Adverse childhood experiences and their relationship to complex health profiles among child welfare-involved children: A classification and regression tree analysis

The Role of the Medical Director and Psychiatric Medical Director in Child Welfare Serving Agencies

Collaboration between the child welfare system and health care practitioners has become increasingly necessary in order to meet the often-significant health needs of system-involved youth. Child welfare medical directors and psychiatric medical directors have been implemented as a means to address this need in several state child welfare systems. Building on the core principles of the National Guidelines for Child and Youth Behavioral Health Crisis Care, medical and psychiatric medical directors can help ensure youth receive the least-restrictive, most appropriate level of behavioral health care; prioritizing care involvement with caregivers in community-based settings.

Adverse childhood experiences and residential care environment: The mediating role of trauma-related symptoms and psychological maladjustment in adolescents

BACKGROUND

Research has consistently found poorer outcomes in adolescents who have been exposed to early interpersonal adversities, especially those in out-of-home placements. The presence of mental health problems also contributes to the perception of a more negative group climate and peer interactions through cascading effects.

OBJECTIVE

To analyze the sequential relationships between exposure to adverse childhood experiences (ACEs), trauma-related symptoms, psychological maladjustment, and the perception of group climate and peer interactions. In addition, the study analyzes the mediating role of trauma-related symptoms and psychological maladjustment.

PARTICIPANTS AND SETTING

The sample comprised 161 adolescents in out-of-home care (46.6 % males, 49.7 % females, 3.7 % non-binary), aged 12-18 (M = 15.22, SD = 1.59) from 24 residential facilities in Spain.

METHODS

This study is part of the VRINEP project. Group care workers reported about ACEs and trauma-related symptoms through online questionnaires, whereas adolescents self-reported about psychological maladjustment, group climate, and peer interactions.

RESULTS

Differential associations between ACEs with trauma-related symptoms and internalizing problems were found. The relationship between certain ACEs and externalizing problems was fully mediated by trauma-related symptoms. Likewise, psychological maladjustment was related to a more negative perception of the group climate and peer interactions. Although trauma-related symptoms were not directly associated with the perception of the residential environment, they were indirectly associated with peer relational aggression through externalizing problems.

CONCLUSIONS

Mental health has a significant impact on the perception of the group climate and peer interactions among adolescents in residential care who have been exposed to ACEs.

The impact of early adversity on the cerebral cortex - a Mendelian randomization study

Background

The early adversity is associated with a series of negative outcomes in adulthood, and the impact on the cerebral cortex may be one of the fundamental causes of these adverse consequences in adulthood. In this study, we aim to investigate the causal relationship between early adversity and changes in cerebral cortex structure using Mendelian randomization (MR) analysis.

Methods

The GWAS summary statistics of 6 early adversity traits were obtained from individuals of European ancestry in the UK Biobank. The GWAS summary statistics of 34 known functional cortical regions were obtained from the ENIGMA Consortium. Causal relationships between the adversity factors and brain cortical structure were assessed using the inverse-variance weighted (IVW), MR-Egger, and weighted median methods, with IVW being the primary evaluation method. Cochran's Q-test, MR-PRESSO, leave-one-out analysis, and funnel plot examination were employed to detect potential heterogeneity and pleiotropy, as well as to identify and exclude outliers.

Results

At a global level, no causal relationship was found between early adversity and cortical thickness (TH) or surface area (SA) of the brain. However, at the regional level, early adversity was found to potentially influence the TH of the caudal anterior cingulate, superior temporal, entorhinal, paracentral, lateral occipital, banks of the superior temporal sulcus, and supramarginal regions, as well as the SA of the pars triangularis, lateral occipital, parahippocampal, medial orbitofrontal, and isthmus cingulate regions. All findings were nominally significant and passed sensitivity analyses, with no significant heterogeneity or pleiotropy detected.

Discussion

Our study provides evidence for the association between early adversity and alterations in brain cortical structure, which may serve as a foundation for certain mental disorders. Furthermore, magnetic resonance imaging (MRI) might be considered as a promising tool to aid healthcare professionals in identifying individuals with a history of adverse experiences, allowing for early interventions.

