Category: Trauma & Resilience

Dimensional models of adverse childhood experiences: An empirical analysis and critique

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Mersky, J. P., & Plummer Lee, C. (2026). Dimensional models of adverse childhood experiences: An empirical analysis and critique. Child Maltreatment. Advance online publication. https://doi.org/10.1177/10775595251415193

Abstract

Dimensional models of adversity are growing in popularity, but they have also been subjected to critique. For this analysis, adverse childhood experiences (ACEs) data were drawn from a cohort of low-income adults to evaluate the Dimensional Model of Adversity and Psychopathology, which distinguishes experiences of threat and deprivation, and a recent extension of the life history model that differentiates three dimensions: (1) harshness/threat; (2) harshness/deprivation; (3) unpredictability. Confirmatory factor analyses of an expanded ACE assessment showed that both models fit the data well, though there were signs of low discriminant validity between dimensions. Harshness/threat was more strongly correlated with some physical and mental health outcomes and unpredictability was more strongly correlated with some indicators of risk behavior. Findings were largely consistent across models using latent measures and basic ACE scores. Further research is needed that compares dimensional models to cumulative risk models that are rudimentary but highly replicable.

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The effects of adverse childhood experiences on adult mental health across gender, race/ethnicity, and economic status in the U.S.

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Liu, X., Hu, Min, Varline, J., Yang, H., Bo, A., & Mersky, J. P. (2026). The effects of adverse childhood experiences on adult mental health across gender, race/ethnicity, and economic status in the U.S.: A systematic review and meta-analysis. Trauma, Violence, & Abuse.  Advance online publication. https://doi.org/10.1177/15248380261433022

Abstract

Associations between Adverse childhood experiences (ACEs) and poor mental health are well documented, but it remains unclear to what degree these associated effects vary among demographic subgroups. This systematic review and meta-analysis aims to synthesize the evidence linking ACEs to depression, anxiety, and posttraumatic stress disorder (PTSD) while exploring whether these associations vary by gender, race/ethnicity, and economic status. We searched studies published from January 1998 to January 2025 in PubMed/MEDLINE, PsycINFO, CINAHL, Web of Science, ProQuest Dissertations and Theses Global, and Sociological Abstracts. Included studies reported associations between ACEs and depression, anxiety, and PTSD among specific subgroups of U.S. adults. This review used a 13-item assessment tool to evaluate study methodological quality. We conducted random-effects robust variance estimation meta-analyses to pool effect sizes and used Wald tests to compare subgroup differences. A systematic literature search yielded 45 studies with 110,556 participants. ACEs were positively associated with depression, anxiety, and PTSD. Associations were significant across genders, economic statuses, and most racial/ethnic groups. Wald tests showed that there were no statistically significant subgroup differences. Findings confirmed that ACEs are significantly linked to adult mental health outcomes, with an especially strong connection to PTSD. The lack of subgroup differences suggests that ACEs are universally harmful, underscoring the urgent need for ACE prevention strategies and trauma-responsive interventions that can be scaled at the population level.

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Advancing the study of adverse adult experiences:  A validation study of the Adult Experiences Survey

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Mersky, J. P., Plummer Lee, C., Liu, X. (2025). Advancing the study of adverse adult experiences:  A validation study of the Adult Experiences Survey. Journal of Family Violence. 1-13. Advance online publication.

Purpose

Extending research on adverse childhood experiences (ACEs), this study examined the occurrence, co-occurrence, and associated outcomes of adverse adult experiences (AAEs). We also explored subgroup differences in the effects of AAEs and responses to the Adult Experiences Survey, a seminal assessment of AAEs.

Method

Survey data were collected between October 2021 and May 2023 from more than 2,000 Wisconsin adults who enrolled in the Strong and Stable Families Study, a prospective investigation of risk and resilience in families with children. Descriptive analyses produced sample prevalence estimates of AAEs overall and by race/ethnicity, income, and gender. Analyses were performed to test bivariate associations among AAEs and to calculate the mean number of additional adversities associated with each AAE. Multivariate regressions were conducted to test associations between AAE scores and indicators of mental health and well-being along with the moderating effects of race/ethnicity, income, and gender. A multigroup confirmatory factor analysis with an alignment optimization procedure was used to assess measurement invariance by race/ethnicity, income, and gender.

Results

More than 75% of participants reported at least one AAE, and more than 25% reported four or more AAEs. Higher levels of cumulative adversity were reported by non-White than White adults, women than men, and adults from lower-income than higher-income backgrounds. All 10 AAEs were significantly intercorrelated, and specific AAEs such as sexual abuse, violent crime victimization, and homelessness were linked to especially high levels of cumulative adversity. Adult adversity scores were positively associated with depression and anxiety symptoms and negatively associated with quality of life and life satisfaction ratings. Significant adversity-by-race and adversity-by-income interaction effects were observed. Response patterns to AAE questions were similar across racial/ethnic, income, and gender subgroups, providing support for measurement invariance of the Adult Experiences Survey.

Conclusions

Like ACEs, AAEs are common, correlated, and consequential events and conditions. The findings are discussed in light of their significance for research on life course and intergenerational adversity and their implications for practice and policy.

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A validation study of the Evidence-based Practice Attitude Scale-36 in a U.S. Sample of trauma-responsive treatment providers

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Mersky, J. P., Bacalso, E., & Plummer Lee, C. (2025). A validation study of the Evidence-based Practice Attitude Scale-36 (EBPAS-36) in a U.S. Sample of trauma-responsive treatment providers. Implementation Science Communications, 6(47), 1-12. 

