Legislating to Prevent Adverse Childhood Experiences: Growth and Opportunities for Evidence-Based Policymaking and Prevention

Structural adverse childhood experiences associated with suicidal ideation, suicide attempts, and repetitive nonsuicidal self-injury among racially and ethnically minoritized youth

INTRODUCTION

High rates of suicidal ideation (SI), suicide attempts (SA), and repetitive nonsuicidal self-injury (NSSI) among some ethnoracially minoritized United States youth populations may be related to adverse childhood experiences (ACEs) with structural roots.

METHODS

Using the 2013-2019 Minnesota Student Surveys, we assessed associations of student-reported structural ACEs (parental incarceration, housing instability, food insecurity, and foster care involvement) with SI, SA, and repetitive NSSI within the past 12 months using multilevel logistic regression stratified by ethnoracial group (American Indian/Alaskan Native [AIAN], Hmong, other Asian, Black Latino, other Latino, Somali, other Black/African American [AA], Native Hawaiian/Pacific Islander [NHPI], and multiracial), and adjusted for sex, grade, ACEs experienced within one's household, mental health treatment, and perceived safety.

RESULTS

Structural ACEs were strongly associated with increasing SI, SA, and NSSI. At ≥2 structural ACEs, repetitive NSSI rates ranged from 7% to 29% (female), 8% to 20% (male); SA rates ranged from 13% to 35% (female), 10% to 22% (male); and SI rates ranged from 31% to 50% (female), 20% to 32% (male). Black Latino, NHPI, AIAN, and Black/AA students most often reported structural ACE exposures.

CONCLUSION

Reducing structural ACEs may reduce SI, SA, and repetitive NSSI among ethnoracially minoritized youth populations. Disaggregating diverse youth groups revealed variations in these outcomes that remain hidden when subpopulations are aggregated.

What's the matter with ACEs? Recommendations for considering early adversity in educational contexts

BACKGROUND

Currently, some trauma-informed education practices use "ACE scores," a number that represents the sum of endorsed items from a survey derived from the Adverse Childhood Experiences (ACEs) study in 1998. We caution that the survey provides limited information within education, and such scores have limited utility for designing and delivering individualized intervention to support students who have experienced adversity.

OBJECTIVE

We sought to illustrate why ACEs are not well-suited for use in trauma-informed education, provide definitions for adversity-related terms from which a broader and common understanding of adversity can stem, and provide recommendations for integration of adversity-informed approaches to the educational context.

METHODS

We compiled definitions of adversity-related constructs and made recommendations based on review of relevant research from the fields of psychology and education.

RESULTS

Rather than tailoring educational practices to specific children based on the "traumatic" events they experience, we recommend educators focus their efforts on building supportive classrooms geared toward supporting students with best practices drawn from the Science of Learning, and with the understanding that early adversity can influence heterogeneous trajectories in student development and behavior. In addition, further research on educational practices, including the use of a shared language for describing and defining adversity-related experiences, are the concrete steps needed to better support a goal of adversity-informed education.

Partisan differences in the effects of economic evidence and local data on legislator engagement with dissemination materials about behavioral health: a dissemination trial

BACKGROUND

State legislators make policy decisions that influence children's exposure to adverse childhood experiences (ACEs), such as child maltreatment, and their effects on behavioral health. Effective dissemination of scientific research can increase the likelihood that legislators' decisions are aligned with evidence to prevent ACEs and their consequences, and effective dissemination requires legislators to engage with dissemination materials. Informed by the elaboration likelihood model of persuasive communication and Brownson's Model of Dissemination Research, we tested the hypothesis that inclusion of economic evidence and local data would increase legislator engagement with dissemination materials about evidence-supported policies related to ACEs and behavioral health.

METHODS

A three-arm randomized dissemination trial was conducted. A university researcher e-mailed dissemination materials which contained evidence about ACEs and behavioral health problems to state legislators (two e-mails sent 2 weeks apart, 12,662 e-mails delivered to 6509 legislators). The e-mail subject lines, text, and policy brief content were manipulated across the study arms. The intervention condition received state-tailored data about rates of ACEs and state-tailored economic evidence about the costs of ACEs for public systems, the enhanced control condition received state-tailored data and not economic evidence, and the control condition received national data and not economic evidence. Outcomes were rates of e-mail views, policy brief link clicks, requests for researcher consultation, and mentions of child maltreatment terms in legislators' social media posts.

RESULTS

For the first e-mail, the e-mail view rate was 42.6% higher in the intervention than in the enhanced control condition (22.8% vs. 14.8%) and 20.8% higher than in the control condition (22.8% vs. 18.5%) (both p < .0001). Similar results were observed for the second e-mail. These differences remained significant after adjustment for demographic differences across study conditions in individual-level models, but not multilevel models. There was a significant interaction between the experimental condition and political party (p < .0001) in which the intervention increased e-mail view rates among Democrats but not Republicans. The intervention had no effect on policy brief link clicks or requests for consultation and a mixed effect on social media posts.

CONCLUSIONS

Inclusion of state-tailored economic evidence in dissemination materials can increase engagement with research evidence among Democrat, but not Republican, legislators. Dissemination strategies tailored for legislators' political party affiliation may be needed.

Legislating to Prevent Adverse Childhood Experiences: Growth and Opportunities for Evidence-Based Policymaking and Prevention

Since the landmark study of Adverse Childhood Experiences (ACEs; Felitti et al., American Journal of Preventive Medicine, 14(4):245-258, 1998), there has been a significant growth in efforts to address ACEs and their impact on individual health and well-being. Despite this growing awareness, there has been little systematic review of state legislative action regarding variation in focus or scope or of the broader context impacting the introduction and enactment of ACE-related policy efforts. To inform the role of psychologists and related professionals to contribute to these legislative efforts, we conduct a comprehensive mixed-method analysis of all state bills introduced over the past two decades to investigate the use and impact of ACE research in introduced and enacted state legislative language (51 states, N_{Total Bills} = 1,212,048, N_{ACE Bills} = 425). In addition, these analyses examine congressional office communications (N = 14,916,546 public statements) and voting records (N = 1,163,463 votes) to understand the relationship between legislative members' public discussion of ACEs and their voting behavior on these bills. We find that legislators' public discourse is significantly related to ACE-related policymaking above and beyond political affiliation or demographic characteristics. Furthermore, key legislative language related to domestic violence, evidence-based practice, and prevention were significant predictors of whether an ACE-related bill becomes law-above and beyond the political party in power. These analyses highlight the ways in which ACE-related research has informed state policy. Based upon this work, we offer recommendations for researchers and policymakers.