Adversity, Engagement, and Later Achievement: The Role of Emotion Regulation and Parent-Child Relationship Quality

Background

Students who have experienced adversity tend to demonstrate poorer academic outcomes than their non-maltreated peers. Academic engagement, a multidimensional, motivational construct, associated with a myriad of positive academic outcomes is an important academically-related mechanism that can be leveraged to improve the outcomes of this population.

Objective

The present study aimed to better understanding of how engagement develops in the context of adversity by exploring the effects emotion regulation skills and parent-child relationships have on engagement development.

Participants and setting

Analyses were conducted on 795 participants in the NSCAW dataset.

Methods

Path analysis was used to estimate mediation and moderated mediation models.

Results

Emotion regulation skills significantly mediated the effect experiencing trauma symptoms had on engagement. Parent-child relationship quality moderated the mediation effect emotion regulation skills had on the relationship between experiencing trauma symptoms and engagement.

Conclusions

Emotion regulation skills and parent-child relationship quality are potential intervention targets to improve engagement for students who have experienced adversity.

Adverse Childhood Experiences and Oral Health Outcomes in U.S. Children and Adolescents: A Cross-Sectional Study of the 2016 National Survey of Children's Health

This study investigated the cross-sectional associations between exposure to nine Adverse Childhood Experiences (ACEs) and U.S. children's and adolescent's oral health outcomes. Data from 41,294 participants of the 2016 National Survey of Children's Health (NSCH) were analyzed. Past year exposure to ACE, oral health outcomes (decayed teeth, bleeding gums, and condition of the teeth), and child and caregiver sociodemographic factors were self-reported. Using SAS v. 9.4, propensity score weighted, multilevel survey-logistic regression estimated adjusted odds ratios (AORs) and 95% Confidence Intervals (CIs) of the proposed associations. The overall mean (SE) age was 8.9 (0.1) years with 51% being male. Fifty-four percent (54%) identified as non-Hispanic white, and 12% as non-Hispanic black. The prevalence of the nine ACE measures ranged from 3% for caregiver death to 25% for financial hardship and parental divorce. Children who experienced caregiver mental illness, when compared to those who did not, were more likely to report decayed teeth (AOR: 1.73 (95% CI: 1.24, 2.42)) and the condition of their teeth as fair/poor (AOR: 1.60, 95% CI: 0.61, 4.19). Children in households with financial hardship were about twice as likely to report dental caries (AOR: 1.85, 95% CI: 1.50, 2.29) and have fair/poor teeth (AOR: 1.87, 95% CI: 1.40, 2.51) and bleeding gums (AOR: 2.39, 95% CI: 1.48, 3.86). ACEs appear to be associated with worse oral health outcomes among children and adolescents. Nevertheless, the cross-sectional nature of this study precludes a causal interpretation of these findings and necessitates more research to elucidate the oral health impacts of exposure to ACEs in longitudinal follow-up studies.

Developing a model of care for substance use in pregnancy and parenting services, Sydney, Australia: Service provider perspectives

INTRODUCTION

The absence of a clear model of care for services supporting pregnant women and mothers with substance use disorders has impeded opportunities to build an evidence base for the effectiveness of these services. Previous research has typically focused on the needs of pregnant women or mothers, as two distinct groups. This paper explores service providers' perceptions of key components of a model of care, extending from perinatal care to community-based support for up to 17 years post-delivery. A model of care is outlined and feasibility factors affecting implementation are highlighted.

METHODS

Qualitative methods were adopted as a first step to informing development of the model of care. Semi-structured in-depth interviews were conducted with thirty-eight staff providing a range of substance use in pregnancy and parenting services (SUPPS) in hospital and community-based agencies, in a metropolitan health district in Sydney, Australia. Interview data was entered into NVivo and analysed using constant comparative methods.

RESULTS

Guiding principles for the model of care included integrated care, harm reduction and person-centredness. Practice approaches integral to the model of care were promoting engagement with women, flexible service provision, trauma-informed care, and continuity of care. Feasibility factors influencing implementation of the model of care included fragmentation or siloing of the service network and workforce sustainability.

CONCLUSIONS

A harm reduction approach was crucial for promoting engagement of women with SUPPS, particularly child protection services. A greater focus on providing ongoing community-based support for mothers also has the potential to achieve sustainable positive outcomes for women and children. Implementation of the SUPPS model of care could be undermined by threats to integration of service delivery and continuity of care. Further research is needed to explore consumer perspectives and inform the model of care as a framework for evaluation.