Background

Mental health providers’ attitudes toward evidence-based practice are likely to influence what interventions they learn, implement, and sustain over time. A 36-item version of the Evidence-Based Practice Attitude Scale (EBPAS) was recently developed to assess provider attitudes in 12 domains. Research suggests the EBPAS-36 is a promising tool, though inconsistencies across studies signal the need to reexamine its validity and reliability along with the correlates of provider attitudes.

Methods

This study assessed the factorial structure of the EBPAS-36, the intercorrelations and reliabilities of its subscales, and correlates of practice attitudes in a U.S. sample of 445 practitioners who received training in trauma-focused cognitive behavioral therapy.

Results

A confirmatory factor analysis (CFA) verified that the EBPAS-36 fits a 12-factor model representing each of its subscales. Reinforcing prior results, the subscales of the EBPAS-36 were weakly to moderately correlated, indicating that the 12 domains are related yet distinct. A hypothesized second-order CFA model with three overarching latent factors was not validated, but an alternative second-order model with two factors fit the data adequately. Most subscales demonstrated good-to-excellent internal consistency, though values for certain subscales ranged from marginally acceptable to poor. Provider attitudes varied by gender, professional experience, and discipline. Practitioners who more frequently assessed client trauma symptoms reported more positive EBP attitudes, and those who expressed greater concerns that trauma assessments may cause harm reported more negative attitudes.

Conclusions

Taken together with previous findings, the results show the EBPAS-36 performs well overall, though some subscales may benefit from refinement. Further validation tests of the EBPAS-36 in diverse samples are warranted.

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Adverse Childhood Experiences and Sexual Orientation: An Intersectional Analysis of Nationally Representative Data

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Mersky, J., Lee, C. P. & Hami, D. (2023). Adverse Childhood Experiences and Sexual Orientation: An Intersectional Analysis of Nationally Representative Data. American Journal of Preventive Medicine, 10.

Introduction

This study compared the prevalence of adverse childhood experiences across intersections of sexual orientation, gender, race/ethnicity, and economic status.

Methods

Data collected between 1994 and 2018 from 12,519 participants in the National Longitudinal Study of Adolescent to Adult Health were analyzed in 2023 to generate adverse childhood experience prevalence estimates. Unadjusted 1-way ANOVAs and multivariate regressions were performed to compare differences in independent and cumulative adversity measures by sexual orientation, gender, race/ethnicity, and poverty status. A multilevel analysis of individual heterogeneity and discriminatory accuracy was conducted to estimate adversity scores across 24 groups that were stratified by sexual orientation, gender, race/ethnicity, and poverty status.

Results

Adolescents with same-sex attractions and adults who identified with a sexual minority group reported more adverse childhood experiences overall than straight participants, although associations varied by type of adversity. Strikingly, adversity scores were higher among White youth with same-sex attractions than among Black youth with same-sex attractions, among more economically advantaged bisexual adults than among poorer ones, and among poor White participants than among poor Black and Hispanic participants, suggesting that the combination of disadvantaged and marginalized statuses does not necessarily correspond with greater childhood adversity. A multilevel analysis of individual heterogeneity and discriminatory accuracy interaction model showed that sexual orientation and poverty status contributed significant variance to cumulative adversity scores, whereas gender and race/ethnicity did not.

Conclusions

The results show that disparities in adverse experiences can be more fully and accurately represented when sexual orientation and other social identities are modeled as intersectional configurations. Given that adverse childhood experiences are linked to morbidity and mortality, the findings have salient implications for understanding health disparities that affect population subgroups.

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Intergenerational transmission of child protective services involvement

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Janczewski, C., Mersky, J., & Lee, C. P. (2023). Intergenerational transmission of child protective services involvement: Exploring the role of ACEs and domestic violence among families who receive home visiting services. Child Abuse & Neglect, 144, 106384.

Abstract

Background
Adverse childhood experiences (ACEs) are associated with negative outcomes over the life course and across generations, including domestic violence (DV) and child maltreatment. However, no studies have examined the connection between parents’ ACEs and their child’s risk of child protective services (CPS) involvement or possible mechanisms of transmission.

Objective
In addition to describing the prevalence and correlates of CPS involvement, our primary aims are to test whether parental adversity in childhood is associated with CPS involvement and whether DV victimization mediates the ACE-CPS association.

Participants and setting
The sample included 3039 primary caregivers and 3343 children served by home visiting programs in Wisconsin between 2014 and 2019.

Methods
Using matched home visiting and CPS records, we generated prevalence estimates of screened-in CPS reports and assessed bivariate associations between CPS involvement and ACEs, DV, and household demographics. We then conducted a two-stage path analysis to test the association between ACEs and CPS involvement and whether DV mediated the ACE-CPS association.

Results
Overall, 22.8 % of caregivers had a screened-in report. Prevalence rates were higher among women who endured ACEs and DV, and they varied by demographic characteristics. ACEs were directly linked to DV and CPS involvement, and there was an indirect pathway linking ACEs to CPS involvement through DV exposure.

Conclusions
Home visiting programs serve families that frequently interact with the child welfare system. By enhancing the trauma-responsive potential of these interventions, it may be possible to interrupt intergenerational mechanisms that contribute to child abuse and neglect and CPS involvement.

