Session: Applying Adverse Childhood Experiences (ACEs) Scores to the Study and Promotion of Healthy Development for Children and Youth (Society for Social Work and Research 21st Annual Conference - Ensure Healthy Development for all Youth)

Adverse Childhood Experiences (ACEs)—a set of 10 experiences, such as child abuse and neglect, that occur before age 18— are known contributors to increased healthcare use and chronic disease incidence in adulthood. To date, over 50 studies demonstrate the negative health impact of ACEs, including increased adult incidence of cancer, diabetes, lung disease, heart disease, and mental illness. Yet, very little research has investigated the relationship between ACEs and concurrent child and youth outcomes. Addressing the public health impact of ACEs requires greater attention to prevention, early intervention and integration of ACEs into health care and other settings.

This symposium will present results from four studies conducted by multidisciplinary teams across the U.S. The symposium goals are to: (1) rigorously examine the ACEs rubric in relation to child and youth outcomes including in an applied setting, (2) propose measurement and methodological recommendations based on study results, and (3) stimulate discussion about social work’s role in ACEs and child health based on results of our empirical studies. Multiple data sources are used to test the studies’ hypotheses, including nationally-representative secondary data from the National Survey of Child and Adolescent Well-being (NSCAW) and the National Survey of Children’s Health (NSCH); local baseline data from a Randomized Control Trial (RCT); and pre-post outcome data from a pilot study in a patient-centered medical home (PCMH). Each uses rigorous analytic approaches, including multivariate logistic regression and latent class analyses to better understand the relationship between ACEs, child health and development, and the implications for social work.

The symposium will begin with a study of children in the child welfare system that created complex health profiles (composed of physical, development, and mental health needs) among children in four age-groups, testing the relationship between ACEs and complex health needs. Following this presentation, a second study will delve deeper into ACEs and health risk behaviors among a group of high-risk youth in foster care. In doing so, subgroups for which the ACE-risk behavior relationship is particularly strong will be reported. These two studies set the stage for discussing how ACEs screeners may be used in child welfare and primary care medical homes to identify families’ multidimensional health and social service needs. Proposing such screeners requires detailed understanding of the best analytical models predicting outcomes using ACEs. A methodological paper, using nationally representative data, will then clarify different methods for analyzing the effects of ACEs on child service needs, making recommendations for preferred analysis to understand these relationships. Finally, a pilot study will examine the feasibility and utility of the Score, Connect, and Nurture (SCAN) program that integrates a Family Development Specialist social worker into a family medicine residency clinic to assess for and provide services related to ACES prevention.  

To conclude, panelists will discuss, based on the evidence presented, an agenda for better detecting and mitigating ACEs across points of contact for vulnerable children and youth. Implications for screening and intervening with prevention efforts will be considered with particular focus for primary care and child welfare systems.