Understanding How Resilience Frameworks Build Resilience Against Mental Health Issues 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 these 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.

Location

Session Four

Strand #1

Health: Mental & Physical Health

Strand #2

Home: Family & Community Engagement

Relevance

The presentation addresses two conference strands: health (mental and physical health) and home (family and community engagement). This presentation builds on the findings of a study that compared the relationship between three resilience frameworks and childhood mental health outcomes among children who experienced adverse childhood experiences. Thus, for the first strand, this study sought to identify the resilience framework and associated protective factors that had the strongest relationship with children not ever being diagnosed with depression, anxiety, ADHD, or behavioral/conduct problems. The implications are that schools, parents, and others who work with children can target these protective factors to build resilience against mental health issues associated with ACEs. For the second strand, the strongest protective factors across analyses were self-regulation, strong parent/caregiver relationships, mastery/after-school activities, and family resilience. Thus, the presentation will discuss how school-based and parent-focused interventions can target these protective factors to build resilience against childhood mental health issues among children who have experienced ACEs.

Brief Program Description

Exposure to multiple adverse childhood experiences (ACEs) is associated with poorer childhood mental health outcomes. Models and frameworks are needed to guide interventions to mitigate ACEs. This presentation presents research that compared three resilience frameworks. Based on the findings, the presenter will discuss the ACEs resilience frameworks and protective factors associated with better childhood mental health outcomes and strategies to target the strongest protective factors.

Summary

The presentation will present the results of secondary data analysis of the 2018-2020 National Survey for Children’s Health (NSCH) that compared the effectiveness of the National Scientific Council on the Developing Child (NSCDC), Health Outcomes from Positive Experiences (HOPE), and Cumulative Positive Childhood Experience (PCEs) frameworks at mitigating the impact of adverse childhood experience (ACEs) on childhood mental health outcomes. ACEs have a well-established relationship with childhood mental health issues including anxiety, depression, ADHD, and behavior/conduct issues. With approximately 21.7% of children in the U.S. experiencing multiple ACEs, this presents a serious public health issue. Nevertheless, researchers have only begun to examine resilience frameworks and protective factors that build resilience against ACEs, with no known studies comparing the effectiveness of these frameworks. This presentation will provide an overview of each of these resilience frameworks. Then, the presentation will describe the study results that found that both the NSCDC and HOPE frameworks were associated with a lower likelihood of childhood mental health issues before and after controlling for ACEs, with the NSCDC framework having a strong relationship with childhood mental health issues. Importantly, the study also found that the addition of a cumulative PCE score either did not statistically or practically improve the relationship between either framework and childhood mental health issues. The study also identified the protective factors from each framework that had the strongest relationships with a lower likelihood of childhood mental health issues among children who experienced ACEs. Based on these findings, the presenter will discuss how the NSCDC framework and associated protective factors could be leveraged by schools, parents, and other community organizations to build resilience against ACEs to improve mental health outcomes among children and adolescents. The presenter will also discuss future research needed to guide ACEs interventions.

Evidence

Based on analysis of the 2016 through 2019 National Survey for Children’s Health, approximately 9.8% of children between 3 and 17 years old had ADHD while 7.0% had behavioral/conduct problems, 3.4% currently had depression, and 9.4% had anxiety problems (Bitsko et al., 2022). Furthermore, the rates of anxiety and depression typically increase during adolescence (Ghandour et al., 2019). One factor associated with poorer childhood mental health outcomes is adverse childhood experiences (ACEs). Children who have experienced 4 or more ACEs are at increased risk for ADHD, behavioral issues, depression, and anxiety (Bomysoad & Francis, 2020; Elmore & Crouch, 2020). ACEs are categories of childhood maltreatment and household dysfunction that have a negative dose-wise relationship with multiple adult and child outcomes (Felitti et al., 1998; Hughes et al., 2017; Petruccelli et al., 2019). With approximately 46.3% of children experiencing at least one ACE and 21.7% of children experiencing multiple ACEs (Bethell et al., 2017), ACEs pose a threat to childhood mental health outcomes.

