The therapeutic alliance is a core element of successful treatment in therapy. Recent literature has explored variables that predict the alliance at various time points during therapy, but few studies have explored how the alliance develops over time and the factors that influence its rate of change. The current study addresses these questions by estimating latent growth-curve models to analyze how male and female partners' alliance scores develop over time and how adverse childhood experiences (ACEs) impact the development of the alliance during the first six sessions of therapy. Results from these analyses show that neither men nor women's ACEs had a significant effect on the rate of change in the alliance. A discussion of the attachment implications of these findings, as well as the limitations of this study and potential directions for future research are then presented.

Background: A 1998 seminal study catapulted adverse childhood experiences (ACEs) into the zeitgeist and shaped assessment of these experiences and long-term health consequences via The ACEs Study Questionnaire (ACE-SQ). However, the ACE-SQ's childhood sexual abuse (CSA) item requires the perpetrator have been 5-years or older than the survivor for endorsement. This may not adequately capture CSA and limit the questionnaire's ability to detect survivors. Objective: This study assessed whether CSA survivors were missed by this 5-year modifier, whether service access was restricted, and whether those missed were at elevated risk for adverse outcomes. Participants and setting: A sample of 974 women (M age = 30.46) completed an online survey. Methods: Histories of CSA were assessed using the original ACE-SQ and an alternative version without the 5-year modifier. Participants were grouped by endorsement (Modifier, No Modifier, No CSA) and compared across numerous physical and mental health outcomes using MANOVA, ANOVA, and logistic regression. Results: Numerous CSA survivors are presently missed by the 5-year modifier (n = 118 of N = 249). This group demonstrated the same elevated depression (t = 3.44, p = .002, d = 0.34), heightened somatic symptom burden (t = 3.34, p = .003, d = 0.35), and poorer subjective health (t = -2.86, p = .012, d = 0.27) as those captured by the modifier. Conclusions: Recommendations for research, practice, and policy include removing the 5-year modifier from CSA assessment, creating an empirically informed CSA definition, and eliminating or adjusting requisite cut-scores for accessing services.

Offenders and persons with serious mental illness experience disproportionate exposure to Adverse Childhood Experiences (ACEs). This study examines prevalence, distribution, and correlates of ACEs in 182 male and female forensic psychiatric inpatients in secure care. Descriptive statistics, chi-squares analysis, ANOVA, and logistic regression were used to describe ACEs by race and gender and to identify associations between ACEs and onset of aggression, arrest, and psychiatric hospitalization. Participants evidenced significant exposure to ACEs, with significant differences by race and gender. ACE score, race, and foster care or investigations of child abuse were significant predictors of outcomes related to aggression and criminality.

Introduction: A culturally competent survey currently does not exist to characterize the burden of Adverse Childhood Experiences (ACEs) among a HIV/AIDS population receiving care at a local Center of Excellence (COE). Methods: A qualitative study was conducted including 11 interviews involving opinions on national surveillance questions to develop a culturally competent survey. Purposive sampling, reactive probing, and analysis of transcribed interviews were completed using structured coding to determine which questions were kept, modified, or removed in the final survey. Results: The final 55-question survey contained more generalized ACE questions, topics pertaining to barriers to HIV care, and a list that patients could select from to indicate what they need to improve their HIV care. Conclusion: The final survey provided the opportunity to characterize the burden of ACEs at a COE. Future directions involve piloting the survey as a quality improvement tool with the goal of increasing retention rates through more individualized HIV care.

