Introduction: Homelessness is a living condition associated with a number of adverse health outcomes. Unaccompanied homeless youth are at risk for many of the same health outcomes as other homeless persons, but these youth are especially vulnerable because they are young and without the protection or support of an adult caregiver. Aim: The purpose of this capstone project is to present a basic overview of the topic as well as to highlight what more needs to be done to address this issue. Methods: This project involved a review of the literature related to homeless youth, child sexual or physical abuse, and mental health issues associated abused and/or homeless youth, focusing on United States information, for the years 1995 to present. Discussion: to discuss current prevention and intervention efforts, and to discuss needs for future research and intervention

ABSTRACT INTRODUCTION: Studies on the topic of adverse childhood experiences (ACEs) and childhood obesity collectively indicate an association, but there is a lack of replication in nationally representative sample of children aged 10-17 years. This study aims to expand on the definition of ACEs to include: socio-economic hardship, racial discrimination, witness or victim of neighborhood violence, and bereavement, and to examine their individual and joint association with BMI levels, especially childhood obesity (primary outcome). METHODS: The 2011-2012 National of Children’s Health (NSCH) was used for this study (N=45,309). One child interview weight was produced; hence, the estimates are generalized to all non-institutionalized children 10-17 years of age in the US and each state. Statistical methods used included descriptive statistics and multivariable multinomial logistic regression models. ACEs examined included: (1) Socioeconomic hardship, (2) Parental divorce or separation, (3) Bereavement, (4) Incarcerated family member, (5) Witness to domestic violence, (6) Victim/witness of neighborhood violence, (7) Household mental illness, (8) Household substance abuse, (9) Racial discrimination. BMI for the same sex and age (10-17 years) percentile relative measurement, using growth charts recommended by CDC, among children and teens were used as indicators of BMI. BMI-95th percentile or greater was considered obese. RESULTS: The prevalence of childhood obesity and ACE exposure was higher for boys compared to girls. Controlling for gender, among those who were obese, White-non-Hispanic children had the highest prevalence of obesity compared to other races for both genders. Southern States constituted 80% and 60 % of top 10 states with the highest prevalence of childhood obesity and ACE, respectively. Approximately 25.4 million (89.5%) children aged 10-17 years had experienced 3 or less ACE. The most prevalent ACE category of nine asked about for child was-living with parents who were either divorced or separated after his/her birth (26.77%) and the least prevalent was living with a parent who died (4.84 %). ACEs were not mutually exclusive, and all nine categories of ACEs were interrelated. The adjusted odds ratio of covariates to their reference groups that were only statistically significant for childhood obesity relative to healthy weight encompassed: a) Place of residence in metropolitan statistical area, b) two or more chronic health conditions of 18 asked about, c) Watching TV, videos, or playing video games across categories >1 to≥4 hours, d) family members in the household eat a meal together 7 days of the week, e) and computer, cell phone or electronic device use ≤1 hour. Moreover, the explanatory variables, namely, age, sex, the physical health status of parents, and physical activity, were strongly related to childhood obesity (associated both with higher odds and lower odds of outcome) compared to overweight and underweight BMI categories. CONCLUSIONS: This is the first study to explore the co-occurrence, individual and joint association of ACEs with childhood obesity using nationally representative sample of children aged10-17 years in the U.S. Having childhood obesity, BMI-95th percentile or above was strongly related to ACE dichotomy, ACE score ≥2 and two ACE types (socioeconomic hardship and bereavement) than the probability of overweight, BMI-85th to 94th percentile. Underweight-BMI less than 5th percentile had only statistically significant association with socioeconomic hardship ACE category. Sociodemographic, parental, and childhood related factors were also independently associated with childhood obesity.

Childhood sexual abuse (CSA) has been linked to a number of adverse effects in adulthood including higher levels of depression, shame, guilt, self-blame, somatic concerns, anxiety, dissociation, repression, denial, relationship problems, and sexual problems. Little is known, however, about the influence CSA has on parenting, specifically among African American mothers, as previous researchers have primarily focused on the trauma experienced by survivors. Examining the impact of CSA on African American mothers' parenting is important as those children of survivors will often also experience the impact of the long-term sequelae associated with CSA. Guided by womanist theory, the purpose of this hermeneutic phenomenological qualitative inquiry was to explore the lived experiences in relation to parenting of African American mothers who survived CSA. Experiential anecdotes of data collected from interviews with 7 participants were hand coded for emergent themes; analysis generated 4 essential themes and 10 subthemes of experience. Themes included impact of abuse, bonding, efforts to protect, spirituality, and desires. This study's implications for positive social change include contributing to the knowledge base about the process of parenting experienced by African American female survivors of CSA. Findings may add insight shedding light on cultural nuances in parenting and coping with trauma and inform culturally-competent practice. Using study findings, mental health providers may be able to develop tailored treatment interventions and better support services for the prevention of adverse long-term effects of CSA in African American women.