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Adverse adult experiences and health outcomes: Racial and ethnic differences in a low-income sample

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Mersky, J. P., Plummer Lee, C., & Janczewski, C. E. (2023). Adverse adult experiences and health outcomes: Racial and ethnic differences in a low-income sample. Stress & Health. Advance online publication. https://doi.org/10.1002/smi.3212

Extending research on adverse childhood experiences (ACEs), this study aimed to investigate whether the prevalence of and outcomes associated with adverse adult experiences vary among racial and ethnic subgroups. Survey data were collected from 1566 low-income women in Wisconsin using the Adult Experiences Survey (AES). Ten major adult adversities were assessed, including items that reference an intimate partner or household member (e.g., physical or emotional abuse, substance use) along with other social and economic stressors such as homelessness and discrimination. Adverse adult experiences were highly prevalent overall, but even more so among non-Hispanic Whites than their Black and Hispanic counterparts. The results reinforce prior research on ACEs in low-income populations. Lending further credence to these findings, tests of measurement invariance indicated that the AES demonstrated acceptable configural and scalar invariance across racial and ethnic groups. As expected, greater exposure to adult adversity was significantly related to poorer physical and mental health. These associations manifested cross-sectionally and longitudinally for observed and latent measures of adult adversity—even after controlling for ACEs. Associations between adult adversity and health were not moderated by race/ethnicity. In sum, adverse adult experiences were unequally distributed across racial/ethnic groups, but the consequences associated with adversity appeared to be evenly dispersed.

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Life course adversity and sleep disturbance among low-income women with young children

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Mersky, J. P., Plummer Lee, C., & Jackson, D. B. (2023). Life course adversity and sleep disturbance among low-income women with young children. Sleep Health. Advance online publication. https://doi.org/10.1016/j.sleh.2023.02.007

Objectives: This study explored whether patterns of lifetime adversity are associated with sleep disturbance and tested whether adult adversity mediates the relationship between childhood adversity and sleep.

Methods: A sample of 1510 postpartum women in Wisconsin who received home visiting services completed assessments of childhood adversity, adult adversity, and sleep disturbance; 989 women completed another sleep assessment about one year later. Latent class analysis was used to identify classes of lifetime adversity, which were then used to predict later sleep ratings while controlling for earlier sleep ratings and demographic variables. A path analysis was conducted to explore whether adult adversity mediated the association between childhood adversity and sleep.

Results: Adverse childhood and adult experiences were highly prevalent, and greater life-course adversity was associated with sleep disturbance. The association between childhood adversity and sleep was significantly mediated by adult adversity.

Conclusions: Sleep quality appears to correspond with life-course adversity, pointing to ongoing opportunities for prevention and intervention.

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Linking adverse experiences to pregnancy and birth outcomes

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Mersky, J. P., Jeffers, N. K., Plummer Lee, C., Shlafer, R. A., Jackson, D. B, & Gómez, A. (2024). Linking adverse experiences to pregnancy and birth outcomes: A life course analysis of racial and ethnic disparities among low-income women. Journal of Racial and Ethnic Health Disparities. Advance online publication. https://doi.org/10.1007/s40615-023-01647-w 

Racial and ethnic disparities in birth outcomes have persisted in the United States for decades, though the causes remain poorly understood. The life course perspective posits that poorer outcomes of Black birthing people stem from heightened exposure to stressors early in life and cumulative exposure to stressors over time. Despite its prominence, this perspective has seldom been investigated empirically. We analyzed longitudinal data gathered from 1319 women in low-income households in Wisconsin who received perinatal home visiting services. Variable- and person-centered analyses were performed to assess whether 15 adverse childhood experiences (ACEs) and 10 adverse adult experiences (AAEs) were associated, alone and in combination, with pregnancy loss, preterm birth, and low birth weight among Hispanic (i.e., Latinx) and non-Hispanic Black and White participants. As expected, there were disparities in preterm birth and low birth weight, and both ACEs and AAEs were linked to poorer pregnancy and birth outcomes. Unexpectedly, bivariate and multivariate analyses showed that the associated effects of ACEs and AAEs were most robust for non-Hispanic White women. A latent class analysis produced four patterns of life course adversity, and multigroup latent class analyses confirmed that, compared to White women, higher-adversity class assignments were associated with less robust effects for Hispanic women, and even less robust effects for Black women. We discuss interpretations of the paradoxical findings, including the possibility that alternative sources of stress such as interpersonal and structural racism may better account for the reproductive disparities that disproportionately affect Black birthing people.

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Trauma-Responsive Vocational Rehabilitation Services

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Chopp, S., Topitzes, J., & Mersky, J. P. (2023). Trauma-responsive vocational rehabilitation services. Behavioral Sciences, 13(6), 511.  https://www.mdpi.com/2076-328X/13/6/511

Research on the effectiveness of Vocational Rehabilitation (VR) Programs has revealed that VR services are less effective for trauma-affected and Black consumers. For instance, consumers with trauma exposure disengage from services earlier than their non-traumatized counterparts, and Black consumers benefit less from each phase of VR services compared to others. One midwestern state’s VR program sought to address these disparities by offering trauma-informed and trauma-responsive services that emphasize cultural responsiveness, racial equity, and strengths-based practices. To begin this work, the state’s VR program collaborated with an applied research unit in a public university to establish two work groups: a communications group and a training group. The purpose of the communications group was to build a robust referral network within the VR Division and with other community-based agencies and providers, particularly for low-income, Black consumers. The purpose of the training group was to develop and deliver a training program to support VR professionals in providing trauma-informed and trauma-responsive services. Results from an evaluation of the training indicated that each training module generated for staff both reminders and new insights into ways to effectively work with consumers. Staff expressed that they wanted opportunities to further explore and apply the training content and needed additional, ongoing support to implement what they were learning. In response to staff needs, the state’s VR program is continuing to invest in this community–university partnership by establishing communities of practice for staff and evaluating the effectiveness of the training program.

