 % CI 3·01, 5·20), when compared with children with no childhood adversity.

Conclusion:

Given the critical period of development during the first few years of life, preventing ACE and food insecurity and early intervention in cases of adversity exposure is crucial to mitigate their negative impact on child development.

Time, trauma, and the brain: How suicide came to have no significant precipitating event

In this article, we trace shifting narratives of trauma within psychiatric, neuroscience, and environmental epigenetics research. We argue that two contemporary narratives of trauma - each of which concerns questions of time and psychopathology, of the past invading the present - had to be stabilized in order for environmental epigenetics models of suicide risk to be posited. Through an examination of these narratives, we consider how early trauma came to be understood as playing an etiologically significant role in the development of suicide risk. Suicide, in these models, has come to be seen as a behavior that has no significant precipitating event, but rather an exceptional precipitating neurochemical state, whose origins are identified in experiences of early traumatic events. We suggest that this is a part of a broader move within contemporary neurosciences and biopsychiatry to see life as post: seeing life as specific form of post-traumatic subjectivity.

Adverse childhood experiences and mental and physical health disparities: the moderating effect of race and implications for social work

Adverse childhood experiences (ACEs) have been linked to mental and physical health problems, leading to ACEs being viewed as a public health concern. Yet, less research has focused on the prevalence and impact of ACEs among diverse racial and ethnic groups. Given the increasing diversity in the USA, coupled with research that has found certain racial and ethnic groups to experience larger-scale adversity such as poverty or discrimination more frequently than White individuals, it is important to understand how ACEs are experienced by people of color. The current study examined the prevalence of ACEs among diverse racial and ethnic groups, and associations between ACE score and mental and physical health. Even after adjusting for sociodemographic factors, ACE scores of 3 or higher were linked to more physical and mental health problems. Furthermore, there was a significant interaction effect between ACE score and race on physical health, while none of the interaction terms were significant between ACE score and race on mental health. This suggests that higher ACE scores have a more detrimental impact on physical health for people of color. Implications for social work include implementing community-level ACE-informed responses, especially in communities that serve traditionally marginalized populations.

The Association between Adverse Childhood Experiences and Personality, Emotions and Affect: Does Number and Type of Experiences Matter?

Background

There is strong evidence that adverse childhood experiences (ACEs) negatively impact mental health. However, the association between ACEs and personality, emotions and affect are poorly understood. Therefore, we examined the association between composite ACE score and ACE type and personality, emotions and positive and negative affect.

Methods

Three waves of data from the Midlife Development in the United States (MIDUS) study were used. ACE was the primary independent correlate. Covariates included demographic variables and survey wave. Outcome variables included generativity, personality traits (agreeableness, conscientiousness, extraversion, neuroticism, openness, agency), and affect (positive, negative.) Statistical analyses included 3 approaches: 1) treatment of ACE as dichotomous, 2) ordinal composite of ACE score, and 3) three individual ACE type components to assess the association between ACE and psychological constructs.

Results

Of 6,323 adults in the sample, 53% were female, and 56% had a past ACE. In the adjusted analyses, dichotomized ACE was significantly associated with neuroticism (β=0.10; 95% CI 0.07, 0.13) and conscientiousness (β=-0.03; 95% CI -0.05, -0.01). All ACE scores were significantly and positively associated with neuroticism and negatively associated with conscientiousness. Abuse was significantly associated with neuroticism (β=0.20; 95% CI 0.16, 0.24), openness (β=0.08; 95% CI 0.05, 0.11), conscientiousness (β=-0.05; 95% CI -0.08, -0.02), and agency (β=0.06; 95% CI 0.02, 0.10). All ACE categories, except financial strain, were significantly associated with affect.

Conclusion

ACEs are significantly associated with personality, emotions, and affect, with greater effect seen at higher ACE scores and with ACE abuse type, which helps support the cumulative risk hypothesis and our study hypothesis. There is a need for continued research to understand the mechanistic processes and the directionality of the association between ACEs, emotions, and behaviors to help continue to drive biopsychosocial interventions.

Reconsidering interactive resilience processes in mental health: Implications for child and youth services

Research consistently demonstrates resilience as an interactive process, drawing on personal assets together with relational and contextual resources, to support improved outcomes in contexts of nonnormative adversity. What remains unclear are the dynamics of this process and what drives it. This article draws on a prior scoping review of the literature to conceptually explore the positioning of the individual within this dynamic interplay of risks, resilience, and sociocultural context as it pertains to child and youth mental health. The paper begins by summarizing findings from this scoping review, highlighting core resilience elements and processes. These are then considered in relational to the global meaning theory, situating meaning-making as a key mechanism that mediates the interaction between individuals and their ecologies. Drawing on the literature, this article considers how this interaction shapes the particular ways in which resilience then manifests itself in the lives of individuals and becomes available as a resource to assist in the promotion of mental health.