Bakgrund: Elever upplever traumatiska barndomsupplevelser (TBU) som påverkar förmågan att hantera livet som barn och vuxen. Det är angeläget att upptäcka och identifiera elever med TBU eftersom de har rätt till skydd, rehabilitering och social återanpassning. Uppgiften är central i skolsköterskans hälsofrämjande roll. Syfte: Undersöka hur skolsköterskor arbetar med att upptäcka och identifiera traumatiska barndomsupplevelser hos elever. Metod: En retrospektiv enkätstudie användes och 100 skolsköterskor lämnade sina svar mellan 20 februari och 21 mars. Nästan alla hade specialistsjuksköterskeutbildning. Resultat: Frågor om TBU ställdes av 66 % och 34 % gjorde det inte. Majoriteten frågade muntligt. Frågan om TBU fanns i skolans hälsoenkät hos 38 % och en använde validerade formulär för att upptäcka och identifiera TBU. Av samtliga respondenter ville 78 % lära sig använda Barnafrids validerade formulär för att upptäcka och identifiera TBU. Konklusion: Många frågar om TBU men en tredjedel gör det inte. Mindre än hälften hade frågor i skolans hälsoenkät. Få kände till att validerade formulär kunde hjälpa till i arbetet med TBU och användes av en. Skolsköterskor, vårdgivare, lärosäten och forskare kan tillsammans utveckla systematisk screening av TBU. Det främjar elevers hälsa, välbefinnande och möjlighet att nå utbildningens mål. / Background: Students experience adverse childhood experiences (ACE) that affect the ability to cope with life as a child and as an adult. It's important to detect and identify ACE because students have the right to protection, rehabilitation and social reintegration. This task is central for school nurse’s health promoting role.  Aim: To investigate how school nurses’ work to detect and identify ACE in students.  Method: A retrospective survey study was used and 100 school nurses provided their responses between 20 February and 21 March. Almost all had specialist nursing training.  Findings: Questions about ACE were asked by 66% and 34% did not. A majority asked verbally. ACE questions was present in 38 % of the school health questionnaire. One used validated form and of all 78% wanted to learn how to use validated form to detect and identify ACE.  Conclusion: School nurses ask about ACE but a third do not. Less than half had questions in the school health questionnaire and few knew that validated forms could help in the work with ACE. School nurses, healthcare providers, universities and researchers can together develop systematic screening for ACE. It promotes students' health, wellbeing and the opportunity to reach the goals of the education.

Trauma-informed care is a relatively new construct in K-12 education, and districts across the United States are seeking avenues to meet the needs of their students. The COVID-19 pandemic elevated the need for districts to develop appropriate supports to address student and adult trauma. Traumatic events can affect a child’s mental, physical, social-emotional, and/or spiritual well-being (Substance Abuse and Mental Health Service Administration, 2011). Furthermore, children with an elevated risk of trauma may not be able to access these supports outside of the school setting (Baweja et al., 2015). Therefore, educational systems need to develop trauma-informed care models for schools that furnish a sense of safety and community so that students receive the necessary support. This evaluation aimed to identify how the moderating factors of district administrators, site administrators, climate and culture, and teacher capacity affect trauma-informed care via a multi-tiered system of support (MTSS) framework. It included a specific focus on Tier 1, universal access, to improve timely support for students. This formative program evaluation explored the impact of the moderating factors through the viewpoint of a newly created conceptual framework. I used qualitative and quantitative data sources to explore the multiple aspects of the phenomenon. The ARTIC-45 provided descriptive statistics about educators’ attitudes toward trauma-informed care. The observational data and analysis of the Panorama Education social-emotional learning (SEL) survey that assessed 3rd-12th students social-emotional well-being provided character to the evaluation. The data analysis yielded inconsistent results. The observational data strongly indicated a trauma-informed environment in which students were given clear expectations and engaged in positive reciprocal interactions with peers and adults. The ARTIC-45 data showed that administrators, teachers, and support staff responded favorably to trauma-informed care approaches. Though statistical significance could not be obtained due to the sample size constraint of being too small, the data provided context to the other data sources. For example, teacher capacity could not be quantified, but the data provided context to the overall staff capacity. The review of the archival and current SEL survey data showed that favorability among domains varied by site and grade level. The variations in students' social-emotional favorability can be related to their lived experiences and it is important to track over time to monitor how experiences, expressions, and feelings change over time. Students' perspectives regarding themselves and their environment differed from the observational data. This indicates that educators should not solely rely on observational data to determine students’ social-emotional well-being. Furthermore, an SEL survey can be used as a tool to understand students’ well-being and thus provide them with timely support. The evaluation determined that district administration, site administration, climate and culture and staff capacity can positively impact a multi-tiered, trauma-informed care environment. In these settings, student behavior and social-emotional well-being is viewed in a healing-centered manner. Districts can create a multi-tiered, trauma-sensitive culture and provide support to enhance teachers’ capacity to implement trauma-informed care, take advantage of administrative influence, develop community partnerships, and create a culture that is open to systematic change.

