Assessment tools, relationships key to addressing child trauma

September 8, 2017, Johns Hopkins University Bloomberg School of Public Health

Two new studies led by researchers at the Johns Hopkins Bloomberg School of Public Health suggest that the bevy of tools available to assess and address childhood adversity and trauma, as well as the interconnected webs of relationships among families and the providers who care for children, are key to healing the effects of these potentially life-altering circumstances.

The findings, published online in a special issue of Academic Pediatrics, offer useful insights in helping and their families recover from adverse childhood experiences, which can have myriad and serious consequences.

Researchers have known for decades that adverse childhood experiences—which can include physical, sexual, or emotional abuse and neglect, parental incarceration, and household substance abuse, among other circumstances—are associated with a variety of other long-term health problems or high-risk behaviors, including depression, heart disease, substance abuse and sleep disorders. Only more recently have researchers understood the prevalence of these experiences among children and youth. A 2014 study found that nearly half of all US children had experienced at least one and that effects on health, school success and well-being show up early.

Despite this knowledge, efforts have thus far not fully addressed these issues, setting many children up for what could be lifelong health problems.

 "This really is a public health opportunity, because we know children can thrive with proper support systems," says Christina D. Bethell, PhD, professor in the Bloomberg School's Department of Population, Family and Reproductive Health and director of the Child and Adolescent Health Measurement Initiative. "With a clear agenda, we can help create a paradigm shift. And that will help more children do well despite adverse experiences."

To establish a research and policy agenda, Bethell and her colleagues at the Bloomberg School and elsewhere worked with more than 500 individuals across a dozen stakeholder groups to address what priorities should be for preventing and treating traumatic childhood experiences in children's health services.

The resulting agenda, published in the same issue of Academic Pediatrics, lays out four primary goals: educating policymakers and healthcare providers; cultivating cross-sector collaboration; restoring and rewarding healthy relationships; and launching research, innovation and implementation efforts.

Critical to this agenda is understanding which assessment tools are most useful. In another paper in the special issue, Bethell and her co-authors assessed the state of tools used to evaluate adverse childhood experiences. The researchers identified and compared 14 assessment tools, each of which used parent responses to evaluate adverse childhood experiences.

The study found that each of these tools share four adverse experiences: parental incarceration, domestic violence, household mental illness/suicide, and household alcohol or . Other experiences common to many of the 14 tools are exposure to domestic/household violence, neighborhood violence, bullying, discrimination, or a parent's death.

Each assessment tool used cumulative scoring methodology that assessed health risks based on the number of adverse that an individual had been exposed to, rather than giving more weight to different ones.

The researchers focused on a new measure included in the the National Survey of Children's Health which looked at children's past or current exposure to adversity. Several methods were employed to validate the tool and its scoring.

"Assessing is strongly linked to the health and school success of children and youth.  Counting exposures rather than specific events holds up," Bethell says.

A separate paper also recommends encouraging relationships that promote healing. In a review article in the same issue of Academic Pediatrics, Lawrence Wissow, MD, MPH, who holds joint appointments at the Johns Hopkins University School of Medicine and the Bloomberg School, and his colleagues combine conclusions from three previous systematic reviews examining relationships between pediatric patients and healthcare providers, among healthcare staff at the same practice, and among primary care providers and specialists.

This research suggests that it's vital for patients to form healthy relationships with staff from the moment they contact a care facility, not only including those that directly provide healthcare, but also those that answer phones or check them into appointments.

"For trauma patients, knowing that you'll be respected, that people will explain things to you, that you'll have choices and won't be trapped, all of this is important to achieving good outcomes," Wissow says.

Similarly, he adds, research shows that having staff at the same healthcare practice who collaborate well despite constant exposure to patients' crises, as well primary care providers who have personal relationships with specialists and community organizations that also assist trauma patients, is key to getting patients the resources they need to heal.

"Trauma care really depends not only on what you do for patients but how you do it," says Wissow, who is board certified in pediatrics, psychiatry, and child/adolescent psychiatry. "Forging these strong and among staff creates an environment where you can deliver care that makes a positive impact."

Explore further: Adverse events affect children's development, physical health and biology

More information: Child Well-Being and Adverse Childhood Experiences in the U.S.: www.academicpedsjnl.net/issue/ … 1876-2859(17)X0002-8

Related Stories

Adverse events affect children's development, physical health and biology

October 21, 2016
It's known that adverse childhood experiences carry over into adult life, but a new study is focusing on the effect of these experiences in the childhood years.

Higher use of general health care services throughout adult life linked with traumatic childhoods

July 12, 2017
Experiencing physical, sexual or emotional abuse as a child, or other stresses such as living in a household affected by domestic violence, substance abuse or mental illness, can lead to higher levels of health service use ...

Half of US kids exposed to traumatic social or family experiences during childhood

December 8, 2014
Nearly half of all children in the United States are exposed to at least one social or family experience that can lead to traumatic stress and impact their healthy development - be it having their parents divorce, a parent ...

New psychology study finds adverse childhood experiences transfer from one generation to the next

June 27, 2017
Women who suffer four or more adverse childhood experiences before the age of 18 are more likely to face pregnancy and postpartum problems, which they may in turn pass on to their children in a "cascade of risk," according ...

Study finds ADHD and trauma often go hand in hand

May 6, 2014
When children struggle with focusing on tasks, staying organized, controlling their behavior and sitting still, they may be evaluated for attention-deficit/hyperactivity disorder (ADHD). Clinicians, however, shouldn't stop ...

Stable relationships protect kids from toxic trauma and stress

May 31, 2017
Parents are often reminded to keep harmful substances out of their child's reach. But what if a child's experiences at home were as toxic to their health as household solvents and cleaners?

Recommended for you

Color of judo uniform has no effect on winning

February 22, 2018
New research on competitive judo data finds a winning bias for the athlete who is first called, regardless of the colour of their uniform. This unique study, published in Frontiers in Psychology, puts to rest the debate on ...

Antidepressants are more effective than placebo at treating acute depression in adults, concludes study

February 22, 2018
Meta-analysis of 522 trials includes the largest amount of unpublished data to date, and finds that antidepressants are more effective than placebo for short-term treatment of acute depression in adults.

Smartphones are bad for some teens, not all

February 21, 2018
Is the next generation better or worse off because of smartphones? The answer is complex and research shows it largely depends on their lives offline.

Self-compassion may protect people from the harmful effects of perfectionism

February 21, 2018
Relating to oneself in a healthy way can help weaken the association between perfectionism and depression, according to a study published February 21, 2018 in the open-access journal PLOS ONE by Madeleine Ferrari from Australian ...

Researchers uncover novel mechanism behind schizophrenia

February 21, 2018
An international team of researchers led by a Case Western Reserve University School of Medicine scientist has uncovered a novel mechanism in which a protein—neuregulin 3—controls how key neurotransmitters are released ...

How people cope with difficult life events fuels development of wisdom, study finds

February 21, 2018
How a person responds to a difficult life event such as a death or divorce helps shape the development of their wisdom over time, a new study from Oregon State University suggests.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.