Translating Trauma-Informed Principles into Social Work Practice

Trauma-informed social work is characterized by client-centered practices that facilitate trust, safety, respect, collaboration, hope, and shared power. Many agencies have adopted trauma-informed care (TIC) initiatives and many social workers are familiar with its basic principles, but it is challenging to infuse these ideals into real-world service delivery. This article offers 10 trauma-informed practices (TIPs) for translating TIC concepts into action by (a) conceptualizing client problems, strengths, and coping strategies through the trauma lens and (b) responding in ways that avoid inadvertently reinforcing clients' feelings of vulnerability and disempowerment (re-traumatization). TIPs guide workers to consider trauma as an explanation for client problems, incorporate knowledge about trauma into service delivery, understand trauma symptoms, transform trauma narratives, and use the helping relationship as a tool for healing.

Childhood experiences and adult health: the moderating effects of temperament

Existing literature demonstrates a strong relationship between childhood experiences and adult health outcomes. The Differential Susceptibility to Environment Theory suggests that there are several factors, including personality, that affect a child's sensitivity to adverse and advantageous experiences. A sample of 246 adults (ages 19–57) were asked questions about extroverted personality characteristics, adverse and advantageous childhood experiences (ACEs and counter-ACEs), and several indicators of adult health, including executive functioning, perceived stress levels, depression, and past smoking habits. The sample was then stratified based on level of extroversion scores with the top quartile being labeled as “extroverts”, the bottom quartile as “introverts”, and those in between as “ambiverts”. Regression analyses were then used to assess the relationship between childhood experiences and each adult health outcome. The results of the study showed that the relationship between childhood experiences and adult health was generally stronger among extroverted individuals. These results suggest that extroverts may be more sensitive to environmental influences in childhood as compared to introverts and ambiverts. More research is needed to understand the neurobiological mechanisms that increase environmental sensitivity among extroverts.

Health-related masculine values, depression and suicide risk in men: associations among men with a history of childhood maltreatment

Background: Identification of masculine values associated with men's depression and suicide risk may generate new intervention targets for those with known static risk factors (e.g., exposure to childhood maltreatment).Aims: To validate the factor structure of a measure of health-related masculine values and examine correlates relative to childhood maltreatment exposure.Method: Self-report data was collected from 530 Canadian men, mean age 47.91 years (SD  =  14.51).Results: Confirmatory factor analysis validated an abbreviated eight-item, two-factor model of the Intensions Masculine Values Scale (IMVS-8; CFI = .984, TLI = .977, RMSEA = .054, SRMR = .032). Cluster groups of low (n = 57), moderate (n = 206) and high (n = 267) adherence to these health-related masculine values were identified, equivalent on exposure to childhood maltreatment and previous mental health treatment. A multivariate group × maltreatment interaction was observed (p = .017) whereby males in the low cluster with a maltreatment history endorsed higher mood-related symptomology. This same pattern was observed in a univariate group × maltreatment interaction for suicide risk (p = .006).Conclusions: Health-related masculine values were associated with lower depression and suicide risk in men who have a history of childhood maltreatment. Future intervention studies should investigate whether development of health-related masculine values can reduce depression and suicide risk among men with a history of childhood maltreatment.

Effectiveness of a trauma-informed care psychoeducational program for foster carers - Evaluation of the Fostering Connections Program

BACKGROUND

The need to improve the quality of foster care training has been highlighted and evidenced-based programs that aim to support foster carers in the care of children who have experienced trauma are warranted.

OBJECTIVE

This study aimed to evaluate the effectiveness of the Fostering Connections program, a newly developed trauma-informed care program within the national child welfare agency in Ireland.

PARTICIPANTS AND SETTING

The study included 79 foster carers. The Fostering Connections group-based experiential intervention was delivered over a period of 6-weeks in a community-based setting to intervention group participants.

METHODS

A quasi-experimental design was used to compare the results of the intervention group (n = 49), to a control group (n = 30,) who received usual care. Standardized assessment measures were used at baseline, 6-weeks on completion, 16 weeks and 15 months post-intervention. Foster carers' knowledge of trauma-informed fostering, tolerance of misbehavior and fostering efficacy, and children's emotional and behavioral difficulties were assessed.

RESULTS

Significant improvements were found in foster carers' knowledge of trauma-informed fostering (p < 0.001), tolerance of child misbehavior (p = 0.007) and fostering efficacy (p < 0.001), with effect sizes ranging from medium to large and sustained over fifteen months (ES = 0.07-0.14). Significant improvement was also found in children's emotional and behavioral difficulties at fifteen months (p = 0.019), with a small effect size (ES = 0.05).

CONCLUSION

Preliminary evidence suggests that Fostering Connections is potentially an effective intervention in increasing foster carer's capacity to provide children with trauma-informed care.

Exploring practitioner and policymaker perspectives on public health approaches to address Adverse Childhood Experiences (ACEs) in South Carolina

OBJECTIVE

We examined the perspectives of child and family-serving professionals (CFSP) and state policymakers on protective factors to develop policy and program recommendations including current and needed approaches for addressing ACEs.

METHODS

In 2018, we conducted semi-structured, in-depth interviews with 23 CFSP and 24 state policymakers in South Carolina. Data were analyzed applying the Multiple Streams Theory using thematic analyses.

