Identifying Protective Factors that Promote Better School-Related Outcomes Among Children Who Experienced ACEs

Format

Individual Presentation

First Presenter's Institution

University of Alabama at Birmingham

First Presenter’s Email Address

keane@uab.edu

First Presenter's Brief Biography

Dr. Kevin Keane is the Assistant Dean for Evaluation and an instructor at the University of Alabama at Birmingham (UAB) School of Nursing. Dr. Keane leads the UAB School of Nursing’s Office of Evaluation; he works throughout the school in academic and program evaluation. Dr. Keane also teaches data management and analysis. His educational background is in health promotion/health education and psychology/counseling. Prior to working at UAB, Dr. Keane worked in residential care with youth involved in the juvenile justice and foster care systems. In those roles, he saw the impact of trauma and adverse childhood experiences (ACEs) on youth along with the importance of resilience and relationships in helping youth thrive despite childhood trauma. As a result of these experiences, his research interests focus on adverse childhood experiences (ACEs), resilience, protective factors, child/adolescent mental health, and program evaluation.

Second Presenter's Institution

University of Alabama at Birmingham

Second Presenter’s Email Address

rrevans@uab.edu

Second Presenter's Brief Biography

Dr. Evans has a PhD in health sciences with an emphasis in nutrition. For over 15 years she has worked with K-12 school systems to implement programs and policies to improve health, physical activity, and wellness among students. She has also worked with the state department of education in the development of state policies outlining improvements in school nutrition. As a result, Dr. Evans’ presentations and publications have focused primarily on youth and schools related to nutrition, and obesity prevention initiatives. Dr. Evans also co-authored a textbook in 2016 and 2020 focused on training elementary education majors to implement health and wellness in the classroom. Dr. Evans is currently a department chair in the University of Alabama at Birmingham (UAB) School of Education. She is also in the Community Health Program at the UAB, where she teaches, mentors and conducts health-related research.

Third Presenter's Institution

University of Alabama at Birmingham

Third Presenter’s Email Address

larrellw@uab.edu

Third Presenter's Brief Biography

An Associate Professor of Community Health & Human Services at the UAB School of Education, Dr. Larrell Wilkinson is a teacher, researcher, and servant to the Birmingham metropolitan community. Dr. Wilkinson has a Master of Science in Public Health in Health Promotion Education & Behavior (2005) and a Ph.D. in Health Services Policy & Management (2011), both from the Arnold School of Public Health at the University of South Carolina. Dr. Wilkinson started his public health career as an intern at the Centers for Disease Control and Prevention within the National Center for Immunization and Respiratory Diseases (formerly National Immunization Program). Today, Dr. Wilkinson is a behavioral research scientist interested in addressing the biopsychosocial pathways and life course mechanisms determining health and social outcomes and related racial/ethnic health and social disparities.

Fourth Presenter's Institution

University of Alabama

Fourth Presenter’s Email Address

dmking7@ua.edu

Fourth Presenter's Brief Biography

Dr. Dione Moultrie King is an Associate Professor in the University of Alabama School of Social Work and Associate Director of the UAB Social Science and Justice Research, Health Equity and Justice Core. Dr. King received her PhD and MSW from the University of Georgia and holds a B.A. in Sociology from Spelman College. Prior to Dr. King’s transition into the social work profession, she was employed as a middle school educator. Dr. King credits her experience in the K-12 system as the catalyst for her transition to social work. As a social worker, Dr. King provided clinical services to families impacted by domestic violence, homelessness, trauma, and child abuse or neglect, frequently working with youth as her primary clients. The totality of these experiences within the non-profit, child welfare, juvenile justice, and academic system have continued to inform and shape her research trajectory and interests. Dr. King’s scholarship explores health behaviors and health disparities including sexual and reproductive health, dating violence, mental health, and socio-structural determinants that impact the health and well-being of Black adolescents and young adults. Her secondary line of inquiry focuses on the scholarship of teaching and learning (SOTL). Through this research arm, she incorporates and evaluates novel education modalities such as team-based learning, technology usage, and student-centered instructional methods while also assessing the educational landscape giving attention to microaggressions and other barriers that impeded the learning environment.

