[Editor's note: Dr. Harise Stein at Stanford University edits a web site — abuseresearch.info — that focuses on the effects of abuse, and includes research articles on PACEs. Every month, she posts the summaries of the abstracts and links to research articles that address only ACEs, PCEs and PACEs. Thank you, Harise!! — Rafael Maravilla]
Domestic Violence – Effects on Children
Ragavan MI, Murray A.
Supporting Intimate Partner Violence Survivors and Their Children in Pediatric Healthcare Settings. Pediatr Clin North Am. 2023;70(6):1069-86. PMID: 37865431
“In this article, we discuss how pediatric healthcare providers and systems can create healing-centered spaces to support IPV survivors and their children. We review the use of universal education and resource provision to share information about IPV during all clinical encounters as a healing-centered alternative to screening. We also review how to support survivors who may share experiences of IPV, focused on validation, affirmation, and connection to resources. Clinicians are provided key action items to implement in their clinical settings.”
Metzger IW, Moreland A, Garrett RJ, et al.
Black Moms Matter: A Qualitative Approach to Understanding Barriers to Service Utilization at a Children's Advocacy Center Following Childhood Abuse. Child Maltreat. 2023;28(4):648-60. PMID: 37042334
“Black maternal caregivers reported barriers to accessing services at CACs [children’s advocacy centers] including a lack of assistance and information in the referral and onboarding process, transportation issues, childcare, employment hours, system mistrust, stigma associated with the service system, and outside stressors such as stressors related to parenting. Maternal caregivers also shared suggestions for improving services at CACs including increasing the length, breadth, and clarity of investigations conducted by child protection services and law enforcement (LE) agencies, providing case management services, and having more diverse staff and discussing racial stressors.”
Hemler ME, Kojan BH, Anthun KS, Fauske H.
Risk for referral to the child welfare system following parental relationship transitions in Norway. Child Abuse Negl. 2023;146:106459. PMID: 37813020
From a large Norwegian database, “The occurrence of any type of relationship transition increased the likelihood of referral to the child welfare system in the year that the transition occurred, with the transitions to single motherhood, to single fatherhood, and from single fatherhood to a couple associated with greater odds of referral than the transition from single motherhood to a couple.”
Smith A, Bryson H, Gartland D, Mensah F, Wood CE, Price A. Mothers' experiences of emotional abuse from an intimate partner and its associations with children's developmental outcomes at 5 years. Child Abuse Negl. 2023;146:106458. PMID: 37866251
“Intimate partner violence (IPV) is associated with an increased risk of poorer child development. Existing research has focused on physical abuse with less known about emotional IPV.” In this study of 194 Australian women experiencing social adversity, at child ages 3-5 years, 57% of women experienced emotional IPV, which was consistently associated with poorer child development outcomes at age 5.
Zhang Y, Shen F, Paredes J, Lindsay D, Liu Q, Madre N, et al.
Exploring the complex links between childhood exposure to IPV, maltreatment, and self-regulation. Child Abuse Negl. 2023;146:106507. PMID: 37879255
From a long-term study with 4402 families, “exposure to IPV during early childhood significantly predicts long-term behavioral self-regulation difficulties, even after controlling for the effects of child maltreatment.”
Testa A, Lee JG, Jackson DB, et al.
Physical IPV and prenatal oral health experiences in the US. BMC oral health. 2023;23(1):749. PMID: 37828499
From a large study including 31 states, “women who experience physical IPV during pregnancy have lower knowledge of prenatal oral health care, more oral health problems, and greater unmet dental care needs. Given the risk of IPV and oral health problems for maternal and infant health [while the mechanisms are not fully understood, oral health problems during pregnancy have been found to negatively impact birth outcomes, including preterm birth and low birth weight] the study findings point to greater attention toward the oral health needs of IPV-exposed pregnant women.”
Mepham J, Nelles-McGee T, Andrews K, Gonzalez A.