RESULTS

CFSPs and policymakers had varying opinions on state government involvement and primary prevention for ACEs. Three protective factors emerged from their perspectives: 1) loving, trusting, and nurturing relationships; 2) safe home environments; and 3) opportunities to thrive. For each of these protective factors, participants suggested policy options that support existing community efforts, attempt to alleviate poverty, and improve child and family serving systems.

CONCLUSION

This study suggests that CFSPs and policymakers recognize the importance of protective factors in a child's life to buffer the effect of ACEs. More awareness is needed about the feasibility and significance of primary prevention of ACEs. The study's findings can be used to strengthen advocacy priorities for a wide range of public health outcomes associated with ACEs and help further bridge the gap between research and policy.

Adverse Childhood Experiences Associated with Children's Patterns of Out of Home Placement Over Time and Subsequent Negative Outcomes During Adolescence

Background

Out of home placement (OOHP) of welfare involved children is a critical problem associated with child abuse and neglect and household dysfunction. Few studies have also implicated greater instability in OOHP with more negative outcomes. However, several gaps remain.

Objectives

Objectives were twofold. To identify combinations of adverse childhood experiences that are associated with OOHP - based on both duration of OOHP and change in actual placement during each time point, among welfare involved youth. The second objective was to understand long-term negative outcomes during adolescence that are associated with greater placement instability.

Methods

Data come from the National Survey of Child and Adolescent Wellbeing (n = 1,657). Multinomial logistic regression was used to evaluate adverse childhood experiences that were associated with specific patterns of OOHP. Multivariate regression models were estimated to evaluate delinquency, aggression as well as depressive and trauma symptoms during adolescence that were associated with specific patterns of OOHP.

Results

There were six categories of OOHP found in the sample: 1) no OOHP, 2) OOHP one time, 3) OOHP two times, 4) OOHP two times with change in placements, 5) OOHP three times, and 6) OOHP three times with change in placement. Longer duration of OOHP was associated with more adversity exposure. Longer duration and more change in placement were associated with the most negative outcomes.

Conclusions

Findings demonstrate the need for future testing of these findings in prevention trials.

Associations of Adverse Childhood Experiences with Past-Year DSM-5 Psychiatric and Substance Use Disorders in Older Adults

OBJECTIVES

To examine the prevalence of adverse childhood experiences (ACEs) and the associations of ACEs with psychiatric and substance use disorders among older adults in the United States.

DESIGN

Cross-sectional analysis of the 2012-2013 National Epidemiological Survey on Alcohol and Related Conditions Wave III (NESARC-III).

SETTING

Nationally representative drug-related health interview survey in the United States.

PARTICIPANTS

Survey respondents aged 65 or older (n = 5806 unweighted).

MEASUREMENTS

ACEs, the key independent variable, were assessed using validated measures. Outcome variables consisted of past-year psychiatric disorders (eg, major depressive disorder and generalized anxiety disorder) and substance use disorders (eg, alcohol use disorder) using criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. We estimated the national prevalence of ACEs in older adults and used multivariable-adjusted logistic regression analyses to assess the association between ACEs and the outcomes after adjusting for sociodemographics and clinical comorbidities.

RESULTS

Overall, 35.9% of older adults, representative of 14.8 million older adults nationwide, reported some form of ACEs. The most common types were parental psychopathology (20.3%), other traumatic events (14.0%), and physical/psychological abuse (8.4%). Having experienced any ACEs was associated with higher odds of having a past-year psychiatric disorder (adjusted odds ratio = 2.11; 95% confidence interval = 1.74-2.56). Similar results were found for substance use disorders (P < .01).

CONCLUSION

ACEs are linked to an increased risk for past-year psychiatric and substance use disorders in older adults. ACEs may have long-term effects on older adults' mental well-being. Although further research is needed, preventing ACEs may lead to large improvements in public mental health that persist well into older age. J Am Geriatr Soc 67:2085-2093, 2019.

Addressing adults with adverse childhood experiences requires a team approach

Objective

The primary care office is an ideal setting to identify and address adverse childhood experiences, which is a strong predictor of chronic health outcomes and morbidity. This study sought to understand the experiences of primary care from the perspective of patients who experienced trauma.

Method

Purposive sampling was used to select eligible and interested participants who identify a high adverse childhood experience score at a residency-based community health center, which offers integrated behavioral health services in primary care. Semistructured in-depth interviews conducted by doctoral-level behavioral health clinicians were audio-recorded, transcribed, and analyzed thematically.

Results

Subjects ( n = 6) described aspects of medical setting, including removal of clothing or physical touch, that trigger their past trauma, which often resulted in maladaptive stress responses. Subjects also reported sensing when their complexity resulted in negative interpersonal dynamics between team members, and they described fearing abandonment from their team during these heightened stress states. The behavioral health clinician on the health care team served as an advocate, enhanced trust, and allowed for increased continuity and access to care.

Conclusions

Given the role of adverse childhood experiences in health outcomes and the results of this study, incorporating a trauma-informed approach is essential to treating patients with adverse childhood experiences. We propose that integrating mental health professionals into primary care settings better serves patients with trauma histories.