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Trauma Screening, Brief Intervention, and Referral to Treatment (T-SBIRT) Implemented within TANF Employment Services: An Outcome Study

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Topitzes, J., Bacalso, E., Plummer-Lee, C. T., Jonas-Gordon, S., & Mersky, J. P. (2022). Trauma Screening, Brief Intervention, and Referral to Treatment (T-SBIRT) Implemented within TANF Employment Services: An Outcome Study. Journal of Social Service Research, 48(6), 753-767.

Abstract

The current study tested a trauma screening, brief intervention, and referral to treatment (T-SBIRT) interview protocol as implemented within Temporary Assistance to Needy Families programming. Using a non-experimental process evaluation and quasi-experimental outcome evaluation (N = 88), the study assessed four research questions. First, do T-SBIRT providers reach model adherence rates above 90%? Second, do over 90% of T-SBIRT completers experience the intervention as tolerable? Third, is T-SBIRT completion associated with decreases in mental health symptoms? Fourth, is T-SBIRT completion linked to reductions in positive mental health screenings? Process data emerged from provider-completed integrity checklists. Participant-completed baseline and follow-up surveys furnished outcome data, i.e., mental health indicators from validated scales of depression, anxiety, and post-traumatic stress disorder (PTSD). Descriptive statistics answered questions one and two; multivariate analyses addressed questions three and four. Results revealed that providers realized adherence rates at 98.5%; 91.3% of completers found the protocol tolerable; and completers reported significant reductions in depression symptoms, PTSD symptoms, and positive PTSD screenings relative to a comparison group. Findings recommend integrating T-SBIRT into social services to promote participant mental health and potentially enhance program outcomes. Future T-SBIRT research should include a randomized controlled trial assessing long-term mental health, employment, and income outcomes.

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Adverse adult experiences and health outcomes: Racial and ethnic differences in a low-income sample

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Mersky, J. P., Plummer Lee, C., & Janczewski, C. E. (2022). Adverse adult experiences and health outcomes: Racial and ethnic differences in a low-income sample. Stress & Health.

Abstract

Extending research on adverse childhood experiences (ACEs), this study aimed to investigate whether the prevalence of and outcomes associated with adverse adult experiences vary among racial and ethnic subgroups. Survey data were collected from 1566 low-income women in Wisconsin using the Adult Experiences Survey (AES). Ten major adult adversities were assessed, including items that reference an intimate partner or household member (e.g., physical or emotional abuse, substance use) along with other social and economic stressors such as homelessness and discrimination. Adverse adult experiences were highly prevalent overall, but even more so among non-Hispanic Whites than their Black and Hispanic counterparts. The results reinforce prior research on ACEs in low-income populations. Lending further credence to these findings, tests of measurement invariance indicated that the AES demonstrated acceptable configural and scalar invariance across racial and ethnic groups. As expected, greater exposure to adult adversity was significantly related to poorer physical and mental health. These associations manifested cross-sectionally and longitudinally for observed and latent measures of adult adversity—even after controlling for ACEs. Associations between adult adversity and health were not moderated by race/ethnicity. In sum, adverse adult experiences were unequally distributed across racial/ethnic groups, but the consequences associated with adversity appeared to be evenly dispersed.

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Mental health among university employees during the COVID-19 pandemic: The role of previous life trauma and current posttraumatic stress symptoms

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Goldstein, E., Topitzes, J., Brown, R. L., & Jussel, A. B. (2022). Mental health among university employees during the COVID-19 pandemic: The role of previous life trauma and current posttraumatic stress symptoms. Psychological Trauma: Theory, Research, Practice, and Policy.

Abstract

Objective: Previous studies indicated that the coronavirus disease 2019 (COVID-19) pandemic has harmed the mental health of diverse samples. Adopting a trauma lens with a sample of university faculty and staff, this study examined risk conferred by previous exposure to traumatic life events (TLE) on pandemic-related mental health harm (MHH) and stress and the mediating influence of posttraumatic stress disorder (PTSD) symptoms. Method: In Spring 2021, employees (N = 641) of a public university in the United States completed an online cross-sectional survey, including validated scales of TLE and PTSD and single-item measures of MHH and stress taken from published COVID-19 studies. A structural probit model was used to estimate: (a) direct effects of cumulative TLE on PTSD, MHH, and stress; and (b) indirect effects of cumulative TLE via PTSD adjusting for age. Gender was tested as a moderating influence. Results: Nearly 36% of the sample reported positive PTSD screens along with high levels of MHH (22.5%) and stress (42.3%). Cumulative TLE was significantly and positively associated with MHH and stress. Both genders experienced a negative impact on mental health and stress either fully or partially through PTSD symptoms; however, the gender by trauma interaction term was not significant. As age decreased, PTSD and MHH increased. Conclusion: Results suggest that PTSD symptoms play a crucial role in the experience of MHH and stress during the pandemic for those who endured previous trauma. Implications for employer policies, public health messaging, and mental health services are explored.

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Intergenerational transmission of parental adverse childhood experiences and children’s outcomes: A scoping review

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Zhang, L., Mersky, J. P., Gruber, A. M., & Kim, J. Y. (2022). Intergenerational transmission of parental adverse childhood experiences and children’s outcomes: A scoping review. Trauma, Violence & Abuse. 