SAMMANFATTNING  Bakgrund: Adverse Childhood Experience (ACE) nämns som svåra/traumatiska barndomsupplevelser och inkluderar barns utsatthet för fysiska, psykiska- och sexuella övergrepp, försummelse och dysfunktion i hemmet. Det inkluderar psykisk ohälsa, missbruk, självmord, våld mot modern samt kriminell verksamhet inom familjen. Även om det finns lagar och förordningar som skyddar barn från övergrepp och försummelse, är barnmisshandel fortfarande en vanlig företeelse.  Syftet med denna litteraturöversikt var att utforska vuxnas upplevelser av att ha blivit utsatta för negativa och traumatiska händelser som barn och hur det har påverkat dem samt hur de valt att hantera effekterna. .  Metod: En litteraturöversikt med en deskriptiv design som inkluderade tio kvalitativa originalartiklar som granskades.    Resultat: Resultatet av granskningen presenteras utifrån fem huvudteman; Det sexuella utnyttjandet, substanssyndromets utveckling och inflytande, psykiska och fysiska konsekvenser samt copingmekanismer. Fyra underteman; relationer, tillitsproblem samt negativa- och positiva upplevelser av professionell hjälp. Det visade att majoriteten av deltagarna upplevde en mängd olika psykiska och fysiska konsekvenser genom hela livet. Upplevelserna skadade inte bara dem själva utan även människor i deras omgivning då svårigheter att skapa anknytning, tillit och nära relationer var återkommande. Många använde sig av både passiva och aktiva copingstrategier. Slutsats: Det blev tydligt hur den psykiska och fysiska ohälsan var ett faktum för dessa individer genom hela livet. Genom en tidig upptäck av barnmisshandel samt ett erhållande av kunskap hos sjuksköterskan kring bemötandet av dessa individer i vuxen ålder, kan en del konsekvenser minskas och där med påverka livskvalitén för dessa individer på ett positivt sätt. Nyckelord: Barnmisshandel, negativa/traumatiska händelser som barn, psykisk ohälsa, upplevelser, anknytning / ABSTRACT  Background: Adverse Childhood Experience (ACE) is mentioned as difficult/traumatic childhood experiences and includes children's exposure to physical, psychological and sexual abuse, neglect and dysfunction in the home which includes mental illness, substance abuse, suicide, violence against the mother and criminal activities within the family. Although there are laws and regulations that protect children from abuse and neglect, child abuse is still a common occurrence. Aim: The purpose of this literature review was to explore adults' experiences of being exposed to negative and traumatic events as children, how it has affected them and how they chose to handle the effects.  Method: A literature review with a descriptive design which included ten qualitative original articles.  Results: The results are presented based on five main themes; sexual exploitation, substance syndrome development and influence, psychological and physical consequences and coping mechanisms. Four sub-themes; relationships, trust problems and negative and positive experiences of professional help. The results further showed that the majority of participants experienced a variety of psychological and physical consequences throughout their lives. The experiences not only damaged themselves but also people in their surroundings. Difficulties in creating attachment, trust and close relationships, which was recurring throughout their lives. Many used both passive and active coping strategies.   Conclusion: It became clear how their mental and physical health became affected throughout their lives. Through an early detection of child abuse and the acquisition of knowledge by the nurse regarding the treatment of these individuals in adulthood, some consequences can be reduced and thereby affect the quality of life for these individuals in a positive way. Keywords: Child abuse, Adverse childhood experience, mental illness, experience, Attachment

