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Lundberg DJ, Chen JA. Structural ableism in public health and healthcare: a definition and conceptual framework. LANCET REGIONAL HEALTH. AMERICAS 2024; 30:100650. [PMID: 38188095 PMCID: PMC10770745 DOI: 10.1016/j.lana.2023.100650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 01/09/2024]
Affiliation(s)
- Dielle J. Lundberg
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Jessica A. Chen
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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Mailhot Amborski A, Bussières EL, Vaillancourt-Morel MP, Joyal CC. Sexual Violence Against Persons With Disabilities: A Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2022; 23:1330-1343. [PMID: 33657931 PMCID: PMC9425723 DOI: 10.1177/1524838021995975] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A growing number of large-scale studies suggest that people with disabilities are at greater risk of sexual victimization than nondisabled individuals. However, certain results are inconsistent and whether potential moderators explain this variability in previous findings remain to be considered. This meta-analysis aimed to determine the magnitude of the difference in risk of being sexually victimized based on the presence of a disability. An additional objective was to evaluate the relative influence of gender, age, type of disability, type of sexual violence, and relationship with the perpetrator on the association between the presence of a disability and sexual victimization. Studies were searched using pertinent databases and retained if they included a group with a disability, provided data that quantify the occurrence of abuse, indicated the type of sexual violence, and was published between 1970 and 2018 in French or English. A total of 68 studies, allowing 84 independent samples and 12,427 participants, were included. Individuals with disabilities were at significantly higher risk of sexual victimization than persons without disabilities (odds ratio = 2.27). The risk of sexual victimization among individuals with a disability was significantly higher in adult participants compared with the risk in minor participants. Sensory impairment was the type of disability associated with the highest risk of sexual victimization. Odds of sexual victimization among individuals with a disability were significantly higher in African countries compared with all others, and odds in Western Europe were significantly lower than in the United States. No significant differences emerged across eras.
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Affiliation(s)
| | - Eve-Line Bussières
- Department of Psychology, Université du Québec à Trois-Rivières, Québec, Canada
| | | | - Christian C. Joyal
- Department of Psychology, Université du Québec à Trois-Rivières, Québec, Canada
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Presnell J, Keesler JM, Thomas-Giyer J. Assessing Alignment Between Intellectual and Developmental Disability Service Providers and Trauma-Informed Care: An Exploratory Study. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2022; 60:351-368. [PMID: 36162048 DOI: 10.1352/1934-9556-60.5.351] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 03/24/2022] [Indexed: 06/16/2023]
Abstract
People with intellectual and developmental disabilities (IDD) are disproportionately impacted by potentially traumatic experiences; however, organizations serving this population have lagged in their integration of trauma-informed care (TIC). Trauma-informed care is a systemwide response to the pervasiveness of trauma that frequently requires an organizational shift rooted in staff training. Using an online statewide survey, the present study examined beliefs and training among IDD service providers. Responses from 288 service providers suggested some alignment among beliefs and staff training content with TIC principles. Although the findings indicate a foundation for TIC, intentional efforts are needed for IDD agencies to fully embrace TIC.
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Affiliation(s)
- Jade Presnell
- Jade Presnell, John M. Keesler, and Jen Thomas-Giyer, Indiana University
| | - John M Keesler
- Jade Presnell, John M. Keesler, and Jen Thomas-Giyer, Indiana University
| | - Jen Thomas-Giyer
- Jade Presnell, John M. Keesler, and Jen Thomas-Giyer, Indiana University
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Moonen X, Festen D, Bakker-van Gijsel E, Vervoort-Schel J. A Dutch Perspective on Two Health Related Issues Regarding Children and Adolescents with Intellectual Disabilities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11698. [PMID: 36141966 PMCID: PMC9517279 DOI: 10.3390/ijerph191811698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
In this opinion article, we want to inspire readers by highlighting recent Dutch developments about two important health related issues regarding the quality of life of children and adolescents with intellectual disabilities. Firstly we focus on the prevention, treatment and reduction of (disability-related) somatic and psychological problems by specialized physicians for people with intellectual disabilities. Secondly, we emphasize the importance of the prevention of adverse childhood experiences and the promotion of protective and compensatory experiences. Subsequently, we stress the need for trauma informed care to support children and adolescents with intellectual disabilities who encounter adverse events. A specialized and multidisciplinary approach is advised as is the need for promoting healthy (family) relations with a focus on (co)regulation and connection as a basis for recovery.