Exploring the effect of prenatal maternal stress on the microbiomes of mothers and infants: A systematic review. Dev Psychobiol. 2023;65(7):e22424. PMID: 37860905
This review evaluates knowledge to date about how prenatal maternal stress (characterized by exposure to stress, anxiety, depression, or intimate partner violence) may detrimentally alter the microbial composition, diversity, and gut immunity in mothers and infants, with possible long-term health implications.
Human Trafficking
Moore JL, Fitzgerald M, Raj A.
Caring for Domestic Minor Sex Trafficking Patients: Recommendations for Identification, Interventions, and Resources. Rhode Island medical journal (2013). 2023;106(10):29-33. PMID: 37890061
In this general review, authors “provide recommendations on how to identify, engage trafficked youth, and provide beneficial linkages with community resources. A coordinated, multidisciplinary, and trauma-informed response that fosters therapeutic alliances promoting agency, safety, and trust are key components of successful care for this vulnerable adolescent population.”
Thomas H, Cromb D, Jacob H.
Acute safeguarding essentials in modern-day paediatrics: neglect, unsupervised minors and modern slavery. Arch Dis Child Educ Pract Ed. 2023 Dec;108(6):397-400. PMID: 37890978
Authors discuss various aspects of practical management of an 11 year-old female non-English speaking child wandering around a train station at midnight, who is being trafficked by relatives.
LGBTQ Concerns
Choi KR, Wisk LE, Zima BT.
Availability of LGBTQ Mental Health Services for US Youth, 2014 to 2020. JAMA Pediatr. 2023 Aug 1;177(8):865-867. PMID: 37273225
“Approximately 1 in 10 children and youth in the US identifies as being in a sexual or gender minority group (lesbian, gay, bisexual, transgender, queer [LGBTQ]). Compared with heterosexual or cisgender youth, LGBTQ youth have 3 times higher prevalence of depression and anxiety, and 42% have considered suicide. Fifty-four percent of LGBTQ youth reported wanting mental health care but not receiving any, partly due to adverse experiences with clinicians and perceptions that clinicians do not understand sexual or gender identity–related mental health needs.” From a data review of service availability by state, “Twenty-eight percent of youth-serving US mental health facilities offered LGBTQ-specific mental health services in 2020. Although some states had relatively high levels of LGBTQ service availability as a percentage of facilities, many of these states had few facilities available to children per capita. Public mental health facilities were less likely to offer LGBTQ-specific mental health services, a concern given that the cost of care is a barrier to services.”
Helminen EC, Scheer JR, Ash TL, Haik AK, Felver JC.
Discrimination, Depression, and Anxiety Among Sexual Minority and Heterosexual Young Adults: The Role of Self-Compassion. LGBT Health. 2023 May;10(4):315-323. PMID: 36656549
From an online survey of 251 college students, “Self-compassion may be a particularly important coping resource to protect against depression symptoms among SMYAs [sexual minority young adults] experiencing discrimination. These findings provide an impetus for SMYA-tailored intervention and prevention efforts that incorporate cultivating self-compassion as a protective coping resource.”
Race/Cultural Concerns
Tolliver DG, He Y, Kistin CJ.
Child Maltreatment. Pediatr Clin North Am. 2023;70(6):1143-52. PMID: 37865436
“Child maltreatment is associated with significant morbidity, and prevention is a public health priority. Given evidence of interpersonal and structural racism in child protective service assessment and response, equity must be prioritized for both acute interventions and preventive initiatives aimed at supporting children and their families. Clinicians who care for children are well-positioned to support families, and the patient-centered medical home, in collaboration with community-based services, has unique potential as a locus for maltreatment prevention services.”
Edwards F, Roberts SCM, Kenny KS, et al.
