This DNP project addresses the healthcare issue of intimate partner, domestic, and sexual violence (IPDSV), its impact on survivors, and reducing the potential for retraumatization by those who care for them in the clinical, behavioral, and social settings. Trauma-informed care interventions are designed to address the sequelae of trauma, promote recovery, and support resilience. Since IPDSV is a global health issue, supporting cultural needs of all clients is an essential aspect of trauma-informed care. This project was guided by a central research question that examined if trauma-informed, culturally competent curriculum be viewed by community stakeholders as an appropriate intervention for the education of their workforce in preventing survivor retraumatization. The framework for this project was informed by the sanctuary model, the 4 major tenets of Leininger's theory of culture care diversity and universality, and the 5 constructs of cultural competence by Campinha-Bacote. The focal site was a domestic violence shelter that provides care for a multitude of culturally diverse trauma survivors. Demographic data were collected, and a descriptive analysis performed to determine the diversity and needs of the residents. These data were then used to develop a culturally competent program using trauma-informed principles to prevent the effects of recidivism, and to promote healing, empowerment, and resilience in survivors.

BACKGROUND: The social causation of preterm birth remains elusive, without an adequate explanatory framework. Thus, this study proposed and evaluated a conceptual model of the social determinants of perinatal health for the understanding of perinatal health disparities. METHODS: A prospective cohort study was conducted with pregnant women between 20 and 35 weeks gestation who were participating in two Healthy Start programs in Central Florida, from July 2011-August 2013. Perinatal health was operationalized based on gestational age, birth weight, and healthy start infant risk screen score. The predictors were: early life adversity, social position, maternal health-related quality of life, maternal stress, racism and discrimination, lack of social support, father involvement during pregnancy, intimate partner violence, and adverse maternal behaviors. Data collection consisted of a self-administered survey and birth outcome data was obtained from Healthy Start administrative databases. The statistical framework was structural equation modeling. RESULTS: The study sample was racially and ethnically diverse (N, Hispanics=72; N, non-Hispanic blacks=61; and N, non-Hispanic whites=48). The majority of mothers in this study were single or not married (cumulative 76%), US born (74.6%), and with English speaking preference (74.6%). The sample tended to cluster in low income groups (cumulative 58% less than $25,000 annual household income) and with education levels of less than high school (79.6%). A greater proportion of Hispanic mothers were married (66.7%) compared to non-Hispanic blacks (34.4%) and non-Hispanic whites (47.9%). Only 41.7% had completed high school, compared to 63.9% non-Hispanic blacks and 64.6% non-Hispanic whites. Nearly all non-Hispanic blacks and non-Hispanic whites were born in the US, compared to only 43.1% Hispanic mothers. Only 40% of non-Hispanic blacks reported on currently living with the baby's father at the time of the survey, compared to 66.2% for Hispanic mothers, and 58.3% for non-Hispanic whites. Furthermore, non-Hispanic blacks reported a greater proportion of discriminatory experiences in daily situations (mean = 4.74), compared to the other groups (mean for Hispanics was 2.14, and mean for non-Hispanic whites was 1.95). Non-Hispanic whites reported the greater proportion of daily alcohol use (mean 3.8 beverages per month), compared to other groups (Hispanic mean was 0.69, and non-Hispanic blacks mean was 1.68). Non-Hispanic white mothers also presented a higher mean of adverse childhood experiences before 18 years of life (mean = 3.4), compared to other groups (mean for Hispanics was 1.63, mean for non-Hispanic blacks was 2.48). With the exception of the confirmatory factor analysis for intimate partner violence (low correlations with common factor), all other confirmatory factor analyses demonstrated an acceptable Chi-square to degrees of freedom ratio (<6), and the RMSEA was less than 0.08 (minimum for acceptance). Thus, structural equation models were estimated subsequently. The first model was a model of direct effects between social position and perinatal health (hypothesis 1: direct effects), which demonstrated a good fit as indicated by X2/DF ratio of 1.4 (Chi-Square = 19, DF =13) and a RMSEA of 0.05. However, the direct effect of social position was very small and non-significant (Beta=-.02, p-value =.76), supporting the conclusion that a simple direct effect of social position on perinatal health was not found in this population. The second model explored indirect effects of social position through intermediate factors (hypothesis 2: indirect effects), which demonstrated a good fit to the data, as indicated by a Chi-square/df ratio = 1.45 and RMSEA=.05. Social support was a statistically significant mediator between social position (Beta=0.284, p<0.05) and perinatal health (Beta=0.22, p<0.05). The third model incorporated adverse childhood experiences as predictor of social position effects. Adverse childhood experiences were significantly associated with social position (Beta=.363, p<0.05) and moderated the effects of social position on social support and perinatal health. In the presence of adverse childhood experiences, the social position was significantly associated to maternal health-related quality of life (Beta=-0.226, p<0.05) and maladaptive maternal behaviors (Beta=0.654, p<0.05). CONCLUSION: This study demonstrated synergistic effects of social determinants of health. Controlling for all factors considered, social support was significantly associated with perinatal health, which presents implications for strengthening prenatal programs that provide support to pregnant women. Findings need to be replicated in larger studies with the US general population. Policy makers and researchers need to pay greater attention to the role of early life adversity on perinatal health outcomes.