Adverse Childhood Experiences (ACEs) such as exposure to abuse, dysfunction, and neglect have been shown to affect adult health outcomes. The Behavioral Risk Factor Surveillance System (BRFSS) captures national data on risk factors and chronic disease and first included ACE items in 2009. The purpose of this study was to determine whether specific ACEs predicted depressive disorders or poor general health in adulthood. ACEs included: living with someone who suffered from a mental illness, and primary exposure (physical abuse) and secondary exposure (interpersonal violence in home) to violence. BRFSS data from 2009- 2012 were included. Analyses were performed using SPSS and SAS. Descriptive statistics were completed for ACEs, race, gender, history of depressive disorder (DD), and general health status (GH). Logistic regression analyses were conducted to predict DD and GH, controlling for race, gender, and age. Odds ratios (OR) and 95% confidence intervals (CI) were reported. A total of 1,148 individuals were including in the analyses, with 31.4% having DD, 26.9% reported poor GH, 27.4% lived with someone who had a mental illness, 31.3% exposed to primary violence, and 30.2% exposed to secondary violence. Individuals who lived with someone who suffered from a mental illness were three times more likely to have DD (OR 3.28, CI 2.40-4.47) compared to those who did not, however, this exposure did not significantly affect GH. Those exposed to primary violence were 40% more likely to have DD (OR 1.40, CI 1.02-1.92) and were two times more likely to report poor GH (OR 2.09, CI 1.51-2.89) compared to those not exposed. Individuals exposed to secondary violence were 70% more likely to have DD (OR 1.70, CI 1.24-2.32) and were 48% more likely to report poor GH (OR 1.48, CO 1.06-2.05). This suggests that exposure to specific ACEs negatively impacts adult health, resulting in a higher likelihood of DD and poor GH.

Through a grounded theory methodology data collection around early childhood experiences with nature leading towards positive civic engagement with the community, the theory of cultural entropy emerged along with a policy recommendation for reconnecting the community to the local watershed. Through qualitative interviews with lifelong residents and analysis of essays from local high school students comparing early experiences with nature, the theory of cultural entropy emerged to explain how perceptions and interactions with the local landscape changed across generations. With the help of key information interviews, archival research, and exploration of the local watershed, cultural entropy was used to theorize how the work culture should do towards protecting and passing along ecological, cultural, and historical knowledge that might help increase civic engagement. Lifelong residents participating in the research were found to have high levels of civic engagement through participation with the local historical society and/or recommendations from people because of their involvement with the community. More than any other theme, the importance of the Arroyo Grande Creek emerged as a significantly early experience in nature amongst all lifelong residents. In contrast, this experience was completely gone from the early experiences by the high school students participating in this study. Creation of the dam, channelization of the creek, and invasive species introduction have almost eliminated access to the creek, and invasive species introduction have almost eliminated access to the creek. Very little evidence was found along the entire stretch of creek from dam to ocean of kids playing in the creek. This is theorized to be a product of larger cultures from outside this local ecosystem diffusing into the local culture, creating disconnect from local ecosystem knowledge. A policy recommendation is to create an interpretive greenbelt system along an already existing dirt farm road controlled by local agricultural land, promoting community engagement with the local watershed. Because so much of the key ecological, historical, and cultural knowledge of the area centers around the watershed, it is hypothesized that a greenbelt system has potential for reversing cultural entropy, increasing ecological, historical, and cultural knowledge of the area, and promoting civic engagement.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Objective: The objective of this study was to evaluate the association between (1) different types of ACEs and migraine, and (2) the number of ACEs and migraine among adolescent mothers in Lima, Peru. Methods: Our cross-sectional study included 787 adolescent mothers (14- to 18-years of age) in Peru. In-person interviews were conducted postpartum, in hospital, within 2-days of delivery. Nine types of ACEs were assessed, including exposure to three categories of abuse, two categories of neglect, and four categories of household dysfunction. Multivariable logistic regression procedures were used to estimate odds ratios (ORs) and 95% confidence intervals (95% CI) for the association between ACEs and migraine while adjusting for putative confounders. Results: Approximately 75% of adolescent mothers reported having experienced at least one type of ACE. Adolescent mothers who reported any childhood abuse had 1.49-fold increased odds of migraine (aOR = 1.49; 95% CI 1.03–2.18) compared to those with no history of childhood abuse. Adolescent mothers who reported experiencing household dysfunction had 1.56-fold increase odds of migraine (aOR = 1.56; 95% CI 1.09–2.24). Compared to participants who reported no ACE, those who experienced four or more ACEs had 3.09-fold (aOR = 3.09; 95% CI 1.80–5.40) increased odds of migraine (ptrend < 0.001). Conclusion: Exposure to ACEs is highly prevalent in adolescent-aged mothers postpartum and is associated with increased odds of migraine. These findings support the importance of screening for ACEs and migraine among adolescent mothers; and the need for providing culturally appropriate, trauma-informed headache care. / National Institutes of Health / Revisión por pares

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