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Affiliation(s)
- Xavier Moonen
- Ben Sajet Center, Zwanenburgwal 206, 1011 JH Amsterdam, The Netherlands
- Department of Child Development and Education, University of Amsterdam, 1018 WS Amsterdam, The Netherlands
- Koraal Center of Expertise, De Hondsberg, Hondsberg 5, 5062 JT Oisterwijk, The Netherlands
| | - Dederieke Festen
- Erasmus MC, University Medical Center Rotterdam, Postbus 2040, 3000 CA Rotterdam, The Netherlands
| | | | - Jessica Vervoort-Schel
- Ben Sajet Center, Zwanenburgwal 206, 1011 JH Amsterdam, The Netherlands
- Department of Child Development and Education, University of Amsterdam, 1018 WS Amsterdam, The Netherlands
- Koraal Center of Expertise, De Hondsberg, Hondsberg 5, 5062 JT Oisterwijk, The Netherlands
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Son E, Lee H, Cho H, Choi YJ, Seon J. The effects of disability status and perceived neighbourhood cohesion and safety on adverse childhood experiences among college students. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2179-e2190. [PMID: 34812542 DOI: 10.1111/hsc.13656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 10/07/2021] [Accepted: 11/09/2021] [Indexed: 06/13/2023]
Abstract
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.
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Affiliation(s)
- Esther Son
- College of Staten Island, The City University of New York, Staten Island, NY, USA
| | - Hyunji Lee
- University of Wisconsin, Milwaukee, WI, USA
| | - Hyunkag Cho
- Michigan State University, East Lansing, MI, USA
| | | | - Jisuk Seon
- Kyungnam University, Changwon, South Korea
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Flannigan K, Pei J, McLachlan K, Harding K, Mela M, Cook J, Badry D, McFarlane A. Responding to the Unique Complexities of Fetal Alcohol Spectrum Disorder. Front Psychol 2022; 12:778471. [PMID: 35145454 PMCID: PMC8821085 DOI: 10.3389/fpsyg.2021.778471] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/31/2021] [Indexed: 11/20/2022] Open
Abstract
Fetal alcohol spectrum disorder (FASD) is a multifaceted disability, characterized not only by brain- and body-based challenges, but also high rates of environmental adversity, lifelong difficulties with daily living, and distinct sociocultural considerations. FASD is one of the most common neurodevelopmental disabilities in the Western world and associated with significant social and economic costs. It is important to understand the complexities of FASD and the ways in which FASD requires unique consideration in research, practice, and policy. In this article, we discuss our perspectives on factors that distinguish FASD from other disabilities in terms of complexity, co-occurrence, and magnitude. We provide an overview of select literature related to FASD as a socially rooted disability with intergenerational impacts and multiple layers of stigma. These social issues are intertwined with notable experiences of adversity across the lifespan and high rates of co-occurring health concerns for individuals with FASD, all of which present unique challenges for individuals, caregivers, families, service providers, and policy makers. Understanding these factors is the first step in developing and implementing specialized initiatives in support of positive outcomes for individuals with FASD and their families. Future directions are proposed for advancing research, practice, and policy, and responding to the unique complexities of FASD.