One promising approach to mitigating ACEs is to identify protective factors that build resilience against the negative impact of ACEs. Building on historic resilience research not specific to ACEs, researchers have identifying protective factors that may mitigate ACEs (Hornor, 2017; Ortiz, 2019). However, many of these protective factors have yet to be validated, specifically among children who have experienced ACEs (Traub & Boynton-Jarrett, 2017). Furthermore, historic resilience research has identified that resilience is context-dependent, and protective factors are best understood when considering how they work together to build resilience (Masten, 2018; Wright et al., 2013). Recently, ACEs and resilience researchers have begun to develop frameworks to explain how protective factors may work together to mitigate the impact of ACEs and toxic stress (Bethell et al., 2019; NSCDC, 2015; Sege & Harper Browne, 2017). Three of these frameworks identified in the literature are the National Scientific Council on the Developing Child (NSCDC) framework (NSCDC, 2015), Health Outcomes from Positive Experiences (HOPE) framework (Sege & Harper Browne, 2017), and Cumulative Positive Childhood Experiences (PCEs) framework (Bethell, Jones, et al., 2019). However, despite the promise of the frameworks, each framework has a limited evidence base with few studies examining the relationship between these frameworks and better outcomes, specifically among individuals who have experienced multiple ACEs; no known studies have compared the effectiveness of these frameworks.

Thus, the presenter will present the results of a research study conducted by the presenter and co-authors that compared the relationship between these resilience frameworks and childhood mental health issues (ADHD, behavioral issues, depression, and anxiety) among children who experienced ACEs. The research also identified which protective factors had the strongest relationship with childhood mental health issues. The study conducted model comparisons using hierarchical logistic regression on a sample of 65,072 children between 6 and 17 years old from the 2018-2020 National Survey for Children’s Health. The study found that the NSCDC and HOPE frameworks were both associated with childhood mental health outcomes after controlling for covariates and ACEs, while the cumulative PCE framework either did not statistically or practically improve either model across analyses. Furthermore, the NSCDC had a stronger relationship with childhood mental health outcomes than the HOPE framework. Several key individual protective factors from the NSCDC framework protective factors were significantly associated with better childhood mental health outcomes: strong self-regulation, supportive parent or caregiver relationships, a hopeful family tradition, and mastery. Strong self-regulation and a supportive parent/caregiver relationship had the strongest relationship with childhood mental health issues. This is consistent with a previous study that examined the relationship between the NSCDC framework and childhood mental health outcomes among children who experienced 4 or more ACEs (Keane & Evans, 2022). Building on these findings, the presenter will discuss strategies that schools, parents, and others can use to develop self-regulation (Murray et al., 2016; Murray et al., 2019; Zins & Elias, 2007) while also discussing strategies that can be used to promote positive parent/child relationships and other adult relationships throughout childhood (Centers for Disease Control and Prevention, 2013). The presenter will also describe future directions for research related to resilience frameworks and protective factors among individuals who have experienced ACEs.

References

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

Bitsko, R. H., Claussen, A. H., Lichstein, J., Black, L. I., Jones, S. E., Danielson, M. L., Hoenig, J. M., Davis Jack, S. P., Brody, D. J., Gyawali, S., Maenner, M. J., Warner, M., Holland, K. M., Perou, R., Crosby, A. E., Blumberg, S. J., Avenevoli, S., Kaminski, J. W., Ghandour, R. M., & Contributor (2022). Mental health surveillance among children - United States, 2013-2019. MMWR Supplements, 71(2), 1–42. https://doi.org/10.15585/mmwr.su7102a1

Bomysoad, R. N., & Francis, L. A. (2020). Adverse childhood experiences and mental health conditions among adolescents. Journal of Adolescent Health, 67(6), 868-870. https://doi.org/10.1016/j.jadohealth.2020.04.013