Adverse childhood experiences (ACEs) are among the leading environmental causes of morbidity and mortality. Extending research on within-generation effects, more recent scholarship has explored between-generation consequences of ACEs. Despite growing interest in the intergenerational effects of parents’ ACEs on children’s outcomes, this line of scholarship has yet to be coalesced into a comprehensive review. The current study is a scoping review on the intergenerational transmission of parental ACEs and children’s outcomes. Ten databases such as PubMed, APA PsycArticles, and Social Work Abstracts were searched. To be included, empirical studies must have been published in English and analyzed associations between a cumulative measure of at least four parental ACEs and children’s outcomes. Sixty-eight studies qualified for the review and, among these, 60 were published in the most recent 5 years (2018–2022). Fifty-one studies had sample sizes smaller than 500, and 55 focused on the effect of maternal ACEs. Nearly all studies demonstrated that parental ACEs could affect children’s outcomes directly or indirectly via mechanisms like maternal mental health problems or parenting-related factors. By scoping the extant literature, this review advances the knowledge base regarding the intergenerational impacts of parental childhood trauma and children’s outcomes. It also reveals methodological limitations that should be addressed in future research to strengthen causal inferences along with practical implications for interventions that aim to interrupt the intergenerational transmission of trauma.

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Helping nurses identify and report sentinel injuries of child abuse in infants

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Cleek, E. A., Totka, J. P., Sheets, L. K., Mersky, J. P., Haglund, K. L. (2022). Helping nurses identify and report sentinel injuries of child abuse in infants. Pediatric Nursing Journal, 48(3), 123-128. 

Abstract

Sentinel injuries (SIs) are some of the earliest and most readily identifiable red flags of child abuse. SIs are unexpected bruising or intra-oral injuries in premobile infants and highly correlated with child abuse. However, SIs are not always recognized and reported as red flags of child abuse. Infants are left at risk for continued harm when SIs are not identified and reported. Although increasing nurses’ knowledge of SIs is important, child abuse researchers and behavioral theorists have identified that knowledge alone does not predict nurses’ behaviors when identifying and reporting suspected child abuse. Other predictors may include implicit biases, interpersonal and interprofessional relationships, and nurses’ understanding of mandatory reporting laws. Nurses may improve their recognition and comfort of reporting SIs and all suspected child abuse by being alert for SIs, being aware of potential implicit biases, communicating in non-technical language with families, understanding the clinical evaluation of suspected child abuse, and understanding the processes of Child Protective Services (CPS). Using these steps, nurses can fulfill their legal and ethical responsibilities to protect and advocate for victimized children.

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Increasing mental health treatment access and equity through trauma-responsive care

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Mersky, J. P., Topitzes, J., Langlieb, J., & Dodge, K. A. (2021). Increasing mental health treatment access and equity through trauma-responsive care. American Journal of Orthopsychiatry.

Abstract

Adverse childhood experiences and other potentially traumatic events have lasting implications for mental health. Evidence-based treatments are available to address trauma-related symptoms, but their impact is hindered because access is limited and unequal. In the U.S., adverse experiences and mental disorders disproportionately affect socioeconomically disadvantaged groups that face treatment access barriers—disparities that are compounded by passive systems of care that wait for clients to seek treatment. This article presents a conceptual argument, backed by empirical evidence, that population health can be improved by implementing trauma-responsive practices, and that greater mental health equity can be achieved if these strategies are used to engage underserved clients. A description is provided of the Trauma Screening, Brief Intervention, and Referral to Treatment (T-SBIRT), a promising protocol that can be used by nonclinical providers to detect trauma-related mental health concerns in adults and help them access therapeutic services. The T-SBIRT protocol has been successfully implemented in diverse settings, and it is currently being piloted in a universal postpartum home visiting program called Family Connects. Prior results from three trials of Family Connects are summarized, including evidence of program impact on maternal mental health. New results are also presented indicating that T-SBIRT is feasible to implement within Family Connects, as denoted by indicators of suitability, tolerability, provider adherence, and referral acceptance. Closing recommendations are offered for reducing mental health disparities by testing and disseminating T-SBIRT through Family Connects and other large-scale programs and systems of care.

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Disparities in adverse childhood experiences by race/ethnicity, gender, and economic status

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Mersky, J. P., Choi, C., Plummer Lee, C, & Janczewski, C. E. (2021). Disparities in adverse childhood experiences by race/ethnicity, gender, and economic status: Intersectional analysis of a nationally representative sample. Child Abuse & Neglect.

Abstract

Background
Adverse childhood experiences (ACEs) are disturbingly common and consequential. Priority should be given to identifying populations that bear a disproportionate share of the burden of ACEs, but such disparities have received limited attention to date.

Objective
This study analyzes data from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative sample in the U.S., to explore variation in ACEs by race/ethnicity, economic status, and gender.

Methods
In addition to using conventional statistical methods to generate unadjusted and adjusted estimates, we conduct an intercategorical intersectional analysis of variation in ACEs using multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA).

Results
Descriptively, we find that ACEs are more prevalent overall among the poor than the non-poor, among most racial/ethnic minority groups than non-Hispanic Whites, and among females than males. However, multivariate regression results indicate that gender is not a robust correlate of cumulative adversity and that economic status moderates racial/ethnic differences. MAIHDA models further expose heterogeneity in aggregate ACE scores between intersectional strata representing unique combinations of gender, race/ethnicity, and economic status.

Conclusions
The MAIHDA results confirm that conclusions based on unadjusted group differences may be spurious. While most variance in ACE scores is explained by additive main effects, accounting for intersections among social categories generates a more complex portrait of inequality. We compare our work to prior studies and discuss potential explanations for and implications of these findings for research on disparities.