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Affiliation(s)
- Katherine Flannigan
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- *Correspondence: Katherine Flannigan,
| | - Jacqueline Pei
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
| | - Kaitlyn McLachlan
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Department of Psychology, University of Guelph, Guelph, ON, Canada
| | - Kelly Harding
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Department of Psychology, Laurentian University, Sudbury, ON, Canada
| | - Mansfield Mela
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Department of Psychiatry, University of Saskatchewan, Saskatoon, SK, Canada
| | - Jocelynn Cook
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada
| | - Dorothy Badry
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Faculty of Social Work, University of Calgary, Calgary, AB, Canada
| | - Audrey McFarlane
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
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Li J, Lin S, Yan X, Pei L, Wang Z. Adverse Childhood Experiences and Trajectories of ADL Disability among Middle-Aged and Older Adults in China: Findings from the CHARLS Cohort Study. J Nutr Health Aging 2022; 26:1034-1041. [PMID: 36519765 DOI: 10.1007/s12603-022-1863-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES There is little evidence on the association between adverse childhood experiences (ACEs) and disability trajectories among middle-aged and older adults. This study aimed to investigate the association between ACEs and activities of daily living (ADL) trajectories over eight years of follow-up and the mediation role of different chronic diseases on this relationship. DESIGN Prospective cohort study, eight-year follow-up. SETTING China Health and Retirement Longitudinal Study(CHARLS). PARTICIPANTS A total of 10651 participants age 45 and over from CHARLS 2011 to 2018 were included in this study. MEASUREMENTS Five ACEs exposure groups were formed based on the cumulative ACE scores. A 6-item ADL score was used, including bathing, dressing, eating, getting in/out of bed, using the toilet, and controlling urination, to measure the ADL disability, and the group-based trajectory model (GBTM) was used to identify the ADL disability trajectories. Multinomial logistic regression was performed to investigate the association between ACEs and ADL disability trajectory memberships, and KHB-method was used to estimate the contribution of different chronic diseases on this relationship. RESULTS Of the 10651 participants, 9.64% showed a mild-increasing trajectory in terms of change in ADL score during follow-up, followed by the low-mild trajectory (32.00%) and low-low trajectory (58.36%). Compared with those without ACEs exposure, participants who had ≥4 ACEs were associated with an increased risk of being on low-mild trajectory (OR 1.32, 95%CI:1.11-1.57) and mild-increasing trajectory (OR 1.41, 95%CI: 1.06-1.89), respectively. Besides, mediation analysis revealed chronic diseases had a mediation effect in this association, with the largest effect from arthritis or rheumatism (over 60%), followed by digestive system disease (around 14%), respiratory disease (around 12%), and cardio-metabolic disease (around 5%). CONCLUSION This study suggested that exposure to ACEs was associated with a higher risk of being worse ADL disability trajectories. Moreover, chronic disease accounts for a meaningful proportion of this association. Further studies are needed to clarify how chronic diseases mediate the association between ACEs and ADL disability trajectories.
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Affiliation(s)
- J Li
- Lijun Pei, PhD, Institute of Population Research/China Center on Population Health and development, Peking University, No.5 Yiheyuan Road, Haidian District, Beijing 100871, China, ; Tel and fax: +86 010-62751974
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Sonu S, Marvin D, Moore C. The Intersection and Dynamics between COVID-19, Health Disparities, and Adverse Childhood Experiences: "Intersection/Dynamics between COVID-19, Health Disparities, and ACEs". JOURNAL OF CHILD & ADOLESCENT TRAUMA 2021; 14:517-526. [PMID: 34025900 PMCID: PMC8122187 DOI: 10.1007/s40653-021-00363-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/05/2021] [Indexed: 06/12/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is shining a spotlight on health disparities that have long been overlooked in our society. The intersection between Adverse Childhood Experiences (ACEs), longstanding health disparities, and COVID-19 cannot be ignored. The accumulation of traumatic events throughout the childhood and adolescent years can cause toxic stress in the absence of supportive adults. This repetitive activation of the stress response system can be a catalyst to long-term, negative effects on both the body and brain. A major factor to appreciate is that ACEs do not affect all populations equally. ACEs disproportionately affect groups that have been historically oppressed. The current COVID-19 pandemic highlights this point when observing both case rates and fatality rates of the virus and has the potential to create a new series of long-term health conditions that will disproportionately affect marginalized communities. A foundational first and critical step of adopting a trauma-informed approach will help lead to system change, advance equity, and create a setting of mutuality and empowerment for our patients.