Fifth Presenter's Institution

University of Alabama at Birmingham

Fifth Presenter’s Email Address

leleban@uab.edu

Fifth Presenter's Brief Biography

Dr. Lindsay Leban is an assistant professor in the Department of Criminal Justice at the University of Alabama at Birmingham. She received her PhD in Criminology from the University of Florida in 2018. Her research lies within the domains of victimization and drug/substance use, with a particular focus on gender and criminological theory. She uses both quantitative and qualitative methodologies to address these issues. Dr. Leban is currently working on several projects related to Adverse Childhood Experiences (ACEs) and victimization, which assess how early experiences of adversity and trauma are related to deviant and negative life outcomes. She is especially interested in factors that foster resilience in the face of harmful experiences.

Strand #1

Head: Academic Achievement & Leadership

Strand #2

Heart: Social & Emotional Skills

Relevance

The presentation addresses two conference strands: head (academic achievement) and heart (social and emotional skills). The proposed presentation will build on the findings of a research study that compared the relationship between three resilience frameworks and three school-related outcomes (school engagement, absenteeism, and grade retention) among children who experienced multiple adverse childhood experiences (ACEs). This study also identified the protective factors that had the strongest relationship with each outcome. The presentation will be associated with the head strand as the presentation will describe the relationship between the three resilience frameworks/protective factors and school-related outcomes. By targeting the protective factors identified in this study, schools, parents, and communities can potentially improve academic outcomes/achievement among children who have experienced multiple ACEs. For the second strand, many of the strongest protective factors identified across outcomes were related to social and emotional skills, including strong self-regulation, mastery/after school activities, family resilience, hopeful/affirming traditions, and parent/caregiver relationships. Therefore, many potential strategies to mitigate the impact of ACEs on school-related outcomes are closely associated with social and emotional skills.

Brief Program Description

Experiencing multiple adverse childhood experiences (ACEs) has been associated with poorer school-related outcomes. However, modifiable protective factors can potentially build resilience against ACEs. Based on research conducted by the presenter and co-authors, the presentation describes the protective factors from three resilience frameworks associated with better school-related outcomes among children who have experienced ACEs and strategies that can potentially be adopted to target these factors.

Summary

Based on previous research, the presentation will summarize adverse childhood experiences (ACEs) and the relationship between ACEs and poorer school-related outcomes. The presenter will also summarize three prominent resilience frameworks (the National Scientific Council on the Developing Child (NSCDC), Health Outcomes from Positive Experiences (HOPE), and Cumulative Positive Childhood Experiences (PCEs) frameworks). Then, based on secondary data analysis conducted using the 2018-2020 National Survey for Children’s Health, the presentation will discuss the results of a study that examined the relationship between three resilience frameworks and three school-related outcomes (school engagement, absenteeism, and grade retention) among children who experienced ACEs. The presenter will then discuss the protective factors from each framework that had the strongest relationship with each school-related outcome. Across outcomes, both the NSCDC and HOPE frameworks were associated with all three school-related outcomes after controlling for ACEs, but the NSCDC framework had a stronger relationship across outcomes. However, the Cumulative PCEs framework either did not statistically or practically improve any regression models. The study also identified that strong self-regulation, parent/caregiver relationships, sharing ideas, mastery, and after-school activities were the strongest protective factors across outcomes, with some other protective factors having a significant relationship with specific school-related outcomes. The presentation will discuss the implications of these findings and future research. Building upon these findings, the presenter will also discuss strategies that can potentially be implemented by schools and communities using the Gelberg-Andersen Model for Vulnerable Populations and the Centers for Disease Control and Prevention’s ACEs Prevention Strategy to target these protective factors to build resilience against the negative school-outcomes associated with ACEs.