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A mutual process of healing self and healing the community

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Mueller, D., Bacalso, E., Ortega‐Williams, A., Pate Jr, D. J., & Topitzes, J. (2021). A mutual process of healing self and healing the community: A qualitative study of coping with and healing from stress, adversity, and trauma among diverse residents of a midwestern city. Journal of Community Psychology.

Abstract

Residents of urban American neighborhoods facing economic hardship often experience individual and collective adversities at high levels. This study explores how racially diverse adults experience stress, adversity, and trauma, and how they cope and heal in the context of their environment. Following a critical realist grounded theory methodology, four focus groups were conducted with African American, White and Latinx participants (N = 21) within an employment service program. Participants identified key stressors ranging from financial and job challenges, violence, and trauma. To cope with and heal from adversity, they practiced positivity, named trauma and its effects, sought social connection, envisioned community‐based resources, and addressed structural and systemic barriers. The data generated a theory of “a mutual process of healing self and healing the community” through intrapersonal, interpersonal, and structural change. The results of this study indicate a need for peer‐led, community‐engaged initiatives and holistic, trauma‐informed, healing‐centered practices.

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Toward the Assessment of Adverse Adult Experiences: An Initial Validation Study of the Adult Experiences Survey

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Mersky, J. P., Plummer Lee, C., & Janczewski, C. E. (2020). Toward the Assessment of Adverse Adult Experiences: An Initial Validation Study of the Adult Experiences Survey. Psychological Trauma: Theory, Research, Practice, and Policy.

Objective: The current investigation is a validation study of the Adult Experiences Survey, a seminal assessment of adverse adult experiences.

Method: Data were collected between July 2015 and June 2019 from a sample of 1,747 low-income women as part of a longitudinal study in Wisconsin, United States. Analyses of 10 adversities were conducted to assess item prevalence and internal consistency in the full sample and test-retest reliability in a subsample of 90 participants. Exploratory and confirmatory factor analyses were performed to examine the factor structure of the measure, and multivariate regressions were conducted to estimate the effects of adult adversity on 3 health-related outcomes: poor physical health, depression, and posttraumatic stress disorder.

Results: Most participants (86%) endorsed at least 1 adversity. Each item demonstrated good test-retest reliability except crime victimization, and the full measure had sound internal consistency. Each adversity was associated with all health-related outcomes at the bivariate level, and most were linked to 1 or more outcomes in multivariate analyses. Exploratory and confirmatory factor analyses validated 1- and 2-factor solutions with good fit. A cumulative adult adversity score was associated with all study outcomes controlling for adverse childhood experiences, and effects associated with a latent adversity score were even larger in magnitude.

Conclusions: Extending research on adverse childhood experiences, the findings indicate that adverse adult experiences can be measured reliably and validly using a brief assessment. Implications are discussed, including opportunities to advance the study of trauma and resilience over the life course.

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Validity of an expanded assessment of adverse childhood experiences: A replication study

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Choi, C., Mersky, J. P., Janczewski, C. E., Plummer Lee, C., Davies, W. H., & Lang, A. C. (2020). The Childhood Experiences Survey: Replication study of an expanded assessment of adverse childhood experiences. Children and Youth Services Review.  

Research has shown unequivocally that adverse childhood experiences (ACEs) are prevalent and consequential, but the field lacks consensus around how they should be measured. This replication study reexamined the construct and concurrent validity of the Childhood Experiences Survey (CES), an expanded assessment of 10 conventional ACEs and seven novel childhood adversities. The CES was administered to three samples of adults with children in a Midwest state: (1) caregivers whose children were the subject of a screened-in child protective services report (n = 1,087), (2) low-income women who voluntarily enrolled in a home visiting program (n = 659), and (3) a convenience sample from general population (n = 667). The prevalence of childhood adversities and their intercorrelations were assessed. Extending a previous exploratory analysis, a confirmatory factor analysis was conducted to examine the underlying structure of the CES, and tests of association were performed between the factors and adult mental health outcomes. Results confirmed that all 17 adversities were common and interrelated. For each sample, the 10 conventional ACEs fit a two-factor structure: child maltreatment and household dysfunction. The expanded assessment of 17 adversities fit a four-factor solution: direct victimization/household dysfunction, neglect, poverty, and family separation/loss. All factors were significantly associated (p < .05) with depressive symptoms and anxiety symptoms in all three samples. Implications for further measurement development aimed at advancing ACE research are discussed.

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Adverse childhood experiences and psychological well-being in a rural sample of Chinese young adults

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Zhang, L., Mersky, J. P., & Topitzes, J. (2020). Adverse childhood experiences and psychological well-being in a rural sample of Chinese young adults. Child Abuse & Neglect. 

Background

International interest in adverse childhood experiences (ACE) is on the rise. In China, recent research has explored the effects of ACEs on health-related outcomes, but little is known about how ACEs impact the psychological functioning of rural Chinese youth as they make transition to adulthood.

Objective

This study is aimed to assess the prevalence and psychological consequences of ACEs among a group of rural Chinese young adults.

Participants and settings

1019 rural high school graduates from three different provinces of China participated in this study.

Methods

A web-based survey was used to assess ten conventional ACEs and seven other novel ACEs using the Childhood Experiences Survey. Using validated brief measures, six indicators of psychological functioning were assessed: anxiety, depression, perceived stress, posttraumatic stress, loneliness, and suicidality. Descriptive and correlational analyses of all ACEs were performed, and multivariate regressions were conducted to test associations between ACEs and study outcomes.

