Adolescence is a high-risk period for substance use, and the prevalence of adolescent substance use is a public health concern. Contributing factors for adolescent substance use are adverse childhood experiences (ACEs). ACEs are potentially traumatic childhood events that have negative associations with health and risk behaviors. The purpose of this study is to examine how the accumulation, timing, and duration of early ACEs (by age 5) impacts adolescent substance use. In addition, this study examines differences in these relationships by gender. Data from the Fragile Families and Child Wellbeing Study (FFCW) were used for the logistic regression analyses. The results generally showed significant relationships for early cumulative ACEs and early ACE timing and duration variables for the full and female sample when considering bivariate models, recency of trauma, and demographic variables. For male samples, statistical significance was only reached for extreme early cumulative ACEs and extreme early ACE timing and duration variables in all models. No significant relationships existed between early ACEs (accumulation, timing, or duration) and adolescent substance use when considering other major predictors of adolescent substance use at year 15. There were also no significant gender differences for early ACEs and adolescent substance use (accumulation, timing, or duration). Future studies should consider the impact of mediating variables on the relationship between early ACEs and adolescent substance use.

Grandfamilies, or families in which grandparents are raising their grandchildren, often form due to adverse childhood experiences (ACEs) experienced by the grandchildren. ACEs have been linked to multiple negative short- and long-term behavioral and emotional consequences for children. Yet, having an ACE history does not guarantee negative outcomes, as protective factors such as positive relationships with a safe and caring adult, healthy family functioning, and utilization of formal services can mitigate the negative effects of ACEs. Researchers have regularly called on families to seek timely intervention and services for ACEs; however, many grandparents raising grandchildren report negative interactions with service providers as well as service delivery. Limited research has explored the extent to which grandfamilies with ACEs may have experienced similar interactions while seeking and using formal services. Guided by Andersen's (1995) Behavioral Model of Health Service Use, this qualitative study sought to explore (1) the service needs of grandchildren with an ACE history who are being raised by their grandparents; (2) the service needs of grandparents raising grandchildren with an ACE history; (3) the process of seeking services when grandparents raising a grandchild with an ACE history look for services for their grandchild; and (4) best practices for delivering services to grandfamilies with an ACE history. The research questions were primarily addressed through via interviewing 10 grandparents from Central Appalachia who were raising a grandchild with an ACE history and by conducting two focus groups of 8 to 12 formal service providers with experience working with grandparents raising grandchildren with an ACE history. Interview data were analyzed using grounded theory and focus group data were analyzed through thematic analysis. Study findings indicated that grandchildren have emotional and developmental needs. Grandparents described needs related to the emotional impact of raising a grandchild with an ACE history, family and parent involvement, and parenting a grandchild with an ACE history. Study results also highlighted how grandparents can expect to encounter barriers throughout the service seeking and delivery process. Study results also highlighted the critical nature of having a strong relationship with a service provider and the importance of a service provider reducing barriers, being attentive to grandfamily needs, and involving the grandparent in the treatment process. Finally, results from the focus groups revealed best practices such as providing grandparents with education on ACEs, being aware of intergenerational ACE cycles, and engaging in assessment and intervention when working with this population. Implications for clinical practice as well as directions for future research are discussed. / Doctor of Philosophy / Historically, grandparents have long been called upon to assist with caring for their grandchildren. In the last forty years, grandparents have increasingly shifted to a new role—that of parent. Grandfamilies are commonly created due to adverse childhood experiences, or ACEs, which can include child abuse, child neglect, or household challenges such as parental substance abuse or parental incarceration. Experiencing ACEs does not guarantee negative outcomes in a child's life, but their presence and number can affect it, particularly when a child has experienced numerous ACEs. Professional services or treatment are one way to support these children. However, negative interactions with service providers or unfulfilled expectations with service delivery can dissuade grandparents from continuing services. This study sought to understand how grandparents raising a grandchild with an ACE history identify the grandchild's needs, come to the realization that their grandchild needs professional help, the process and experience of receiving that professional help, as well as what happened after the grandchild received professional services. After interviewing 10 grandparents raising a grandchild with an ACE history, study findings revealed how grandparents identify grandchild needs, and then manage those needs as well as grandchild behaviors. Study findings also illustrated a recursive relationship between grandparents managing grandchild needs and building a relationship of trust with the formal service provider once services have started. Building a relationship of trust with a formal service provider can then result in creating change or the grandparent deciding to end services. Finally, grandparent interview data revealed that throughout the entire process of service seeking, grandparents raising a grandchild with an ACE history commonly experience barriers hindering their access to services including personal, availability, and systemic barriers. Finally, the study sought to understand best practices for working with grandparents raising grandchildren with an ACE history, which include assessing for and creating interventions targeting ACEs, providing education on ACEs to grandparents, and being aware of intergenerational ACE cycles with these families. Strategies for clinical practice are also identified.