Evidence

Students who drop out of school have a higher likelihood of lower income, unemployment, arrest, drug use, and poorer health (Lansford et al., 2016; McFarland et al., 2018). Previous research has found that factors such as school engagement, excessive absenteeism, and grade retention were associated with an increased likelihood of students dropping out of school (Giano et al., 2021; Henry et al., 2012; Mireles-Rios et al., 2020; Wang & Fredricks, 2014). One factor that may contribute to poorer school engagement, excessive absenteeism, and grade retention is adverse childhood experiences (ACEs), which are categories of childhood maltreatment and household dysfunction with a dose-wise relationship with poorer outcomes (Felitti et al., 1998). Previous studies have found that children who experienced multiple ACEs are more likely to have low school engagement, miss more days of school, and repeat a grade (Bellis et al., 2018; Crouch et al., 2019; Hinojosa et al., 2019; Stempel et al., 2017; Suleiman et al., 2021). Since almost 50% of U.S. children have experienced an ACE, with over one in five experiencing multiple ACEs (Bethell et al., 2017), interventions are needed to mitigate the impact of ACEs on negative school-related outcomes such as low school engagement, excessive absenteeism, and grade retention given the increased likelihood of dropping out of school and subsequent negative long-term outcomes.

Previous resilience research has identified modifiable protective factors that help build resilience against childhood adversity. Consistent with previous resilience research, protective factors are context-dependent and work together to build resilience (Masten, 2018; Wright et al., 2013). While ACEs researchers have begun to adopt protective factors from previous resilience research (Hornor, 2017; Ortiz, 2019), studies have only begun to examine whether they specifically mitigate the impact of ACEs (Traub & Boynton-Jarrett, 2017). Further, few studies have examined how protective factors work together to mitigate ACEs. Nevertheless, three resilience frameworks have recently emerged in the literature that examine how protective factors work together to build resilience. Three promising resilience frameworks include the National Scientific Council on the Developing Child (NSCDC), Health Outcomes from Positive Experiences (HOPE), and Cumulative Positive Experiences (PCEs) frameworks (Bethell et al., 2019; NSCDC, 2015; Sege & Harper Browne, 2017). Despite the promise of these frameworks, each has a limited evidence base, with few studies considering school-related outcomes (Crouch et al., 2021; Robles et al., 2019) and no known studies comparing the effectiveness of these frameworks in mitigating ACEs.

Building upon previous research, this presentation will discuss the findings of a study conducted by the presenter and co-authors that examined the relationship between these three resilience frameworks and each of three school-related outcomes (school engagement, excessive absenteeism, and grade retention) among children who experienced ACEs. The study utilized secondary data analysis of data from the 2018 through 2020 National Survey for Children’s Health. The sample consisted of all children between ages 6 and 17 without missing information on the variables of interest, including covariates, for a given outcome. The sample sizes ranged from 65,548 to 65,772. Based on model comparison using hierarchical logistic regression, both the NSCDC and HOPE frameworks were associated with all three school-related outcomes among children who experienced ACEs, with the NSCDC framework having a stronger relationship across outcomes. The cumulative PCEs framework was either not practically or significantly associated with the three outcomes. The study also identified the protective factors from each framework that had the strongest association with each outcome. For school engagement, strong self-regulation, supportive caregiver relationships/sharing ideas, family resilience, mastery/extracurricular activities, a hopeful/affirming tradition, volunteerism, and a supportive neighborhood were the strongest protective factors across models. For excessive absenteeism, strong self-regulation, supportive caregiver relationships/sharing ideas, mastery/extracurricular activities, a hopeful/affirming tradition, family resilience, volunteerism, and living in a safe neighborhood were the strongest protective factors across models. Finally, for grade retention, strong self-regulation, mastery/extracurricular activities, and strong caregiver relationships/sharing ideas were the strongest protective factors.