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Affiliation(s)
- Stan Sonu
- Department of Medicine, Emory University School of Medicine, Atlanta, GA USA
| | - David Marvin
- Medical Student, Emory University School of Medicine, Atlanta, GA USA
| | - Charles Moore
- Department of Otolaryngology, Emory University School of Medicine, Atlanta, GA USA
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Rich AJ, DiGregorio N, Strassle C. Trauma-informed care in the context of intellectual and developmental disability services: Perceptions of service providers. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2021; 25:603-618. [PMID: 32319343 DOI: 10.1177/1744629520918086] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Traumatic life events have pervasive impacts on health and well-being. A growing body of literature shows that people with intellectual and developmental disabilities are disproportionately impacted by trauma. Trauma-informed care (TIC) is a philosophy of service provision that is committed to preventing traumatization and re-traumatization and promoting healing. This study explores the perceptions of 130 leaders in the field of intellectual and developmental disabilities services on the adoption and practice of TIC through the analysis of quantitative data. Results indicated a disconnect between the level of TIC integration and perceptions detailing how well organizations are currently performing in aspects of TIC. Barriers to TIC included high staff turnover, lack of accessible mental health providers, lack of affordable training, stigma, and restrictive funding structures. Implications and recommendations for service organizations and educators are provided.
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Childhood Maltreatment and Its Interaction with Hypothalamic-Pituitary-Adrenal Axis Activity and the Remission Status of Major Depression: Effects on Functionality and Quality of Life. Brain Sci 2021; 11:brainsci11040495. [PMID: 33924651 PMCID: PMC8069655 DOI: 10.3390/brainsci11040495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/10/2021] [Accepted: 04/12/2021] [Indexed: 11/28/2022] Open
Abstract
Relationships among childhood maltreatment (CM), hypothalamic-pituitary-adrenal (HPA) axis disturbances, major depressive disorder (MDD), poor functionality, and lower quality of life (QoL) in adulthood have been described. We aimed to study the roles of the remission status of depression and HPA axis function in the relationships between CM and functionality and QoL. Ninety-seven patients with MDD and 97 healthy controls were included. The cortisol awakening response, cortisol suppression ratio in the dexamethasone suppression test, and diurnal cortisol slope were assessed. Participants completed measures of psychopathology, CM, functionality, and QoL. Multiple linear regression analyses were performed to study the relationships between CM and functionality and QoL. Only non-remitted MDD patients showed lower functionality and QoL than controls, indicating that depressive symptoms may partly predict functionality and QoL. Cortisol measures did not differ between remitted and non-remitted patients. Although neither HPA axis measures nor depression remission status were consistently associated with functionality or QoL, these factors moderated the effects of CM on functionality and QoL. In conclusion, subtle neurobiological dysfunctions in stress-related systems could help to explain diminished functionality and QoL in individuals with CM and MDD and contribute to the persistence of these impairments even after the remission of depressive symptoms.
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Flannigan K, Kapasi A, Pei J, Murdoch I, Andrew G, Rasmussen C. Characterizing adverse childhood experiences among children and adolescents with prenatal alcohol exposure and Fetal Alcohol Spectrum Disorder. CHILD ABUSE & NEGLECT 2021; 112:104888. [PMID: 33388606 DOI: 10.1016/j.chiabu.2020.104888] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/28/2020] [Accepted: 12/09/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Individuals with Fetal Alcohol Spectrum Disorder (FASD) and prenatal alcohol exposure (PAE) face elevated rates of postnatal environmental adversity across the lifespan. OBJECTIVE We explored early adversity among children and adolescents with PAE. PARTICIPANTS AND SETTING Our sample included 333 children and adolescents with PAE assessed at a Canadian FASD diagnostic clinic, 66% of whom were diagnosed with FASD. METHODS Data were collected retrospectively via record review, and adversity was measured using the Adverse Childhood Experiences Questionnaire (ACE-Q). RESULTS Participants experienced high levels of adversity (mean ACE score of 3.4), which increased with age, mental health comorbidity, and number of living placements. Common ACEs included: not being raised by both biological parents (97.3%), caregiver disruption (88.5%), and exposure to household substance use (69.7%). Females had significantly higher rates of sexual abuse than males (p < .001, ø = -0.18). There was no difference in total ACE scores between participants diagnosed with FASD versus those not diagnosed, but participants with FASD were less likely to live with both biological parents (p < .001, ø = .19) or to have been exposed to household mental health problems (p = .007, ø = -0.15). CONCLUSIONS Children and adolescents with PAE experience high rates of early adversity. Practice and policy initiatives are needed to improve early detection of ACEs among children with PAE, and of PAE among children with ACEs. Targeted supports are needed to strengthen the early caregiving environment and mitigate the risks of adversity to support healthy outcomes for individuals with PAE and FASD.
