Adverse Childhood Experiences (ACEs) exhibit a strong influence on later functioning in adolescence and adulthood, including impacts on physical and mental health, as well as behavioral and risk-related outcomes. Youth who have engaged in sexually abusive behaviors experience ACEs and negative outcomes at significantly elevated rates. The current study evaluates the relationship between ACEs and the youth’s own behavior and onset and length out-of-home placements, including family- or home-based, residential, and correctional placements. Data for this study consisted of archival records that were collected from a nonprofit inpatient treatment facility for adolescents who had engaged in sexually abusive behavior. The sample included 290 males and 5 females between the ages of 10 and 17 years of age (M = 14.8, SD = 1.56). Descriptive frequencies, correlational analyses, and linear regression analyses were performed to examine hypothesized relationships. Differing predictors emerged for initial onset and length of out-of-home placement types, with ACEs as stronger predictors of family-based placements, and the youths’ own aggressive and problematic sexual behaviors more predictive of onset and length of residential and correctional placements. Implications for prevention and treatment are discussed.

In this mixed methods dissertation study, I used design-based research (DBR; Brown, 1992; Cobb et al., 2003; The Design-Based Research Collective, 2003) to develop and refine a Tier 1 professional development (PD) intervention in trauma-informed teaching practices. This intervention was implemented with all full-time educators at one school and focused on Tier 1 practices to be implemented for and applicable to all students. I engaged in ongoing collaboration with educators at Oakdale Elementary School, a suburban Massachusetts school, to study and refine this intervention. I conducted ongoing qualitative and quantitative data collection and analysis, which informed both the intervention design and study of process and outcomes. This study investigated how and why the intervention evolved over time, the acceptability of the intervention, shifts in thinking and teaching practices, and how those shifts were facilitated. Over the course of implementation, 10 collaborative design decisions were made to create an intervention that addressed the needs and desires of Oakdale’s educators as well as the structural affordances and constraints of PD implementation at Oakdale. The intervention contained three after-school PD trainings: (1) Secondary Traumatic Stress and Self-Care, (2) Trauma 101: Supporting Students who Have Experienced Trauma, and (3) Educational Impacts of the Opioid Epidemic. Educators rated the intervention favorably: 88% of year-end survey participants were very satisfied with the trainings and 94% felt that the trainings would be very useful in other schools. In addition, Oakdale’s educators reported shifts in their thinking (e.g., increased empathy) and teaching practices (e.g., enacting proactive strategies) that they attributed to the trainings. Finally, based on the data collected in this study, I developed a theoretical model of how to support educators’ learning and implementation of trauma-informed teaching practices. This theoretical model identifies contextual, relational, and procedural elements of the intervention that participants reported to facilitate learning. This model can be tested in future studies of trauma-informed teaching PD and, if substantiated, used to guide additional intervention design. Implications for policy and practice are discussed. / 2023-05-13T00:00:00Z

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Abstract available through the Annals of Behavioral Medicine.

Adverse Childhood Experiences (ACEs) exhibit a strong influence on later functioning in adolescence and adulthood, including impacts on physical and mental health, as well as behavioral and risk-related outcomes. A dose-response effect is evident, in that as the number of ACEs increase, the likelihood of detrimental outcomes similarly rises. Important outcomes associated with increased ACEs include: physical health problems like cancer or heart disease, risky sexual behaviors, diagnosis of a trauma-related disorder, and criminality (Felitti et al., 1998; Espleta et al., 2018; Lew & Xian, 2019; Ramakrishnan et al. 2019; Van Niel et al., 2014). More recently, the exploration of the impact of ACEs has demonstrated differential accumulated risk in offender populations, with ACEs that are more prevalent and a more intensified dose-response relationship between ACEs and outcomes associated with sexual offending and other violent behaviors (Harlow, 1999; Levenson, Willis, & Prescott, 2014; Baglivio et al., 2014; Stinson, Quinn, & Levenson, 2016). One such population evidencing increased risk are youth who have engaged in sexually abusive behaviors. These youth have experienced ACEs at higher rates than other typical youth in the community, or those involved in the justice system (Baglivio & Epps, 2016; Levenson, Willis, & Prescott, 2016), resulting in them being categorized as high-risk. Predictors like out-of-home placements have been linked to an earlier onset of aggression and sexually abusive behaviors (Hall, Stinson, & Moser, 2017). Conversely, ACEs and the youth’s own behavior are two important factors to consider when evaluating the timing and persistence of an out-of-home placement. The current study evaluates the temporal relationship between two main factors (specific ACEs and the youth’s own behavior) and out-of-home placements. We also plan to examine the relationship between these two factors and the persistence of specific placements. Data for this study consisted of archival records that were collected from a nonprofit inpatient treatment facility for adolescents who had engaged in sexually abusive behavior. The sample was comprised of 290 males and 5 females between the ages of 10 and 17 years of age (M = 14.8, SD = 1.56). The mean age was 14.8 years at time of first admission (SD = 1.56; range: 10-17 years). The sample was minimally diverse with regard to ethnicity: 83.1% Caucasian, 9.5% African American, 0.7% Hispanic, 4.4% mixed race, and 2.4% unspecified. The majority of participants were referred by the state’s Division of Children’s Services (68%), while others were referred by court representatives (20%), parents/guardians (3%), mental health providers (4%), insurance representatives (0.7%), or others (0.3%). These referrals were often used as an alternative to formal legal sanctioning (i.e., court diversion). Prior to admission, the majority of participants were residing in either a family member’s home (40.3%), residential care (78.3%) and/or foster care (48.4%), though others came from group homes (37.3%), inpatient care (36.9%), and/or a friend’s home (4.4%). The majority had only one admission to the current facility (89.5%), while approximately 10% had two or more admissions. It is expected that physical and sexual abuse will be the most significant predictors for placements like juvenile detention centers and residential treatment facilities. It is also expected that ACEs will prompt more immediate but also longer out-of-home placement decisions resulting from the youth’s own behavior. This study is for an honors thesis and has a completion deadline set for next month. For this reason, statistical analyses are still underway. Results and implications for this research will be discussed.