Medical Professional Reports and Child Welfare System Infant Investigations: An Analysis of National Child Abuse and Neglect Data System Data. Health equity. 2023;7(1):653-62. PMID: 37786528
“Between 2010 and 2019, child welfare investigated 2.8 million infants; ∼26% (n=731,705) stemmed from medical professionals' reports. Population-adjusted rates of these investigations doubled between 2010 and 2019 (13.1-27.1 per 1000 infants). Rates of investigations stemming from medical professionals' reports increased faster than did rates for other mandated reporters, such as teachers and police, whose reporting remained relatively stable. In 2019, child welfare investigated ∼1 in 18 Black (5.4%), 1 in 31 Indigenous (3.2%), and 1 in 41 White infants (2.5%) following medical professionals' reports…Investigations related to substance use comprised ∼35% of these investigations; in some states, this was almost 80%...Rates of child welfare investigations of infants stemming from medical professional reports have increased dramatically over the past decade with persistent and notable racial inequities in these investigations.”
Nnoli A.
Historical Primer on Obstetrics and Gynecology Health Inequities in America: A Narrative Review of Four Events. Obstet Gynecol. 2023;142(4):779-86. PMID: 37734087
“Four historical events provide context for racial injustices and inequities in medicine in the United States today: the invention of race as a social construct, enslavement in the Americas, the legal doctrine of Partus sequitur ventrem [children of enslaved mothers were born into slavery], and the American eugenics movement [including forcible sterilization of the poor, disabled, and minorities]. This narrative review demonstrates how these race-based systems resulted in stereotypes, myths, and biases against Black individuals that contribute to health inequities today.”
Gaba H, Shamaskin-Garroway AM, Pierson WE, Berliant MN.
Racial and Ethnic Differences in Patient-Reported Acceptability of Adverse Childhood Experience (ACE) Screening in Adult Primary Care. J Racial Ethn Health Disparities. 2023 Dec;10(6):3107-3114. PMID: 36469290
Among 131 patients seen at a primary care academic safety net clinic, “37% reported 4 or more ACEs. Black/African American patients and Hispanic/Latinx patients were overrepresented in the high ACE score (4 +) group. Over one in three of all patients did not find ACE screening to be an acceptable part of their primary care…patient-reported acceptability was not statistically associated with patients' ACE score or patients' race, ethnicity, gender, or age. Notably, however, in our small sample of Native American and Hispanic/Latino patients, over half did not find ACE screening to be acceptable…We consider routine ACE screening to be unsubstantiated and premature, and instead encourage the development of comprehensive trauma-informed practices for which a disclosure of childhood adversity is not necessary.”
Simpson JE, Landers AL, White Hawk S.
Longing to belong: The ambiguous loss of Indigenous fostered/adopted individuals. Child Abuse Negl. 2023:106441. PMID: 37833120
“Indigenous fostered/adopted persons experienced ambiguous loss in foster care and adoption. Their loss remained unresolved due to a loss of access to information about their family and tribe of origin. Although family of origin, tribal community, and culture were not physically present due to separation by foster care/adoption, they remained psychologically present. As a result of ambiguous loss, participants experienced disenfranchised grief, wondering and longing to belong, and mental health and substance abuse.”
Melendez DR, Alexander AJ, Nardolillo J, et al.
An Exploration of Diversity, Equity, Inclusion, and Antiracism in Standardized Patient Simulations. Am J Pharm Educ. 2023;87(11):100594. PMID: 37783306
Authors report on seven pharmacy training programs incorporating diversity, equity, inclusion, and antiracism (DEIA) in their standardized patient (SP) training scenarios. “Common barriers…included recruitment of diverse SPs, lack of faculty knowledge for implementation of DEIA-focused simulations, and emotional protection of SPs involved. While no best practices or standardized processes exist, the authors provide suggestions for addressing barriers, and make a call to action for further research to determine best practices related to recruitment, training, and utilization of diverse SPs in simulation activities.”
Police and Court Systems
Barnert ES, Schlichte LM, Tolliver DG, et al.