Adverse childhood experiences (ACEs) and their role as mitigators in capital sentencing is an important, yet relatively unexplored, topic in criminological literature. Using data from the North Carolina Capital Sentencing Project, this study explores the role of ACEs as mitigating factors for youthful and non-youthful capital offenders: whether youthful offenders are less likely to be sentenced to death, whether or not ACEs are effective as mitigating factors, and whether ACE mitigators are more effective for youthful or non-youthful offenders. Results show that youthful capital offenders are less likely to be sentenced to death than adult capital offenders, and while ACE variables effectively mitigate against a death sentence, they do not mitigate more effectively for youthful offenders than non-youthful offenders. These findings, along with policy implications and directions for future research, are then discussed.

Schools, families, and neighborhoods can support the development of happy, healthy children and adolescents. However, a majority of children in the United States also experience adversity in their early lives that can have deleterious effects on their cognitive and socioemotional development. Measuring and modeling early adversity is fundamental to understanding development as it occurs through interactions with schools, families and neighborhoods. As outlined by Bronfenbrenner's bioecological model of human development, proximal and distal forces shape development, and cannot be isolated when relating measures of the developmental context to outcomes for individuals. For schools and other social programs to support students from high adversity backgrounds, the nature and structure of adversity and contextual influences must be measured and modeled in a robust manner. The three distinct papers in this dissertation describe the construction and evaluation of measurements for adversity, family conflict, neighborhood quality, and school safety, along with models that relate these elements to each other and cognitive outcomes in childhood and adolescence. Structural equation modeling is used to investigate the latent variables generated to measure the constructs and the nature of their relationships. The studies use nationally representative data from the Panel Study of Income Dynamics to create and test the theoretically driven models. The first study constructs and tests latent variables aligned with the Adverse Childhood Experiences (ACEs) framework in order to generate a continuous and theoretically coherent measurement of adversity. The second study uses this ACEs measurement along with measures of family conflict and neighborhood quality to generate and test path models informed by the bioecological theory of development. The third study applies these measures of developmental constructs to the study of safety in schools and identifies the differential function of school safety for children with varying levels of adversity to better understand the potential for school-based interventions. Results from these studies indicate the utility of a latent variable approach to measuring adversity, and the viability of path analysis for the study of how ACEs, family conflict and neighborhood quality influence cognitive outcomes. Additionally, results provide evidence for the necessity of varied and networked developmental supports for children from highly adverse beginnings, above those that may be available through reforms to school safety. Taken together, these studies provide a rich portrait of childhood development incorporating multiple contextual influences, and add to our understanding of what schools can and cannot do to support children.