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Affiliation(s)
- Katherine Flannigan
- Canada Fetal Alcohol Spectrum Disorder Research Network, PO Box 11364 Wessex PO, Vancouver BC, V5R 0A4, Canada.
| | - Aamena Kapasi
- University of Alberta, Educational Psychology, 6-131 Education North, 116 Street and 85 Avenue, Edmonton AB, T6G 2R3, Canada
| | - Jacqueline Pei
- Canada Fetal Alcohol Spectrum Disorder Research Network, PO Box 11364 Wessex PO, Vancouver BC, V5R 0A4, Canada; University of Alberta, Educational Psychology, 6-131 Education North, 116 Street and 85 Avenue, Edmonton AB, T6G 2R3, Canada
| | - Isabel Murdoch
- University of Alberta, Educational Psychology, 6-131 Education North, 116 Street and 85 Avenue, Edmonton AB, T6G 2R3, Canada
| | - Gail Andrew
- Glenrose Rehabilitation Hospital, 10230 111 Avenue, Edmonton AB, T5G 0B7, Canada
| | - Carmen Rasmussen
- University of Alberta, Educational Psychology, 6-131 Education North, 116 Street and 85 Avenue, Edmonton AB, T6G 2R3, Canada
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Rariden C, SmithBattle L, Yoo JH, Cibulka N, Loman D. Screening for Adverse Childhood Experiences: Literature Review and Practice Implications. J Nurse Pract 2020; 17:98-104. [PMID: 32963502 PMCID: PMC7498469 DOI: 10.1016/j.nurpra.2020.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Adverse childhood experiences (ACEs) are linked with negatively impacting child and adult health outcomes. Clinicians are integral in identifying childhood adversities and offering supportive measures to minimize negative effects. This systematic literature review included 13 ACE studies that examined the acceptability, feasibility, and implementation of ACE screenings from the perspectives of clinicians and patients. The findings of this review can assist clinicians in considering the appropriateness of ACE screenings for their patients and the ethical and practical issues that must be addressed for effective screening implementation.
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Petruccelli K, Davis J, Berman T. Adverse childhood experiences and associated health outcomes: A systematic review and meta-analysis. CHILD ABUSE & NEGLECT 2019; 97:104127. [PMID: 31454589 DOI: 10.1016/j.chiabu.2019.104127] [Citation(s) in RCA: 351] [Impact Index Per Article: 70.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/06/2019] [Accepted: 07/29/2019] [Indexed: 05/13/2023]
Abstract
BACKGROUND The Center for Disease Control (CDC) and Kaiser Permanente developed the Adverse Childhood Experiences (ACE) scale to identify negative experiences in childhood. The goal of this study is to systematically review outcomes associated with the ACEs in the CDC-Kaiser ACE scale to understand the diversity of outcomes associated with this scale. METHODS The authors conducted a search of English language articles published through September 30, 2016 using OVID Medline®; Ovid Medline® Daily; Epub Ahead of Print, In-Process & Other Non-indexed citations; ERIC®; HAPI®; and SCOPUS®. Articles were selected by trained reviewers based on a priori inclusion criteria including: research, healthy sample, used the CDC-Kaiser ACE scale, and assessed some health outcome. Two reviewers used an abstraction form to independently collect data from each study. Unadjusted and adjusted odds ratio associated with ACE scale scores were aggregated and compared. RESULTS From 3167 unique titles, we identified 96 articles that assessed health outcomes associated with the ACEs in the CDC-Kaiser ACE scale. There were more studies focusing on psychosocial/behavioral outcomes than medical outcomes. The majority of the included studies were retrospective, observational, and relied on the same data set. Psychosocial/behavioral outcomes had higher odds ratio than medical outcomes with increasing ACE scale scores. CONCLUSIONS Exposure to multiple ACEs is associated with a wide variety of outcomes. This data suggests a benefit of screening for ACEs using this scale and highlights the need to find interventions to ameliorate their effects.
