Does Number of Adverse Childhood Experiences Differ Based on Timeliness of Engagement with Addiction Services?

Background: Substance use is a prevalent issue among parents involved with the child welfare system. Parents with substance use disorders (SUD) have experienced more adverse experiences as children than those who do not have a SUD. An increased adverse childhood events (ACE) score has been linked to adverse physical and mental health consequences, as well as negative addiction treatment outcomes. In order to effectively address substance use problems, immediate engagement and linkage to services is critical. However, little is known about the role that ACEs play regarding the timeliness to engage individuals with addiction treatment services. Because parents with SUD tend to have higher ACEs, this study investigated whether ACE scores account for differences in engagement with treatment. We hypothesized that those participants whose engagement was delayed have a higher ACE score than those who were engaged quickly.

Methods: This study’s sample included 86 adults who were participants in the Enhancing Permanency in Children and Families (EPIC) study, a collaborative quasi-experimental child welfare intervention designed to improve SUD outcomes. Engagement was operationalized by examining a) number of days from child welfare case open date to completion of SUD screening (UNCOPE) and b) number of days from program agreement date to first visit with a family peer mentor (FPM). We created four distinct timeliness groups: 1) Quick (quick UNCOPE and 1^st FPM), 2) Delayed (delayed UNCOPE and 1^st FPM), 3) Mixed A (quick UNCOPE and delayed 1^st FPM), 4) Mixed B (delayed UNCOPE and quick 1^st FPM). The total ACE score was the dependent variable. We used ANOVA to compare the four groups regarding ACE score to examine whether groups differ in their level of trauma history. The sample was primarily white (92.50%) and mothers (79.50%) ranging from 19.59 to 58.14 years (M=31.61).

Results: Participants’ average ACE score was M=3.63 (range 0-10) and 45.80% of the sample had an ACE score of four or higher. In regards to timeliness, the mean number of days to complete the UNCOPE screening was M=25.49 days (median =5.00) and the mean number of days that passed until the first FPM visit was M=17.85 days (median = 6.00). Mean ACE scores for Quick, Delayed, Mixed A, and Mixed B groups were M=3.53, M=3.47, M=3.79, and M=3.63, respectively. ANOVA results revealed no statistically significant differences regarding the ACE score (F(3,70)=.046, p=.987) between the four timeliness groups.

Conclusions and Implications: This sample was characterized by high scores on the ACE scale with 45.80% of participants scoring four or higher and 24.00% scoring six or above, which points to the need for trauma related services in general. Contrary to our hypothesis, we did not find statistically significant differences in ACE scores between the four timeliness groups. Due to this, other environmental factors must be considered. For example, researchers should look at organizational level indicators at the child welfare agencies or ecological factors of the afflicted parents related to housing, employment, or childcare to examine if these variables contribute to timeliness of linkage with the services.