Parents' Adverse and Positive Childhood Experiences and Offspring Involvement With the Criminal Legal System. JAMA network open. 2023;6(10):e2339648. PMID: 37878312
“In this nationally representative study, children of parents with higher ACEs were at greater risk of arrest during adolescence and young adulthood, even after controlling for parents' PCEs…Having 4 or more parental ACEs was associated with 1.91-fold higher adjusted odds of arrest before age 26 and 3.22-fold higher adjusted odds of conviction before age 26 years, compared with children of parents without ACEs…Addressing and preventing childhood adversity through multigenerational life course approaches may help disrupt intergenerational pathways to the criminal legal system.”
Providers
Arenson M, Forkey H.
Violence Exposure and Trauma-Informed Care. Pediatr Clin North Am. 2023;70(6):1183-200. PMID: 37865439
“Addressing violence in pediatrics requires a working knowledge of trauma-informed care (TIC). TIC weaves together our current understanding of evolution, child development, and human physiology and how these explain common childhood responses to traumatic events. In this article, we describe our current approach to treating childhood trauma in the context of violence…TIC leverages a child's natural strengths and biologic processes by (1) scaffolding the patient's relationships to safe, stable, and nurturing adults and (2) strengthening core resilience skills while addressing trauma symptoms when necessary.”
Esposito J, Davis M, Boyd RC.
Suicide Prevention in Pediatric Health Care Settings. Pediatr Clin North Am. 2023 Dec;70(6):1115-1124. PMID: 37865434
“Suicidal thoughts and behaviors are prevalent among youth. Research has highlighted disparities in suicide risk. Evidence-based practices for suicide screening, assessment, and brief intervention exist, but there are barriers to implementing these practices in health care settings…focus should be on ways to partner with providers, health system leaders, patients, and families to determine optimal ways to consistently implement and sustain best practices for suicide prevention in health care settings…such as the AAP Mental Health Toolkit.”
Culyba AJ, Fleegler EW, Pratt AH, Lee LK.Violence Prevention in Pediatrics: Advocacy and Legislation. Pediatr Clin North Am. 2023 Dec;70(6):1225-1238. PMID: 37865442
“This article focuses on the role of pediatric clinicians in advocating for youth and families, promoting change within clinical and hospital systems, partnering with communities to advance evidence-informed prevention and intervention, and legislative advocacy to advance violence prevention policy, research, and practice.”
Gordon JB, Felitti VJ.
The Importance of Screening for Adverse Childhood Experiences (ACE) in all Medical Encounters. AJPM Focus. 2023;2(4):100131. PMID: 37790951
In this editorial, authors advocate for ACE screening in clinical interactions, and counter recent arguments against doing so.
Ha M, Rowe A, Hendrix K, Anwar S, Mang K, Wen F, et al.
Use of Metaphor as an Explanation Tool in Adverse Childhood Experiences Simulation Training. The Permanente journal. 2023:1-10. PMID: 37876251
“Health care practitioners need effective communication tools for trauma-sensitive inquiries with patients. This study aimed to describe characteristics of effective metaphor use by health care trainees when discussing ACEs and health with adult patients, and to provide example metaphors for clinicians to use to sensitively address ACEs…the most common being the overloaded backpack. Mean metaphor duration was 37 seconds…No one metaphor performed significantly better…Literary devices like metaphors may be efficient and effective explanatory tools to improve clinician communication skills and patient understanding in addressing sensitive topics, such as ACEs.”
Raja S, Rabinowitz EP, Sayer MA, da Fonseca M.
Patient comfort discussing sensitive behavioral health topics. Journal of communication in healthcare. 2023;16(3):239-44. PMID: 37859460
From an online survey, “Participants reported being more comfortable discussing cigarette smoking and less comfortable discussing trauma, IPV and gun ownership compared to depression. Privacy and perceived irrelevance were the most common reasons for discomfort…Patient comfort may increase through provider trainings that focus on communication skills, clear administrative procedures that allow for privacy and adequate time for discussions, and community education that underscores how these issues impact health.”
Davidson J, Karadzhov D, Collins H, Brown A.