Based on these outcomes, the presenter will discuss how schools, parents, and communities can leverage these findings to inform possible school and community-based interventions to promote these protective factors within the context of the NSCDC and HOPE frameworks. Specifically, the presenter will introduce the Gelberg-Andersen Model for Vulnerable Populations (GMVP) and how it can be utilized within schools and communities to identify strategies that target multiple protective factors identified in this study to build resilience to overcome ACEs (Gelberg et al., 2000). Then, the presenter will discuss how parents, schools, and communities can leverage the GMVP with the Centers for Disease Control and Prevention’s (2021) ACEs prevention strategy to prevent and respond to ACEs. The presenter will also discuss future research needed on resilience frameworks and protective factors to inform future ACEs interventions.

References

Bellis, M. A., Hughes, K., Ford, K., Hardcastle, K. A., Sharp, C. A., Wood, S., Homolova, L., & Davies, A. (2018). Adverse childhood experiences and sources of childhood resilience: A retrospective study of their combined relationships with child health and educational attendance. BMC Public Health, 18(1), 792. https://doi.org/10.1186/s12889-018-5699-8

Bethell, C. D., Davis, M. B., Gombojav, N., Stumbo, S., & Powers, K. (2017). A national and across-state profile on adverse childhood experiences among U.S. children and possibilities to heal and thrive. http://www.cahmi.org/wp-content/uploads/2018/05/aces_brief_final.pdf

Bethell, C. D., Jones, J., Gombojav, N., Linkenbach, J., & Sege, R. (2019). Positive childhood experiences and adult mental and relational health in a statewide sample: Associations across adverse childhood experiences levels. JAMA Pediatrics, e193007. https://doi.org/10.1001/jamapediatrics.2019.3007

Centers for Disease Control and Prevention (2021). Adverse childhood experiences prevention strategy. https://www.cdc.gov/injury/pdfs/priority/ACEs-Strategic-Plan_Final_508.pdf

Crouch, E., Radcliff, E., Hung, P., & Bennett, K. (2019). Challenges to school success and the role of adverse childhood experiences. Academic Pediatrics, 19(8), 899-907. https://doi.org/10.1016/j.acap.2019.08.006

Crouch, E., Radcliff, E., Merrell, M. A., Hung, P., & Bennett, K. J. (2021). Positive childhood experiences promote school success. Maternal and Child Health Journal, 25(10), 1646-1654. https://doi.org/10.1007/s10995-021-03206-3

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood experiences (ACE) study. American Journal of Preventive Medicine, 14(4), 245-258. https://doi.org/10.1016/s0749-3797(98)00017-8

Gelberg, L., Andersen, R. M., & Leake, B. D. (2000). The behavioral model for vulnerable populations: Application to medical care use and outcomes for homeless people. Health Services Research, 34(6), 1273-1302.

Giano, Z., Williams, A. L., & Becnel, J. N. (2021). Grade retention and school dropout: Comparing specific grade levels across childhood and early adolescence. The Journal of Early Adolescence, 42(1), 33-57. https://doi.org/10.1177/02724316211010332

Henry, K. L., Knight, K. E., & Thornberry, T. P. (2012). School disengagement as a predictor of dropout, delinquency, and problem substance use during adolescence and early adulthood. Journal of Youth and Adolescence, 41(2), 156-166. https://doi.org/10.1007/s10964-011-9665-3

Hinojosa, M. S., Hinojosa, R., Bright, M., & Nguyen, J. (2019). Adverse childhood experiences and grade retention in a national sample of US children. Sociological Inquiry, 89(3), 401-426. https://doi.org/10.1111/soin.12272

Hornor, G. (2017). Resilience. Journal of Pediatric Health Care, 31(3), 384-390. https://doi.org/10.1016/j.pedhc.2016.09.005

Lansford, J. E., Dodge, K. A., Pettit, G. S., & Bates, J. E. (2016). A public health perspective on school dropout and adult outcomes: A prospective study of risk and protective factors from age 5 to 27 years. Journal of Adolescent Health, 58(6), 652-658. https://doi.org/10.1016/j.jadohealth.2016.01.014

Masten, A. S. (2018). Resilience theory and research on children and families: Past, present, and promise. Journal of Family Theory & Review, 10(1), 12-31. https://doi.org/10.1111/jftr.12255