Recent gains in understanding the effects of childhood maltreatment on the development of the brain and nervous system, combined with the revelation that nearly all psychiatric neuroimaging studies have had an unrecognized confound in childhood maltreatment, imply the possibility that psychotherapy treatment effectiveness studies have been similarly confounded by childhood maltreatment. This study examines whether treatment-seeking adults exposed to childhood maltreatment respond differently to psychotherapy than do individuals who report no history of childhood maltreatment. Response to therapy is conceptualized in this study as reduction in symptom measures pre- and post- treatment, as well as client dropout. It is hypothesized that people with a history of childhood maltreatment experience psychotherapy differently, may experience differences in symptom reduction and be more likely to drop out of treatment, than people with no history of childhood maltreatment. The current study examines psychotherapy effectiveness in symptom reduction and dropout rates of clients who experienced childhood maltreatment as compared to those with no history of childhood maltreatment.

Adolescence is an uphill struggle. Research abundantly displays that Adverse Childhood Experiences (ACEs) have a distinct and detrimental effect on adolescents and their development. Recent research has explored the perspectives, thoughts, behaviours, and beliefs of helping professionals who integrate spirituality into their work with adolescents. The purpose of this qualitative study is to develop a thematic analysis of helping professionals’ narratives of care with this population. The narratives of helping professionals’ care of adolescent males with ACEs points to the desire to connect with spiritual community and to make meaning. Helping professionals’ narratives also highlight the constraints of locating spirituality. Theological reflection on parrhesia focuses on developing open, unencumbered discussion as an ethical, professional, and spiritually-sensitive form of integration. / Thesis / Master of Arts (MA)

Sexual dysfunction can lead to a negative impact upon a person’s mental and relational health, including relational and overall distress, poor relationship and sexual satisfaction, and clinical mood disorders such as depression. Moving upstream to identify factors that may predict sexual dysfunction would therefore be beneficial for early intervention in at-risk populations. History of childhood trauma is one such factor that may influence sexual functioning later in life. While adverse childhood experiences (ACEs) have been less studied in association with sexual dysfunction, there is some evidence to indicate that they may be related. ACEs have been shown to increase the risk of physical and psychological conditions (such as physical inactivity, obesity, heart disease, substance use, depression, and anxiety) which can then impede sexual functioning; further, a study of sex therapy patients found that their ACE scores were significantly higher than those in community samples. Additionally, difficulties in emotion regulation (DERS) may also play an important role in this relationship, as they have been shown to mediate the relationship between ACEs and several subsequent health risks. The purpose of this study was to determine whether there was a significant relationship between ACEs and sexual problems, and further, if emotion regulation difficulties mediated this relationship. College students (N = 696) were recruited to complete an online survey of their health behaviors. The overall mediated model was significant, F(2, 692) = 5.78, p = .003, but explained only 1.6% of the variance in sexual functioning. Although ACEs significantly predicted both sexual functioning (b = 0.60, t(694) = 3.40, p < 0.001) and DERS (b = 2.08, t(694) = 4.83, p < 0.001), DERS did not significantly predict sexual functioning (b = -0.01, t(694) = -0.63, p = 0.52), and did not emerge as a significant mediator of the relationship between ACEs and sexual functioning (b = -.02, CI [-.08,.05]). Further, in contrast to hypotheses, participants with higher ACE scores actually reported higher sexual functioning relative to participants with lower ACE scores in this sample. Results highlight the complexities of the relationship between ACEs and current sexual functioning. While difficulties in emotion regulation are still likely to be clinically significant for individuals with trauma histories, they do not appear to be a major contributing factor to difficulties in sexual functioning.

Unresolved adverse and traumatic experiences in parents can amplify the risk of perpetuating intergenerational transmission of trauma. Parents’ positive and adaptive practices such as self-care might act as a protective factor against this ripple effect. This study investigated whether self-care moderated the relationship between parental ACEs, post-traumatic stress symptoms, and parental reflective functioning in mothers who are experiencing high psychosocial stress (n = 59) residing in rural Appalachia. Within our sample, there was no statistically significant linear relationship between our predictors, ACE score and PTSD symptoms, and our outcome of interest, maternal pre-mentalizing. We did not find empirical support for self-care serving as a protective factor in the context of ACEs and PTSD symptoms. Despite the null findings in the main study hypotheses, the results of this study contribute to the literature on maternal trauma history and parenting outcomes. Implications, limitations, and future directions are discussed.