Au cours des trois dernières décennies, plusieurs modèles théoriques de l’homicide sexuel ont été proposés. Ces modèles ont suggéré qu’il existe une diversité de facteurs associés à la commission d’un ou de plusieurs homicides sexuels, notamment des facteurs développementaux, psychologiques et de l’événement criminel et ont permis de proposer un profil des individus ayant commis un homicide sexuel. Cependant, aucun de ces profils n’a intégré l’ensemble de ces facteurs en un tout cohérent. De plus, ces modèles et profils, à l’exception du modèle proposé par des chercheurs associés au Federal Bureau of Investigation, ont été réalisés à partir d’échantillons d’individus ayant commis un seul homicide sexuel. En conséquence, bien que ces modèles et profils proposent une explication de l’émergence de ces comportements, ils ne permettent pas d’expliquer dans quelles circonstances ceux-ci se répètent et prennent fin. Étant donné que ces modèles et profils n’ont pas pris en considération les caractéristiques du parcours de vie de l’individu après la commission du premier homicide sexuel, ceux-ci n’intègrent pas de paramètres post-homicides, tels que les paramètres de l’enquête criminelle. En conséquence, il existe actuellement peu de certitudes concernant les caractéristiques du profil des individus pouvant constituer des facteurs permettant potentiellement d’expliquer pourquoi certains individus commettront une série d’homicides sexuels tandis que d’autres n’en commettront qu’un. L’objectif principal de cette thèse est d’identifier les caractéristiques distinctives des individus ayant commis une série d’homicides sexuels, afin de proposer des profils d’individus sériels et non-sériels. Afin d’atteindre cet objectif, une série d’études comparatives entre des individus ayant commis des homicides sexuels en série (HSS; n = 33) et des individus ayant commis un seul homicide sexuel (HS; n = 87) ont été réalisées. Les résultats de cette étude mettent en évidence que les caractéristiques qui distinguent les sériels des non-sériels ne se limitent pas à des facteurs individuels ou à la façon dont les individus commettent leur crime, mais aussi à l’échec des intervenants de l’enquête criminelle à appliquer les pratiques considérées comme étant indispensables à la résolution rapide d’un homicide. D’autre part, les résultats de cette étude mettent en évidence qu’il existe deux principaux profils d’individus ayant commis un homicide sexuel, celui des HSS et celle des HS. Finalement, les résultats de cette étude ont servi de fondations au développement d’un modèle conceptuel théorique de l’homicide sexuel sériel et non-sériel qui permet d’expliquer dans quelles circonstances le phénomène semblerait émerger, se répéter et prendre fin. / Over the last three decades, many theoretical models of sexual homicide have been proposed, which have made it possible to propose a profile of individuals. Although these models and profiles have suggested associations between the commission of one or more sexual homicides and a wide variety of factors—notably developmental, psychological, and crime-phase—none has produced a unified vision of sexual homicide that takes into account all factors. Moreover, these models and profiles, with the exception of that of the US Federal Bureau of Investigation, have been based on samples of individuals having committed a single homicide. As a result, although they propose explanations of the emergence of sexual homicide, current models and profiles are silent on the determinants of its repetition and cessation. Additionally, these models and profiles do not address post-homicide parameters, such as those related to the criminal investigation, since they do not take into account the sexual murderer’s life course following the commission of the homicide. For all these reasons, considerable uncertainty remains about why some individuals commit a series of sexual homicides while others commit only one. The principal objective of this thesis’s research was therefore to identify the distinctive characteristics of individuals having committed a series of sexual homicides, in order to proposed profiled of serial and nonserial sexual murderers. To this end, comparative analyses of serial sexual murderers (HSSs; n = 33) and nonserial sexual murderers (HSs n = 87) were conducted. The results indicate that the two groups of participants in this sample can be distinguished not only on individual factors and the manner in which the homicide was committed, but also on the failure of criminal investigators to apply best practices and rapidly resolve the homicides. Finally, this thesis’ research establishes a foundation for the development of theoretical models of serial and nonserial sexual homicide that explain the circumstances responsible for the emergence, repetition, and cessation of this phenomenon.