Centers for Disease Control and Prevention. (2013). Essentials for childhood: Creating safe, stable, nurturing relationships and environment for all children. https://www.cdc.gov/violenceprevention/pdf/essentials-for-childhood-framework508.pdf

Elmore, A. L., & Crouch, E. (2020). The association of adverse childhood experiences with anxiety and depression for children and youth, 8 to 17 years of age. Academic Pediatrics, 20(5), 600-608. https://doi.org/10.1016/j.acap.2020.02.012

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

Ghandour, R. M., Sherman, L. J., Vladutiu, C. J., Ali, M. M., Lynch, S. E., Bitsko, R. H., & Blumberg, S. J. (2019). Prevalence and treatment of depression, anxiety, and conduct problems in US children. The Journal of Pediatrics, 206, 256–267.e3. https://doi.org/10.1016/j.jpeds.2018.09.021

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

Hughes, K., Bellis, M. A., Hardcastle, K. A., Sethi, D., Butchart, A., Mikton, C., Jones, L., & Dunne, M. P. (2017). The effect of multiple adverse childhood experiences on health: A systematic review and meta-analysis. The Lancet Public Health, 2(8), e356-e366. https://doi.org/10.1016/s2468-2667(17)30118-4

Keane, K., & Evans, R. (2022). Exploring the relationship between modifiable protective factors and mental health issues among children experiencing adverse childhood experiences using a resilience framework. Journal of Child & Adolescent Trauma, 15, 987-998. https://doi.org/10.1007/s40653-022-00471-4

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

Murray, D. W., Rosanbalm, K., & Christopoulos, C. (2016). Self-regulation and toxic stress report 3: A comprehensive review of self-regulation interventions from birth through young adulthood. (OPRE Report #2016-34). R. A. E. Office of Planning, Administration for Children and Families, U.S. Department of Health and Human Services. https://www.acf.hhs.gov/sites/default/files/documents/acf_report_3_approved_fromword_b508_0.pdf

Murray, D. W., Rosanbalm, K., Christopoulos, C., & Meyer, A. L. (2019). An applied contextual model for promoting self-regulation enactment across development: Implications for prevention, public health and future research. The Journal of Primary Prevention, 40(4), 367-403. https://doi.org/10.1007/s10935-019-00556-1

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

Petruccelli, K., Davis, J., & Berman, T. (2019). Adverse childhood experiences and associated health outcomes: A systematic review and meta-analysis. Child Abuse & Neglect, 97, 104127. https://doi.org/10.1016/j.chiabu.2019.104127

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

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

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.

Zins, J. E., & Elias, M. J. (2007). Social and emotional learning: Promoting the development of all students. Journal of Educational and Psychological Consultation, 17(2-3), 233-255. https://doi.org/10.1080/10474410701413152

Learning Objective 1

Participants will be able to explain adverse childhood experiences and how they are related to childhood mental health outcomes.

Learning Objective 2

Participants will be able to describe the National Scientific Council on the Developing Child (NSCDC), Health Outcomes from Positive Experiences (HOPE), and Cumulative Positive Childhood Experiences (PCEs) frameworks.

Learning Objective 3

Participants will be able to identify the protective factors with the strongest relationship with childhood mental health outcomes and at least one strategy that can be used to promote each.

Keyword Descriptors

Resilience Frameworks, Adverse Childhood Experiences, Childhood Mental Health, Protective Factors, Self-Regulation, Parent-Child Relationships

Presentation Year

2024

Start Date

3-5-2024 8:30 AM

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Mar 5th, 8:30 AM

Understanding How Resilience Frameworks Build Resilience Against Mental Health Issues Among Children Who Experienced ACEs

Session Four

Exposure to multiple adverse childhood experiences (ACEs) is associated with poorer childhood mental health outcomes. Models and frameworks are needed to guide interventions to mitigate ACEs. This presentation presents research that compared three resilience frameworks. Based on the findings, the presenter will discuss the ACEs resilience frameworks and protective factors associated with better childhood mental health outcomes and strategies to target the strongest protective factors.