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Affiliation(s)
- Kaitlyn Petruccelli
- Sidney Kimmel Medical College at Thomas Jefferson University, 1025 Walnut St, Philadelphia, PA 19017, United States.
| | - Joshua Davis
- Penn State Milton S. Hershey Medical Center, 500 University Dr, Hershey, PA 17033, United States.
| | - Tara Berman
- Sidney Kimmel Medical College at Thomas Jefferson University, 1025 Walnut St, Philadelphia, PA 19017, United States; Nemours duPont Pediatrics, Primary Care, 833 Chestnut St, Suite 300, Philadelphia, PA 19107, United States.
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Berg KL, Shiu CS, Feinstein RT, Acharya K, MeDrano J, Msall ME. Children with developmental disabilities experience higher levels of adversity. RESEARCH IN DEVELOPMENTAL DISABILITIES 2019; 89:105-113. [PMID: 30974258 DOI: 10.1016/j.ridd.2019.03.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 04/16/2018] [Accepted: 03/26/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Individuals with developmental disabilities (DD) experience significant health disparities. An overlooked risk factor for health disparities in the DD population is adverse childhood experiences (ACEs). The purpose of this study was to generate population prevalence data about level of adverse experiences among children with DD in comparison to children without DD and the extent to which potential confounders may influence observed associations between adversity and child DD status. METHODS Data from the 2011-12 National Survey of Child Health (NSCH) were analyzed to estimate prevalence of adversity among families of children with and without DD, age 3-17 years (N = 62,428; DD = 2622). Level of adversity was assessed via parent response to the Adverse Family Experiences questionnaire. Bivariate and multinomial logistic regressions were utilized to investigate the relationship between adverse family experiences (AFEs) and child DD status, adjusting for covariates. RESULTS Child DD status was significantly and independently associated with higher probability of reporting 1-2 AFEs (RRR = 1.28, 95% CI 1.06, 1.5) and 3+ AFEs (RRR = 1.60, 95% CI 1.16, 2.21). CONCLUSION This study documents significant disparities in adversity among children with DD using a population-based sample. These adversities potentially compromise successful transition to adulthood and overall health outcomes.
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Affiliation(s)
- Kristin L Berg
- University of South Dakota, Department of Social Work, Sioux Falls, SD, United States.
| | - Cheng-Shi Shiu
- University of California-Los Angeles, Los Angeles, CA, United States
| | | | - Kruti Acharya
- University of Illinois-Chicago, Chicago, IL, United States
| | | | - Michael E Msall
- University of Chicago Medicine, Comer Children's Hospital, Kennedy Research Center on Intellectual and Developmental Disabilities Chicago, IL, United States
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Abstract
OBJECTIVES Although there is agreement that childhood disability is both a risk and result of maltreatment, the extent of disability in the child welfare system remains unclear. Our objective is to determine the prevalence and severity of child impairment in a national sample of child abuse and neglect investigations in the United States. METHODS We used data from the National Survey of Child and Adolescent Well-Being II, a study of 2644 children older than 3 years who were subjects of child abuse and neglect investigations. Groups of children were identified by latent profile analysis using continuous standardized measures of intelligence, emotional or behavioral impairments, adaptive behaviors, and social skills. RESULTS Whether the child remained in home or was removed to foster care after an investigation, 3 classes of children were identified: (1) slightly over one-tenth were in an intellectual disability subgroup characterized by marked intellectual impairments alongside delays in daily living functioning, (2) over one-third were in an emotional or behavioral impairment subgroup characterized by both frequent and severe internalizing and externalizing behaviors, and (3) slightly over half were in a typically developing subgroup. CONCLUSION When using standardized measures of disability, nearly half of the children investigated by child protection in the United States are not typically developing. These findings suggest that those working for the child welfare system need to be attentive to the complex needs of children with intellectual disabilities and emotional or behavioral impairments and their families, many of whom are under significant stress.