Results

Three-fourths of Chinese youth endorsed at least one of ten conventional ACEs. The most prevalent ACEs were physical abuse (52.3 %) and domestic violence (43.2 %). Among seven new adversities, prolonged parental absence (37.4 %) and parental gambling problems (19.7 %) were most prevalent. Higher conventional ACEs scores were significantly associated with poorer psychological functioning, and each type of new adversity was associated with one or more psychological problems.

Conclusion

ACEs were prevalent among rural Chinese young adults and had deleterious effects on their psychological well-being. Further work is needed to address ACEs by developing culturally appropriate assessment practices, interventions, and policy responses.

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Bidirectional Relations between Adverse Childhood Experiences and Children’s Behavioral Problems

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Zhang, L., & Mersky, J. P. Bidirectional relations between adverse childhood experiences and children’s behavioral problems. (2020). Child and Adolescent Social Work Journal.

Research has shown that adverse childhood experiences (ACEs) increase the risk of poor health and well-being, yet less is known about the pathways through which these life outcomes emerge. For instance, prospective, longitudinal research into the link between ACEs and the trajectories of children’s behavioral problems is limited. Moreover, no longitudinal study has investigated whether children’s behavioral problems also increase their risk of adverse experiences over time. Therefore, the main purpose of this study is to explore bidirectional relations between adverse childhood experiences (ACEs) and children’s behavioral problems in a sample of low-income children. This study uses the Fragile Families and Child Wellbeing Study, a birth cohort study of 4898 children followed from birth through 15 years of age. A random intercept cross-lagged panel model was fit to examine the bidirectional relations between ACEs and child behavioral problems. Study findings indicated that age 5 ACEs score significantly predicted age 9 anxious or depressed problems and age 9 aggressive problems. Age 5 anxious or depressed problems also significantly predicted age 9 ACEs exposure. From age 3 to age 9, ACEs also played a dominant role in the bidirectional relations with behavioral problems. There were certain bidirectional relations between ACEs and child behavioral problems. The findings have implications for understanding the etiology and consequences of adversities as well as the design of prevention and intervention strategies.

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The transmission of violence and trauma across development and environmental contexts

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Voith, L. A., Topitzes, J., and Berg, K. A. (2020). The transmission of violence and trauma across development and environmental contexts: Intimate partner violence from the perspective of men with histories of perpetration. Child Abuse & Neglect, 99.

Background
Research has established a relation between ecological contexts and intimate partner violence (IPV), but little is known about how environmental factors affect childhood development over time and culminate in IPV perpetration from the perspective of men who perpetrated IPV.

Methods
Using grounded theory, this study employed focus groups with 32 predominately low-income, African American men in batterer intervention programs to explore factors and processes through which families, neighborhoods, and policy influence men’s development, contributing to their use of IPV. Using an inductive approach, the researchers cycled between data collection and analysis resulting in a parsimonious conceptual model validated by participants.

Results
Three core categories emerged from focused and axial coding: adverse childhood experiences (ACEs) and trauma, structural forces, and systemic forces. Theoretical coding illuminated how these core categories relate to each other, producing a collective narrative illustrating how environmental contexts contributed to men’s development. Study participants described childhood exposure to adversity and trauma within the home that diminished essential foundations of trust and safety. Positive (e.g., Old Heads, matriarchs) and negative (e.g., gangs, community violence) structural neighborhood forces influenced the social learning of violence and exposed participants to re-traumatization outside the home during their adolescence. Finally, key macro forces such as mass incarceration exacerbated violence and trauma exposure through the proliferation of high-risk neighborhoods, predisposing men toward IPV as young adults.

Conclusions
Findings reinforce the notion that environmental stress not buffered by protective adults profoundly affects development and behavior. From the perspective of male perpetrators, our results help identify those stressors and how they might contribute to male-to-female IPV.

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Trauma-responsive child welfare services: A mixed methods study assessing safety, stability and permanency

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Topitzes, J., Grove, T., Pangratz, S, Meyer, E. E., & Sprague, C. M. (2019). Trauma-responsive child welfare services: A mixed methods study assessing safety, stability and permanency. Journal of Child Custody.

Objective
Trauma-informed or trauma-responsive programming has spread across many service sectors including child welfare. However, only a few evaluations of such child welfare programs have been published.

Method
The current mixed methods study assessed a trauma-responsive child welfare program implemented within a private agency located in the Midwest region of the U.S. The intervention combined specialized training, assessment, case planning, and case consultation into a trauma-responsive case management model.

Results
Quantitative data, gathered through a quasi-experimental design (N=598), revealed that program participation was associated with improved permanency but not with enhanced child safety. Qualitative data, gathered from staff interviews (N=10), helped to contextualize quantitative results, highlighting staff experiences and impressions of the program. Implications of results are discussed.

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Implementing Trauma Screening, Brief Intervention, and Referral to Treatment (T‐SBIRT) within employment services: A feasibility trial

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Topitzes, J., Mersky, J. P., Mueller, D. J., Bacalso, E., & Williams, C. (2019). Implementing Trauma Screening, Brief Intervention, and Referral to Treatment (T‐SBIRT) within employment services: A feasibility trial. American Journal of Community Psychology.

