Measuring and Responding to Childhood Adversity

Stoneleigh Fellow: Roy Wade, 2014-2017

There is a substantial and growing body of research on how stress and adversity experienced in childhood affect the health and well-being of children, their brains and neural connections, and their lifetime outcomes. While adverse childhood experiences (ACEs) have been defined in numerous ways, there is general agreement that they lead to a wide range of lasting negative effects on cognitive and developmental functioning as well as physical, social and emotional well-being. As a result of years of research, we now know that ACEs are quite common in the general population and even more pronounced within vulnerable communities.   

Though research correlating poor adult health outcomes with childhood adversity has been available for a while, few social service and health providers have applied the findings into practice. Thus, until recently, there has been limited application of the science of adversity to improve life outcomes for youth. In response to this gap, Dr. Roy Wade proposes to build a comprehensive, validated, youth-informed childhood adversity measure and use implementation science to promote the adoption of childhood adversity assessment by health and social service organizations in Philadelphia. Dr. Wade will partner with the Children’s Hospital of Philadelphia (CHOP) and be housed within the research group of Christopher Forrest MD, PhD.  

Scope of the Problem

The landmark Adverse Childhood Experiences Study, first published in 1998, found that survivors of childhood trauma are at significantly higher risk as adults of suffering from a broad range of poor health outcomes than counterparts who were never exposed to ACEs. Surveying 10 different types of childhood trauma, the ACE Study is considered one of the most important and largest public health studies to examine the childhood origins of leading adult behavioral problems and chronic diseases including diabetes, heart disease, depression and cancer. While the ACE study examined adult health outcomes, the research on childhood adversity points to negative outcomes throughout the lifespan including developmental delay, cognitive impairment, risk-taking behavior, poor academic achievement, incarceration, unemployment, poverty, mental illness and even early death.

Though some health and social service organizations are using evidence-based interventions to decrease childhood exposure to ACEs, such as parent education, home-visiting programs and trauma-focused cognitive behavior therapy, they rarely address the daily trauma faced by youth growing-up in urban communities. Furthermore, organizations that do this work employ a version of the initial ACE index that focuses on major life events in young children. Thus, it does not effectively capture the trauma of widespread community violence and persistent poverty, or the impact of their frequency.    

The discourse on ACEs across disciplines, both at the practice and policy levels, is shifting to the need to take what we know about ACEs and focus it on prevention: integrating screening, assessment, referrals and interventions into practice. There is a need to go beyond assessing a very small range of one time adverse experiences or intense sentinel events to examine the extent to which chronic exposures (poverty, racism, peer victimization) may contribute to negative outcomes for children. Further, there is a need for a coherent framework to conceptualize the term adversity, which in the literature and related fields is defined in various ways, and to have a more complete understanding of how adversity is experienced by youth.

Fellowship Project

Dr. Wade is proposing to develop a conceptual framework that incorporates the perspectives of youth and health and social service organizations into more effective methods to assess childhood adversity. With a Stoneleigh Fellowship, he will design and develop a childhood adversity assessment tool and integrate it into select health and social service organizations in Philadelphia. The overall goal of the project is to prevent the impact of adverse childhood experiences through the development of a more representative assessment tool than exists, and to have it inform practice at health and social service organizations.

The specific activities of the project are to:

1) Create a comprehensive, validated, easy to administer youth-informed childhood adversity measure.

2) Facilitate the adoption of childhood adversity assessment among health and social service project partner organizations in Philadelphia.

3) Evaluate the impact of childhood adversity assessment on the practice of health and social service project partner organizations in Philadelphia.