Predicting Students' Attitudes Toward Collaboration: Evidence From Structural Equation Model Trees and Forests

Numerous studies have shed some light on the importance of associated factors of collaborative attitudes. However, most previous studies aimed to explore the influence of these factors in isolation. With the strategy of data-driven decision making, the current study applied two data mining methods to elucidate the most significant factors of students' attitudes toward collaboration and group students to draw a concise model, which is beneficial for educators to focus on key factors and make effective interventions at a lower cost. Structural equation model trees (SEM trees) and structural equation model forests (SEM forests) were applied to the Program for International Student Assessment 2015 dataset (a total of 9,769 15-year-old students from China). By establishing the most important predictors and the splitting rules, these methods constructed multigroup common factor models of collaborative attitudes. The SEM trees showed that home educational resources (split by "above-average or not"), home possessions (split by "disadvantaged or not"), mother's education (split by "below high school or not"), and gender (split by "male or female") were the most important predictors among the demographic variables, drawing a 5-group model. Among all the predictors, achievement motivation (split by "above-average or not") and sense of belonging at school (split by "above-average or not" and "disadvantaged or not") were the most important, drawing a 6-group model. The SEM forest findings proved the relative importance of these variables. This paper discusses various interpretations of these results and their implications for educators to formulate corresponding interventions. Methodologically, this research provides a data mining approach to discover important information from large-scale educational data, which might be a complementary approach to enhance data-driven decision making in education.

The social ecology of childhood and early life adversity

An increasing prevalence of early childhood adversity has reached epidemic proportions, creating a public health crisis. Rather than focusing only on adverse childhood experiences (ACEs) as the main lens for understanding early childhood experiences, detailed assessments of a child's social ecology are required to assess "early life adversity." These should also include the role of positive experiences, social relationships, and resilience-promoting factors. Comprehensive assessments of a child's physical and social ecology not only require parent/caregiver surveys and clinical observations, but also include measurements of the child's physiology using biomarkers. We identify cortisol as a stress biomarker and posit that hair cortisol concentrations represent a summative and chronological record of children's exposure to adverse experiences and other contextual stressors. Future research should use a social-ecological approach to investigate the robust interactions among adverse conditions, protective factors, genetic and epigenetic influences, environmental exposures, and social policy, within the context of a child's developmental stages. These contribute to their physical health, psychiatric conditions, cognitive/executive, social, and psychological functions, lifestyle choices, and socioeconomic outcomes. Such studies must inform preventive measures, therapeutic interventions, advocacy efforts, social policy changes, and public awareness campaigns to address early life adversities and their enduring effects on human potential. IMPACT: Current research does not support the practice of using ACEs as the main lens for understanding early childhood experiences. The social ecology of early childhood provides a contextual framework for evaluating the long-term health consequences of early life adversity. Comprehensive assessments reinforced with physiological measures and/or selected biomarkers, such as hair cortisol concentrations to assess early life stress, may provide critical insights into the relationships between early adversity, stress axis regulation, and subsequent health outcomes.

Adverse childhood experiences and their relationship to complex health profiles among child welfare-involved children: A classification and regression tree analysis

OBJECTIVE

To identify the clustering of adverse childhood experiences (ACEs) that best characterize child welfare-involved children with known complex health concerns.

DATA SOURCE

Multi-informant data were obtained from Wave I of the National Survey of Child and Adolescent Well-Being (NSCAW II).

STUDY DESIGN

This study used a cross-sectional design and classification and regression tree (CART) analyses.

DATA COLLECTION

Data were collected from families with children, aged birth to 17, investigated for child maltreatment and their child protective services caseworkers, including demographic characteristics of the children, their histories of adversity, and a wide range of health concerns.

PRINCIPAL FINDINGS

Results indicate that for children between the ages of six and 17, experiences of physical abuse alone, as well as experiences of physical abuse combined with having a caregiver with mental illness, are most strongly associated with complex health concerns. For children aged 2-5 years, results suggest that caregiver mental illness is a key adverse experience associated with complex health concerns.

CONCLUSIONS

Identifying specific combinations of ACEs may be a critical next step for child- and youth-serving agencies to allow providers to better calculate risk of health problems among children exposed to adversity.