No description available.

Child maltreatment and household dysfunction have long been linked to delinquency, adult criminality, and sexual offending. However, the association between adverse childhood experiences (ACEs), factors related to out-of-home placement, and the onset of maladaptive behaviors has not thoroughly been explored in adolescents who have engaged in sexually abusive behavior. In the present study, we examined archival records of 120 male youths who have received treatment for sexually abusive behavior. As expected, the male adolescents in this sample have experienced higher rates of ACEs than samples of adult males in the community, adult males who committed sexual offenses, and juvenile justice–involved males as reported in the literature. Discrete-time survival analyses yielded increased risks of onset of aggression and sexually abusive behavior during early childhood and mid-to-late childhood, with significant associations between higher ACE scores and a greater number of out-of-home placements. Implications and future directions are discussed.

This study aims to evaluate the implementation of Trauma-Informed Care (TIC) trainings in Johnson City, Tennessee, and the surrounding Appalachian area. Previous TIC trainees were sent an email survey asking them if they had followed through with their plan to implement the training at their place of work or in other areas of their lives. The response rate for this study was 2%, possibly due to extraneous variables such as the Coronavirus Pandemic and the lag time between the initial training and survey follow-up. The responses that were analyzed indicated promise for the practical implementation of TIC concepts at the companies involved in the training initiative. Additional research is needed in order to further analyze TIC implementation.

The purpose of this qualitative study was to examine educators perceptions of the effects of generational poverty and adverse childhood experiences on student learning and to understand the factors that might facilitate breaking the cycle of generational poverty and adverse childhood experiences with respect to student learning. Data collection strategies included individual interviews and document review. Analysis of data occurred in three phases: categorization of data, building the explanation in narrative form and reexamination of the data. The analysis of the data was based on Payne’s idea of generational poverty and the CDC-Kaiser Permanente Adverse Childhood Experiences(ACE) study. The credibility of the analysis was protected by triangulation of data through multiple sources of evidence, establishment of a chain of evidence, and member checking. After interviews were conducted the following themes emerged as ways to break the cycle of generational poverty and adverse childhood experiences: tutoring/after school programs, mentors/peer buddies, educating educators, parent involvement, and accountability. The results are detailed in the study.

No description available.

Relationship between Adverse Childhood Experiences and Illness Perceptions among Individuals with Fibromyalgia by Susan D. Fay MS, Drexel University, 1994 BS, Metropolitan State University of Denver, 1983 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Psychology Walden University February 2015 Adverse childhood experiences (ACEs), including abuse and neglect, are a significant social health problem. Exposure to ACEs can place a child at a high risk for developing different diseases or illnesses in adulthood, including fibromyalgia. The purpose of this study was to determine if exposure to ACEs, moderated by perceived social support and/or social undermining, would result in more negative illness perceptions of personal control and/or treatment control. A survey research design was used in this quantitative study. Purposive convenience sampling methods were used to solicit 231 participants to complete an online survey. Moderated multiple regression analysis was used to assess the moderating roles of perceived social support and social undermining on the relationship between ACEs with personal control and treatment control facets of illness perceptions among individuals with fibromyalgia. Developmental traumatology, allostatic load, social support, social undermining, and illness perceptions served as the theoretical and empirical foundation for this study. Social undermining was found to be a significant moderator of the relationship between sexual abuse, perceived social support, and personal control perceptions, F(7, 174) = 1.28, p <.001, but only when levels of social undermining were moderate to high. The relationship was not significant for treatment control perceptions as the criterion variable, or for physical or emotional abuse as predictor variables. Positive social change implications include an expanded knowledge of important social and psychological factors that influence the health of fibromyalgia patients, especially those exposed to sexual abuse. Such information can assist health care providers develop more effective therapies, treatments, and screening protocols.