The evidence base for routine enquiry into adverse childhood experiences: A scoping review

BackgroundExposure to adverse childhood experiences (ACEs; e.g., maltreatment, household dysfunction) is associated with a multiplicity of negative outcomes throughout the life course. Consequently, increasing interest is being paid to the application of routine enquiry for ACEs to enable identification and direct interventions to mitigate their harms.ObjectiveTo explore the evidence base for retrospective routine enquiry in adults for ACEs, including feasibility and acceptability amongst practitioners, service user acceptability and outcomes from implementation.MethodsA scoping review of the literature was conducted, drawing upon three databases (CINAHL, MEDLINE, PsycINFO) and manual searching and citation tracking. Searches included studies published from 1997 until end of April 2018 examining enquiry into ACEs, or the feasibility/acceptability of such enquiry across any setting. All included studies presented empirical findings, with studies focusing on screening for current adversities excluded.ResultsSearches retrieved 380 articles, of which 15 met the eligibility criteria. A narrative approach to synthesize the data was utilized. Four studies examined practitioner feasibility and/or acceptability of enquiry, three reported service user acceptability and six studies implemented routine ACE enquiry (not mutually exclusive categories). Further, eight studies explored current practice and practitioner attitudes towards ACE enquiry.ConclusionsLimited literature was found providing evidence for outcomes from enquiry. No studies examined impacts on service user health or service utilization. Few studies explored feasibility or acceptability to inform the application of routine ACE enquiry. The implementation of routine ACE enquiry therefore needs careful consideration. Focus should remain on evaluating developing models of ACE enquiry to advance understanding of its impact.     

Identifying underlying constructs of childhood adversity in a low-income population

BackgroundExtensive research has documented the association between adverse childhood experiences (ACEs) and poor outcomes later in life, as well as the high prevalence of ACEs in the American population. Studies consistently find that over half of American adults have experienced at least one ACE. Despite this, research on the long-term impacts of ACEs is challenging due to the complex nature of adversity.ObjectiveOur study aimed to define underlying constructs of adversity, and explore how they changed throughout childhood, in a low-income population.Participants and SettingWe fielded a survey to Medicaid-enrolled adults in the Portland, OR metropolitan area.MethodsOur survey captured different experiences in childhood, including relationships and support, educational challenges, housing and employment stability, neighborhood environment, discrimination, abuse, neglect, and household dysfunction; questions were asked for 6–12 and 13–18 years of age. We then used factor analysis to identify underlying constructs of adversity in the two age ranges.ResultsWe identified two factors - Inadequate Emotional Support and Instability – in each age range. Inadequate Emotional Support remained consistent in both time periods while the Instability factor changed, expanding from household-centric experiences in childhood to a wider variety of experiences in adolescence. Additionally, a number of variables did not load on either factor in either age range.ConclusionsThese results underscore the importance of expanding how we think about instability specifically, and childhood adversity in general.     

Associations between childhood deaths and adverse childhood experiences: An audit of data from a child death overview panel

BackgroundDespite strong associations between adverse childhood experiences (ACEs) and poor health, few studies have examined the cumulative impact of ACEs on causes of childhood mortality.MethodsThis study explored if data routinely collected by child death overview panels (CDOPs) could be used to measure ACE exposure and examined associations between ACEs and child death categories. Data covering four years (2012–2016) of cases from a CDOP in North West England were examined.ResultsOf 489 cases, 20% were identified as having ≥4 ACEs. Deaths of children with ≥4 ACEs were 22.26 (5.72–86.59) times more likely (than those with 0 ACEs) to be classified as ‘avoidable and non-natural’ causes (e.g., injury, abuse, suicide; compared with ‘genetic and medical conditions’). Such children were also 3.44 (1.75–6.73) times more likely to have their deaths classified as ‘chronic and acute conditions’.ConclusionsThis study evidences that a history of ACEs can be compiled from CDOP records. Measurements of ACE prevalence in retrospective studies will miss individuals who died in childhood and may underestimate the impacts of ACEs on lifetime health. Strong associations between ACEs and deaths from ‘chronic and acute conditions’ suggest that ACEs may be important factors in child deaths in addition to those classified as ‘avoidable and non-natural’. Results add to an already compelling case for ACE prevention in the general population and families affected by child health problems. Broader use of routinely collected child death records could play an important role in improving multi-agency awareness of ACEs and their negative health and mortality risks as well in the development of ACE informed responses.     

