Children's Exposure to Trauma through Community Adversity

Background: A growing body of research has found that prolonged exposure to trauma and adverse childhood experiences (ACEs) can alter the brain development of children and lead to poor health and social outcomes later in life. As the evidence has evolved, effective approaches for addressing childhood trauma have also emerged. Interventions have typically focused on helping children and families heal from trauma, while promising practices to prevent the exposure to significant adversity have lagged behind. Furthermore, while the ACEs research has clearly improved understanding of the substantial impact of abuse, neglect and family chaos, more attention is needed on the adverse community environments that can lead to and exacerbate exposure to significant adversity in childhood.

This research was conducted to explore where community-based prevention efforts should focus strategy by asking key stakeholders about the risks children and families are experiencing and their perceptions about prioritizing approaches to reduce exposure to significant adversity and build community resilience.

Methodology: In order to address the research questions, 29 in-depth, semi-structured interviews were conducted with key stakeholders from one large, urban community representing various sectors that impact vulnerable families with young children. The interviews lasted 60-90 minutes and were with a non-random convenience sample. Using snowball sampling methods, the research team also asked stakeholders to recommend others that could provide novel data, and sought input from community partners to ensure a wide and representative sample. Content analysis of the interviews was used to explore content themes and to guide the development of the framework. Member checking strategies were utilized to add rigor to the analysis.

Results: Community stakeholders recognized a number of risks that can make children more vulnerable to significant adversity that could contribute to long-term negative outcomes. Many of the risks they identified were related to the interpersonal adversities found in the ACEs research, like abuse, neglect, family violence, and parental mental health and substance use issues. However, many stakeholders described these risks as symptoms of larger community-based adversities and emphasized the priority of addressing system level problems in order to effectively prevent children’s exposure to significant adversity. All stakeholders highlighted community issues such as structural inequalities related to poverty, discrimination and de-facto segregation that decrease access to quality services, healthcare, housing, employment and education.

Conclusion and implications: Much of the prevention and intervention work developed in response to the increased understanding on the impact of trauma is focused on screening children at risk for experiencing significant adversity and targeting services to mitigate risk and heal from exposure. Early prevention and intervention in young children’s exposure to significant adversity through various multi-level, cross-sector approaches is critical to the creation of healthy, resilient communities where children and families can thrive. However, it is also necessary to explore larger system issues related to equity in order to make substantial reduction in negative outcomes associated with exposure to trauma. Advocacy is needed to implement community solutions that acknowledge that children experiencing poverty and discrimination are exposed to disproportionate risks to their wellbeing.