Session: Translating Research on Adverse Childhood Experiences (ACEs): The Implications of How We Measure, Screen, and Conceptualize Child Adversity (Society for Social Work and Research 23rd Annual Conference - Ending Gender Based, Family and Community Violence)

Background: The findings from the Kaiser-CDC Adverse Childhood Experiences (ACEs) study have greatly influenced our understanding of childhood adversity as a social determinant of health. The ACEs study relies on a cumulative risk approach to measuring ACEs that adds up the number of exposures to predict health outcomes. This methodological approach has been translated into generalized ACEs screening in child-serving systems, namely pediatric primary care and child welfare settings. However, research on the measurement of ACEs should be further explored and scrutinized before widespread translation. Three main concerns are addressed in this symposium. First, emerging research indicates that exploring clusters of ACEs may be more informative in predicting outcomes than a summative cumulative ACE score. The first paper examines whether cluster of ACEs differentially predict child mental health outcomes. Further, no studies have examined the clustering of ACEs across race and ethnic groups, supporting an assumption that ACEs are experienced similarly across child subgroups. The second paper examines whether ACE clusters are similar between child race/ethnic subgroups. The last key concern addressed in this symposium is the inherently deficit-based approach to ACE research. The third paper presents findings from a recent report using a conceptual framework of HOPE (Health Outcomes of Positive Experiences). This framework suggests that examining ACEs alone is a limited approach to understanding child and family well-being.

Methods: The first paper uses data from the National Survey of Child and Adolescent Well-Being (NSCAW II), a longitudinal, nationally representative survey of children who have been the subject of a child welfare investigation. Latent class analysis (LCA) was used to identify sub-groups of children with similar ACE exposure. The second paper uses data from the recently released 2016 National Survey of Children's Health (NSCH) and also employs LCA to compare ACE subgroups for White, Black, and Hispanic children. The last paper describes findings from a recent feasibility report that applied the HOPE framework to four studies: the NSCH, the Wisconsin Behavioral Risk Factor Surveillance Survey, yougov.com, and a nationwide social norms survey developed by Prevent Child Abuse America.

Results: The first paper found evidence for 5 subgroups of children in the NSCAW sample based on ACE exposure. Behavioral health symptoms were predicted by ACE subgroup. Similarly, the second paper found evidence of latent subgroups of ACEs in the NSCH. Importantly, the subgroup structure varied significantly across child race/ethnicity. The findings of the HOPE studies collectively reinforce the need to promote positive experiences for children and families in order to foster healthy childhood development despite the adversity common in so many families.

Conclusions: Existing research on ACEs has generated a new dialogue about the importance of early childhood experiences. As these findings are translated into practice, these studies indicate a need for a more nuanced conceptualization of adversity, as well as inclusion of positive experiences. Childhood experiences tend to cluster together, and are experienced differently among child subgroups. This body of research has significant implications for policy and practice.