Psychometric evaluation of the Adverse Childhood Experience International Questionnaire (ACE-IQ) in Malawian adolescents

BackgroundAdverse childhood experiences (ACEs) can have lifelong adverse impacts on health and behavior. While this relationship has been extensively documented in high-income countries, evidence from lower-income contexts is largely missing. In order to stimulate greater research on the prevalence and consequences of ACEs in low-income countries, the World Health Organization (WHO) developed the ACE-International Questionnaire (ACE-IQ).ObjectiveIn this paper, we explore the factor structure, validity and reliability of the original ACE-IQ, and evaluate whether potential adaptations improve its predictive validity.Participants and settingFour hundred and ten adolescents (age 10–16 years old) from Malawi.MethodsThe adolescents answered an adapted version of ACE-IQ and Beck Depression Inventory (BDI).ResultsTaken together, our results suggest that (a) the ACE-IQ is structured in three dimensions: household disruption, abuse, and neglect; (b) there is support for the validity of the scale evidenced by the correlation between subdimensions (average across 13 correlations, phi = .20, p < 0,01; across subdomains (phi = .10, p < 0,01); partial agreement among children with the same caregiver (ICC = .43, p < .001) and correlation between ACE and depression (predictive validity; r = .35, p < .001); (c) information on the timing of the adversities (“last year” in addition to “ever”) modestly improved the predictive value of the ACE-IQ in models of depression (from R² = .12 to .15, p < .001); and (d) additional HIV-related questions showed low endorsement and a modest correlation with BDI (r = .25, p < 0,01).ConclusionOur findings suggest that the ACE-IQ is appropriate for use among adolescents from a low-income context.     

Self-reported adverse childhood experiences and quality of life among children in the two last grades of Dutch elementary education

BackgroundAdverse Childhood Experiences (ACEs) may have a life-long impact on mental health and are related to physical disease, such as diabetes and cardiovascular diseases in adulthood. Research on ACEs suffers from recall bias when performed with adults.ObjectiveTo estimate the prevalence of ACEs and the interrelationships between ACEs as reported by children, and to determine the impact on their self-reported quality of life (QoL). Children’s opinions on the ACE-Questionnaire were also obtained.MethodA cross-sectional study was conducted with a child version of the ACE-Questionnaire. This questionnaire assesses parental separation or divorce, physical and emotional child abuse and neglect, sexual violence, domestic violence, household substance abuse, psychological issues or suicide, and incarceration of a household member. QoL was measured with the Kidscreen-10.Participants and settingThe questionnaire was completed by 644 children at a mean age of 11 years (range 9–13 years), in the two last grades of regular elementary schools, recruited throughout the Netherlands.ResultsData were weighted by ethnicity to obtain a representative sample of children in Dutch elementary education. Of all children, 45.3% had one or more out of ten ACEs. Child maltreatment was experienced by 26.4%. ACEs often co-occurred. A higher number of ACEs correlated with a lower mean level of QoL (p < 0.001). Mean QoL was 8.5 points lower (Cohen’s d = 0.8) in children who experienced child maltreatment. Children’s opinions on the questionnaire were positive in 82.4%.ConclusionPrevention of ACEs, professional training and trauma-focus in schools are urgently needed.     