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Exposure to more types of Adverse Childhood Experiences (ACEs) has been associated with a greater likelihood of general and sexual offending behaviors. However, few studies exist that consider both the impact of varied ACE exposures and community correlates on pathways to offending behaviors in adolescents who have engaged in sexually abusive behaviors. The current study examined these pathways using data collected from archival records of male adolescents (N= 285) who had received treatment for sexually abusive behavior at a youth facility. Structural equation modeling revealed a three-factor model for ACEs, which included: nonsexual abuse and neglect; household dysfunction; and sexual abuse and more passive indicators of sexual boundary problems in the home of origin. Direction and significance of paths between ACEs and the onset, persistence, and nature of maladaptive behaviors differed. Household dysfunction was related to an earlier onset and more persistent nonsexual delinquent offending and contact sexual offending. Conversely, sexual abuse and exposure to sexual boundary problems were associated with an earlier onset of sexually abusive behavior as well as indicators of adolescent-onset, less persistent, and nonviolent delinquency. Nonsexual abuse and neglect were uniquely associated with contact sexual offending. Thus, these findings suggest variations in ACE exposures differentially influence the development, severity, and continuance of nonsexual delinquent and sexually abusive behaviors among these youths. Socioecological variables associated with participants’ counties of origin, including social and economic environment and percentage of rurality, were not retained as covariates due to producing a poor model fit for the data. Additional study with regard to the role of community characteristics on delinquent and sexual offending behaviors is warranted.

Twenty years ago, a seminal study on adverse childhood experiences (ACEs) and subsequent increased health risks catapulted ACEs into the zeitgeist of research and application. Though a validated construct, the questionnaire, particularly the child sexual abuse (CSA) item is not without limitation and yet is used by the Centers for Disease Control and state agencies to quantify need and allocate resources to services accordingly. Currently, CSA is counted only when the perpetrator is 5-years or older than the victim. This requirement makes neglect of sibling and peer assault very likely. Accordingly, this study aimed to assess whether individuals with CSA experiences within an age gap smaller than 5 years are missed by the 5-year modifier embedded in CSA assessment wording and whether this missed group would otherwise qualify for services if detected. The study also aimed to assess whether this missed group has equivalently poor health outcomes to CSA groups currently captured by the 5-year modifier and whether outcomes for all CSA groups were higher than those who did not have a CSA history. An international sample of 974 women aged 18 to 50 completed an online survey hosted by Reddit regarding their substance use, multiple domains of current health, and CSA history using the original ACEs questionnaire and an experimental version of the CSA item without the 5-year modifier. All statistical analyses were completed in R. Results indicated there was a group of survivors with CSA experiences missed by the 5-year modifier and this had implications for reducing their total ACE scores. This group was nearly equal in size to CSA groups captured by the 5-year modifier and demonstrated equivalently poor health and substance use outcomes. On nearly all variables, CSA groups demonstrated poorer health outcomes than those who had never experienced CSA. These findings suggest the language of how CSA is assessed must be thoughtfully revised to include all CSA experiences as all are equally at risk for adverse outcomes and thus all warrant consideration for services currently afforded those with CSA histories and high ACE scores.