Trauma is a substantial threat to public health. As such, significant effort has been exerted into developing interventions which mitigate the consequences of trauma. Trauma-informed practice (TIP) aims to alleviate the effects of trauma by building policies and practices focused on safety, trust, transparency, support, collaboration, and empowerment. This study investigated how individual-level factors, including readiness for organizational change, perceived benefit of TIP training, and personal trauma history affect one’s ability to apply a TIP lens in a sample (n =100) of members of a graduate-level college. Further, it explored if one’s perceptions of and response to trauma-informed practice training predict changes in well-being, stress, and burnout. Results indicated that perceived benefit and readiness for organizational change are important predictors of post-training outcomes. Participants with a history of trauma performed more poorly on post-training trauma-informed knowledge questions. Results provided initial utility for use of objective measurement of trauma-informed application abilities.

Although previous research identified exposure to significant adverse childhood experiences (ACEs) as harmful to individuals in several psychological and physiological health domains, research examining the mechanisms of action driving this relationship has been lacking. As a result, the current study examined the role that psychological symptoms serve in the relationship between ACEs and substance misuse behaviors. The current study included a sample of 183 participants (i.e., 82 men and 101 women) who completed five questionnaires assessing exposure to ACEs; psychological symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD); and substance misuse behaviors. Correlational analyses indicated significant associations among the variables of interest. Exposure to ACEs was a significant predictor of substance misuse behaviors in both men and women. Additionally, depressive symptoms, anxiety symptoms, and PTSD symptoms were significant predictors of men's substance misuse behaviors, whereas only PTSD symptoms were a significant predictor of women's substance misuse behaviors. Symptoms of depression, anxiety, and PTSD each contributed unique and significant variance to the relationship between ACEs and substance misuse behaviors in men, consistent with partial mediations. A different pattern of prediction was evident for women. Such findings suggested that psychological symptoms of depression, anxiety, and PTSD may serve as a risk factor for substance misuse behaviors in men later in life, especially when they have had a history of ACEs. These results demonstrated the importance of promoting trauma-informed mental health care to remediate negative substance outcomes, particularly in those who have had significant ACEs. The importance of studying the relationships among these variables is discussed further.

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Research has shown that there are a number of risk factors that increase the odds of youth joining gangs, from individual- to family- to neighborhood-level risks. Studies have identified child abuse and other childhood traumatic experiences as influences on gang membership. Adverse childhood experiences (ACEs) provide a framework for how to measure and identify these traumatic events. This dissertation study uses longitudinal data from the Pittsburgh Youth Study (PYS) to inform the relationship between early life events and later gang membership. First, the count of total ACEs experienced by gang involved youth were compared to nongang youth. Then, latent class analysis was used to create groupings of ACEs to determine if particular classes of adverse events are associated with higher odds of gang membership during later adolescence. Using the longitudinal data structure of the PYS, additional latent classes were developed when breaking up the adversity into separate age ranges. ACE categories for the youngest cohort were able to be divided into early school entry (elementary school), early adolescence (middle school), and later adolescence (high school) due to their earlier age of first survey, and then these age-graded categories were added into the latent class model to determine if age specific adversity increased odds of gang membership. Lastly, covariates were added into the model to test if time-stable elements increased odds of belonging to one of the classes identified in the initial latent class analysis. The methods described above produced results, showing that gang involved youth have significantly more childhood adversity than nongang involved youth on average. When the latent class analysis was conducted, a three-class solution was found to be the most appropriate model, with classes with higher odds of adversity leading to greater odds of gang membership. There was no significant difference between two classes that had higher odds of adversity, though both included high rates of community violence experiences and parental separation. There were mixed findings on the impact of age specific adversity. Lastly, covariates were added into the model finding early school achievement plays a large role in predicting class membership, while familial financial strain does not. The findings from this dissertation have important implications for policy and practice around gang prevention and intervention in that they can help pinpoint constellations of risk factors. Evidence-based school intervention programs, such as The Fourth R-- an in-school intervention designed to reduce delinquency through positive relationship building with teachers, parents, and pro-social peers (Crooks et al., 2011)-- are important for reducing the odds of experiencing higher odds of adversity. Additionally, programs that work with youth who experience adversity can help reduce the hurt they perpetrate on others. / Criminal Justice