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Chang X, Jiang X, Mkandarwire T, Shen M. Associations between adverse childhood experiences and health outcomes in adults aged 18-59 years. PLoS One 2019; 14:e0211850. [PMID: 30730980 PMCID: PMC6366931 DOI: 10.1371/journal.pone.0211850] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 01/23/2019] [Indexed: 12/16/2022] Open
Abstract
Background Adverse childhood experiences (ACEs) have been associated with poor health status later in life. The objective of the present study was to examine the relationship between ACEs and health-related behaviors, chronic diseases, and mental health in adults. Methods A cross-sectional study was performed with 1501 residents of Macheng, China. The ACE International Questionnaire (ACE-IQ) was used to assess ACEs, including psychological, physical, and sexual forms of abuse, as well as household dysfunction. The main outcome variables were lifetime drinking status, lifetime smoking status, chronic diseases, depression, and posttraumatic stress disorder. Multiple logistic regression models were used to examine the associations between overall ACE score and individual ACE component scores and risk behaviors/comorbidities in adulthood after controlling for potential confounders. Results A total of 66.2% of participants reported at least one ACE, and 5.93% reported four or more ACEs. Increased ACE scores were associated with increased risks of drinking (adjusted odds ratio [AOR] = 1.09, 95% confidence intervals [CI]: 1.00–1.09), chronic disease (AOR = 1.17, 95% CI: 1.06–1.28), depression (AOR = 1.37, 95% CI: 1.27–1.48), and posttraumatic stress disorder (AOR = 1.32, 95% CI: 1.23–1.42) in adulthood. After adjusting for confounding factors, the individual ACE components had different impacts on risk behavior and health, particularly on poor mental health outcomes in adulthood. Conclusions ACEs during childhood were significantly associated with risk behaviors and poor health outcomes in adulthood, and different ACE components had different long-term effects on health outcomes in adulthood.
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Affiliation(s)
- Xuening Chang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xueyan Jiang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Tamara Mkandarwire
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Min Shen
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- * E-mail:
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Wickramasinghe YM, Raman S, Garg P, Hurwitz R. Burden of adverse childhood experiences in children attending paediatric clinics in South Western Sydney, Australia: a retrospective audit. BMJ Paediatr Open 2019; 3:e000330. [PMID: 30957023 PMCID: PMC6422242 DOI: 10.1136/bmjpo-2018-000330] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 02/07/2019] [Accepted: 02/13/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Adverse childhood experiences (ACE) are associated with poor short, medium and long-term health outcomes. South Western Sydney (SWS) has a large culturally diverse population, including many disadvantaged population groups. Our aims were to determine the burden of ACE in children attending community paediatric (CP) clinics using a purposefully developed ACE checklist, and explore any association with developmental health of children. METHODS We trialled the ACE checklist in all CP clinics including child development (CD) and vulnerable child (VC) clinics between February 2017 and August 2017. Data were collated from completed ACE checklists and relevant clinical information from CP clinics. Statistical analysis was performed using SPSS and MedCalc software. RESULTS Of 279 children seen in CP clinics with checklists completed for the period, 167 (60%) attended CD clinics and 112 (40%) attended VC clinics. Seventy-eight (28%) had ACE ≥4 and 178 (64%) had ACE ≥1. Of those attending CD clinics, 8 (5%) had ACE ≥4 compared with 70 (63%) attending VC clinics (p<0.001). Of all age groups, children ≥10 years of age had the highest proportion of children with ACE ≥4 (65%); significant association between age group and ACE ≥4 (p<0.001). There was a significant association between cultural background and ACE ≥4 (p<0.001); indigenous children had the highest proportion of ACE ≥4 (n=21; 64%), followed by Anglo-Australian children (55%). On logistic regression analysis, only attending VC clinics was significantly associated with ACE ≥4. There was no significant association between ACE ≥4 and developmental health. CONCLUSION Among children attending CP clinics in SWS, more than a quarter had a significant burden of ACE; those attending specialised clinics for vulnerable children, those from particular ethnic groups and from older age groups, had the highest burden of ACE. Our findings support the need for specialised pathways for paediatric assessment for vulnerable, at-risk children.
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Affiliation(s)
- Yuanee Mary Wickramasinghe
- Department of Community Paediatrics, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Shanti Raman
- Department of Community Paediatrics, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Pankaj Garg
- Department of Community Paediatrics, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Romy Hurwitz
- Department of Community Paediatrics, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
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