Complexities of protecting children from violence during the COVID-19 pandemic: Providers' and policymakers' best practices, innovations and challenges in 12 countries. Child Abuse Negl. 2023;146:106480. PMID: 37801758
“Most respondents reported their sectors had experienced challenges in protecting children from violence - particularly delays in reporting abuse and pursuing justice, and reaching those living in poor and/or rural areas. Good practices and innovations in children's protection during the pandemic were reported in several domains: advocacy and signposting; justice; health care; education and awareness-raising; children's visibility; and virtual service delivery. Community resources and involvement were also highlighted as vital. The ineffectiveness of child protection laws, policies and organizational responses, however, hindered the implementation of effective practices…Collectively, the findings reinforce the criticality of collaborative, urgent and child-centered responses.”
Shadik JA, Harris E, McDonald E.
Learning from child welfare staff experiences during the pandemic: Practices to maintain and discontinue. Child Abuse Negl. 2023;146:106481. PMID: 37801759
In a study of 267 staff members from 50 Ohio agencies, “Thematic analysis of practices staff hoped to continue after the pandemic resulted in five themes: Nontraditional Site and Schedule, Remote Meetings, Safety Protocols, Communication and Support, and Helping Children and Families. Thematic analysis or practices staff hoped would end after the pandemic resulted in six themes: Masking, Virtual Meetings, Mandated Work Location, Unreasonable Policies, Overloading and Overwhelming Staff, and Separation from Coworkers.”
Prevention
Gastineau KAB, McKay S.
Firearm Injury Prevention. Pediatr Clin North Am. 2023 Dec;70(6):1125-1142. PMID: 37865435
“Firearms are the leading cause of death for US youth, overtaking motor vehicle collisions in 2020. Approximately 65% are due to homicide, 30% to suicide, 3.5% to unintentional injuries, 2% are undetermined intent, and 0.5% are from legal interventions. In homes with firearms, the likelihood of unintentional death, suicide, and homicide is three to four times higher than those without firearms. Secure storage of firearms, having them locked, unloaded, and separate from ammunition can prevent unintentional firearm injuries.”
Researchers
Networks of Adversity in Childhood and Adolescence and Their Relationship to Adult Mental Health. Res Child Adolesc Psychopathol. 2023 Dec;51(12):1769-1784. PMID: 36331717
Using network analysis to reveal adversity clusters from the Avon Longitudinal Study of Parents and Children, “Emotional and physical abuse were central to the network of adversities. Emotional abuse was especially connected to mental health issues in early adulthood, highlighting that preventing this type of adversity may be relevant in addressing depression as a public health issue. During adolescence, adversities can be divided into direct abuse, family, and social/educational factors. Adolescent adversities such as housing issues and abuse by a romantic partner were central in the network of adversities. Educational issues were strongly connected to mental health issues later in life. Different adversities may need to be considered to support adolescents compared to children. Future research should deepen this understanding and work towards a comprehensive approach to tackle adversity across the lifespan.”
Jain A, Brooks JR, Alford CC, et al.
Awareness of Racial and Ethnic Bias and Potential Solutions to Address Bias With Use of Health Care Algorithms. JAMA Health Forum. 2023 Jun 2;4(6):e231197. PMID: 37266959
42 organization representatives (e.g., clinical professional societies, universities, government agencies, payers, and health technology organizations) and individuals responded to a survey about bias in algorithms used in healthcare. “Algorithms [sets of mathematical rules or calculations] are commonly incorporated into health care decision tools used by health systems and payers and thus affect quality of care, access, and health outcomes…(1) algorithms are in widespread use and have significant repercussions, (2) bias can result from algorithms whether or not they explicitly include race, (3) clinicians and patients are often unaware of the use of algorithms and potential for bias, (4) race is a social construct used as a proxy for clinical variables, (5) there is a lack of standardization in how race and social determinants of health are collected and defined, (6) bias can be introduced at all stages of algorithm development, and (7) algorithms should be discussed as part of shared decision-making between the patient and clinician.”
Goodall K, Sawrikar V.