Adverse childhood experiences and preschool suspension expulsion: A population study

BackgroundPreschool suspension and expulsion rates are typically based on teacher reports, and don’t simultaneously account for adverse childhood experiences (ACEs).ObjectiveTo examine estimates in the United States of parent-reported preschool suspension and expulsion rates, in the context of ACEs.Participants and settingParents of children aged 3–5 years old (N = 6,100) in the 2016 National Survey of Children’s Health dataset.MethodWe reported the prevalence estimates of preschool suspension and expulsion, and estimated the unique variance of ACEs as risk factors using weighted sequential logistic regression.ResultsAn estimated 174,309 preschoolers (2.0%) were suspended, and 17,248 (0.2%) children were expelled annually. If divided by 36 school weeks, the instances of weekly suspension and expulsion were at least 4,842 and 479 respectively. Controlling for previous risk factors (i.e., age, gender, race, ethnicity), the odds ratio increased by 80% for every unit of ACEs increment. Children were more likely to be suspended or expelled if they had domestic violence (OR = 10.6, p < .001), living with mental illness (OR = 9.8, p < .001), adult substance abuse (OR = 4.8, p < .001), and victim of violence (OR = 4.5, p = .004), living in high poverty (OR = 3.9, p = .001), divorced parents (OR = 3.3, p = .001), and parent incarceration (OR = 3.0, p = .009).ConclusionThe alarming suspension and expulsion rates call for more comprehensive outreach prevention and response efforts in preschool settings. Cross system collaboration and family support are essential to this work.     

Effective parental involvement in education: experiences and perceptions of Turkish teachers from private schools

Parental involvement has been associated with numerous student benefits. However, related literature reveals that neither parents nor teachers are content with the scope and depth of parental involvement in schools. This may be partly due to differential understandings that both sides have on the concept of parental involvement. In this study, teachers’ experiences and perceptions of effective parental involvement in the private middle school context of Turkey were examined. Participants are 38 teachers, from five different schools, who were selected by the maximum variation sampling technique. This study provides an insight into how teachers make sense of the educational involvement of the middle to high socio economic status (SES) parents with whom they theoretically share similar cultural capital. The findings of this collective case study demonstrate there are important misunderstandings and related tensions among parents and teachers over the roles of each party. Teachers believe that parents’ educational roles are mostly performed at home. On the contrary, parents are shown as having a higher desire to participate in educational decisions. This divergence between parents and teachers seems to decrease productive partnerships between the two parties. Future studies are needed in order to search for collaboration mechanisms that would work for all actors involved.     

Influence of the natural setting on environmental education outcomes

Abstract

Environmental education (EE) typically occurs in natural settings, which research suggests may enhance learning outcomes. Although field trips are commonly used to teach EE, few studies have isolated the influence of different setting characteristics for enhancing participant outcomes during an EE field trip. According to the literature, certain attributes of the natural setting, including novelty, beauty, and naturalness, as well as how the setting is used such as through place-based education, immersion, and time spent inside vs. outside, are thought to positively impact people’s experiences with nature. In this study, we collected data from 334 EE field trip programs for 5-8^th grade students to investigate the influence of these natural setting characteristics on positive learning outcomes. Results suggest that the naturalness and novelty of the setting, the use of place-based education, and spending more time outside vs. inside all positively correlated with more positive student outcomes. The implications of the results for environmental educators are discussed.     

协调公立与私立高校的关系,推进教育和谐发展——美国的实践和经验

美国高等教育经历了一个由私立高校一统天下到公立高校逐步兴起,再到两者并驾齐驱,并最终公立高校占主流地位的历史发展过程。美国能够最早实现高等教育大众化,靠的就是私立高校和公立高校的共同努力来实现的。在这个过程中,美国政府通过立法和财政资助等途径,不断协调公立与私立高校的关系,推进教育和谐发展。     

游,魏晋士人寻归之路

走出两汉经学牢笼的魏晋士人,一时间失去了人生追求的目标,游观中日趋强烈的失落感,激发出深情的回归歌咏。他们首先在哲学的层面上,通过玄学论辩,设计构建新的人生归宿,同时又在各种“游”的活动中,寻归全新而又陌生的家园。因此,“游”的自由与洒脱、风度与风流的另一面,是失落家园的凄怆与感伤。