McFarland, J., Cui, J., Rathbun, A., & Holmes, J. (2018). Trends in high school dropout and completion rates in the United States: 2018. Compendium Report. NCES 2019-117. National Center for Education Statistics. https://nces.ed.gov/pubs2018/2018117.pdf

Mireles-Rios, R., Rios, V. M., & Reyes, A. (2020). Pushed out for missing school: The role of social disparities and school truancy in dropping out. Education Sciences, 10(4), 108. https://www.mdpi.com/2227-7102/10/4/108

National Scientific Council on the Developing Child. (2015). Supportive relationships and active skill-building strengthen the foundations of resilience. https://developingchild.harvard.edu/resources/supportive-relationships-and-active-skill-building-strengthen-the-foundations-of-resilience

Ortiz, R. (2019). Building resilience against the sequelae of adverse childhood experiences: Rise up, change your life, and reform health care. American Journal of Lifestyle Medicine, 13(5), 470-479. https://doi.org/10.1177/1559827619839997

Robles, A., Gjelsvik, A., Hirway, P., Vivier, P. M., & High, P. (2019). Adverse childhood experiences and protective factors with school engagement. Pediatrics, 144(2). https://doi.org/10.1542/peds.2018-2945

Sege, R. D., & Harper Browne, C. (2017). Responding to ACEs with HOPE: Health outcomes from positive experiences. Academic Pediatrics, 17(7S), S79-S85. https://doi.org/10.1016/j.acap.2017.03.007

Stempel, H., Cox-Martin, M., Bronsert, M., Dickinson, L. M., & Allison, M. A. (2017). Chronic school absenteeism and the role of adverse childhood experiences. Academic Pediatrics, 17(8), 837-843. https://doi.org/10.1016/j.acap.2017.09.013

Suleiman, A. O., Grasso, D. J., Hunter, A. A., Rosenheck, R. A., & Rhee, T. G. (2021). Association of adverse family experiences with school engagement and performance in US adolescents: Do behavioral health conditions mediate the relationship? Psychiatric Quarterly, 92(3), 1201-1215. https://doi.org/10.1007/s11126-021-09900-3

Traub, F., & Boynton-Jarrett, R. (2017). Modifiable resilience factors to childhood adversity for clinical pediatric practice. Pediatrics, 139(5), e20162569. https://doi.org/10.1542/peds.2016-2569

Wang, M.-T., & Fredricks, J. A. (2014). The reciprocal links between school engagement, youth problem behaviors, and school dropout during adolescence. Child Development, 85(2), 722-737. https://doi.org/10.1111/cdev.12138

Wright, M. O. D., Masten, A. S., & Narayan, A. J. (2013). Resilience processes in development: Four waves of research on positive adaptation in the context of adversity. In Handbook of resilience in children (pp. 15-37). Springer.

Learning Objective 1

Participants will be able to explain adverse childhood experiences (ACEs) and their relationship with school engagement, absenteeism, and grade retention.

Learning Objective 2

Participants will be able to identify at least three protective factors associated with school-related outcomes among children who have experienced ACEs.

Learning Objective 3

Participants will be able to identify at least two strategies that schools and communities can use to strengthen the protective factors associated with better school-related outcomes among children who have experienced ACEs.

Keyword Descriptors

Adverse Childhood Experiences, Protective Factors, Resilience Frameworks, Absenteeism, School Engagement, Grade Retention

Presentation Year

2024

Start Date

3-4-2024 9:45 AM

End Date

3-4-2024 10:15 AM

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Mar 4th, 9:45 AM Mar 4th, 10:15 AM

Identifying Protective Factors that Promote Better School-Related Outcomes Among Children Who Experienced ACEs

Experiencing multiple adverse childhood experiences (ACEs) has been associated with poorer school-related outcomes. However, modifiable protective factors can potentially build resilience against ACEs. Based on research conducted by the presenter and co-authors, the presentation describes the protective factors from three resilience frameworks associated with better school-related outcomes among children who have experienced ACEs and strategies that can potentially be adopted to target these factors.