The Rating of Emotional Abuse in Childhood (REACH) Questionnaire: A new self-report measure assessing history of childhood emotional abuse. Child Abuse Negl. 2023;146:106498. PMID: 37844458
Authors discuss validation of a new tool assessing a history of childhood emotional abuse (CEA). Two scales measured threatening and devaluing emotional abuse, which represent “unique dimensions of CEA even though they often co-occur.”
Lee S, Yoon S, Namgung E, et al.
Distinctively different human neurobiological responses after trauma exposure and implications for posttraumatic stress disorder subtyping. Mol Psychiatry. 2023 Jul;28(7):2964-2974. PMID: 36854717
In this detailed brain-research oriented study, authors used a data-driven classification approach of both trauma-exposed and trauma-unexposed individuals across a wide range of assessments. “We identified four distinct and replicable subtypes for trauma-exposed individuals according to posttraumatic stress symptoms. Each subtype was distinct in clinical characteristics, brain functional organization, and long-term trajectories for posttraumatic symptoms.”
Ertanir B, Cobb CL, Unger JB, et al.
Crisis Migration Adverse Childhood Events: A New Category of Youth Adversity for Crisis Migrant Children and Adolescents. Res Child Adolesc Psychopathol. 2023 Dec;51(12):1871-1882. PMID: 36626084
“The present article proposes an extension of the concept of adverse childhood experiences (ACEs) to apply to crisis migration - where youth and families are fleeing armed conflicts, natural disasters, community violence, government repression, and other large-scale emergencies. We propose that adverse events occurring prior to, during, and following migration can be classified as crisis-migration-related ACEs…We propose a research agenda centered around definitional clarity, rigorous measurement development, prospective longitudinal studies to establish predictive validity, and collaborations among researchers, practitioners, and policymakers.”
Kaul A, Chavendera DD, Saunders K, Paphitis SA.
Improving Emotional Safety, Coping, and Resilience Among Women Conducting Research on Sexual and Domestic Violence and Abuse. J Interpers Violence. 2023:8862605231207617. PMID: 37876237
“This study qualitatively explored violence researcher's professional experiences of secondary trauma and their perceptions of what enables and constrains their own coping and resilience…All participants reported experiencing symptoms of secondary trauma from their work including cognitive disturbances; altered beliefs of themselves, others or the world; and challenges connecting with others…Organizational support for violence researchers was rarely provided and participants felt generally unsupported -- left to manage any resultant distress alone. Research organizations and universities should implement trauma-informed policies which positively transform workplace culture, provide peer support spaces, and conduct effective training in order to mitigate psychological harm and promote resilience among violence researchers.”
Other of Interest
Purtle J, Nelson KL, Lê-Scherban F, Gollust SE.
Unintended consequences of disseminating behavioral health evidence to policymakers; Results from a survey-based experiment. Implement Res Pract. 2023;4:26334895231172807. PMID: 37790180
“A preregistered, web-based survey experiment with U.S. state legislators/staffers was conducted in 2021 (n = 133). Respondents were randomized to view a policy brief about the behavioral health consequences of ACEs that included state-tailored data (intervention condition) or national data (control condition) and then answered survey questions…61.2% of respondents in the intervention condition rated parents as ‘very much to blame’ for the consequences of ACEs compared to 37.1% in the control condition…Unintended messaging effects warrant greater attention in dissemination research and practice.”
Borg K, Faulkner N, Slattery P, Tear MJ.
Understanding and Changing Community Attitudes Toward Vulnerable Families: A Review of Literature and Practice. Fam Community Health. 2024 Jan-Mar 01;47(1):66-79. PMID: 37747843
“A number of interventions to change community attitudes and behaviors were identified. Practitioners indicated that success factors for interventions included facilitating active participation from community members; using multifaceted approaches; and increasing empathy toward vulnerable families. Despite increasing evidence around how community members think and act toward vulnerable families, more research is needed to determine how to effectively change these attitudes and behaviors.”
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