Abstract

Research suggests that low‐income adults accessing employment services have experienced high levels of trauma exposure and associated consequences. Moreover, the health‐related effects of trauma undermine employment and employability. A trauma‐informed protocol—trauma screening, brief intervention, and referral to treatment or T‐SBIRT—was therefore implemented within employment service programs serving low‐income urban residents. To assess the feasibility of integrating T‐SBIRT within employment services, five domains were explored as follows: suitability, acceptability, client adherence, provider adherence or fidelity, and intended outcomes. With a sample of low‐income adults (N = 83), the study revealed that T‐SBIRT is suitable for employment service participants given high rates of trauma exposure (90.4% experienced two or more lifetime traumas), along with high rates of positive screening results for post‐traumatic stress disorder (48.8%), major depression (35.4%), and generalized anxiety (47.6%). Study participants appeared to find T‐SBIRT acceptable as evidenced by an 83% acceptance rate. All participants accepting T‐SBIRT services completed them, revealing strong client adherence. Provider adherence or model fidelity was high, that is, 98.5%. Finally, the majority of participants accepted a referral to a mental health care (i.e., 56.6%), and over three‐quarters accepted a referral to any outside service including primary or mental health care. Implications of findings are discussed.

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Applied and translational research on trauma-responsive programs and policy: Introduction to a special issue of the American Journal of Community Psychology

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Herrenkohl, T. I., Mersky, J. P., & Topitzes, J. (2019). Applied and translational research on trauma-responsive programs and policy: Introduction to a special issue of the American Journal of Community Psychology. American Journal of Community Psychology.

Abstract

The special issue highlights work across systems that include child welfare, education, juvenile justice and health, as well as agencies serving adults who are at‐risk for high levels of childhood and adult trauma exposure. While articles appearing in the special issue are not divided equally across these systems, they cover important and overlapping concepts within each. Some articles span more than a single system or domain of research, whereas others fit primarily within single area or domain. Articles provide new insights from research on practices, programs, and policies that help to transform systems so they are increasingly more responsive to the needs of vulnerable populations.

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Adverse childhood experiences and poor birth outcomes in a diverse, low-income sample

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Mersky, J. P., & Plummer Lee, C. (2019). Adverse childhood experiences and poor birth outcomes in a diverse, low-income sample. BMC Pregnancy and Childbirth, 19(387), 1-7.

Background
Adverse childhood experiences (ACE) are associated with an array of health consequences in later life, but few studies have examined the effects of ACEs on women’s birth outcomes.

Methods
We analyzed data gathered from a sample of 1848 low-income women who received services from home visiting programs in Wisconsin. Archival program records from a public health database were used to create three birth outcomes reflecting each participant’s reproductive health history: any pregnancy loss; any preterm birth; any low birthweight. Multivariate logistic regressions were performed to test the linear and non-linear effects of ACEs on birth outcomes, controlling for age, race/ethnicity, and education.

Results
Descriptive analyses showed that 84.4% of women had at least one ACE, and that 68.2% reported multiple ACEs. Multivariate logistic regression analyses showed that cumulative ACE scores were associated with an increased likelihood of pregnancy loss (OR = 1.12; 95% CI = 1.08–1.17), preterm birth (OR = 1.07; 95% CI = 1.01–1.12), and low birthweight (OR = 1.08; 95% CI = 1.03–1.15). Additional analyses revealed that the ACE-birthweight association deviated from a linear, dose-response pattern.

Conclusions
Findings confirmed that high levels of childhood adversity are associated with poor birth outcomes. Alongside additive risk models, future ACE research should test interactive risk models and causal mechanisms through which childhood adversity compromises reproductive health.

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Promoting evidence-based, trauma-informed social work practice

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Mersky, J. P., Topitzes, J., & Britz, L. (2019). Promoting evidence-based, trauma-informed social work practice. Journal of Social Work Education, 55(4), 645-657.

Abstract

Given the human costs of psychological trauma, social workers should be well versed in trauma-informed care (TIC). This framework helps guide the efforts of systems, organizations, and practitioners toward reducing trauma or mitigating its effects. The field has created TIC principles, although they have yet to be fully realized as practical applications. This article makes the case that theoretically and empirically grounded content on trauma should be foundational to social work education. We also argue that social work practice will be advanced by clearly defining trauma and by distinguishing TIC from trauma-focused and trauma-sensitive approaches. Finally, a TIC certificate program illustrates how graduate student training and social work practice are enhanced by integrating trauma content into classroom and field settings.

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Client and provider discomfort with an adverse childhood experiences survey

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Mersky, J. P., Plummer Lee, C., & Gilbert, R. M. (2019). Client and provider discomfort with an adverse childhood experiences survey. American Journal of Preventive Medicine, 57(2), e51-e58.

Introduction
Many service providers report concerns that questions about adverse events may upset clients. Studies indicate that most survey respondents answer sensitive questions without experiencing distress, although little is known about the prevalence or correlates of clients’ discomfort when they are asked similar questions by direct care providers, such as home visitors.

Methods
This study used data collected between 2013 and 2018 from 1,678 clients and 161 providers in a network of home visiting programs in Wisconsin. Clients and home visitors completed an adverse childhood experience questionnaire that concludes by asking about discomfort with the questions. Analyses conducted in 2018 examined overall client discomfort and associations between discomfort and the endorsement of 10 distinct adverse childhood experiences. Multilevel regressions were performed to test whether client and provider factors were associated with client discomfort.

Results
More than 80% of clients were not at all or slightly uncomfortable with the adverse childhood experience questionnaire, and 3% reported extreme discomfort. Bivariate results showed that each adverse childhood experience, except parental divorce, was associated with greater discomfort; sexual abuse was the only adverse childhood experience associated with discomfort in a multivariate analysis. Multiple client variables were linked to increased discomfort, including higher adverse childhood experience scores (b=0.06, 95% CI=0.04, 0.08) and depression scores (b=0.01, 95% CI=0.00, 0.02). Home visitor discomfort was positively associated with client discomfort (b=0.16, 95% CI=0.01, 0.31).

Conclusions
Results indicated that most clients in home visiting programs tolerated an adverse childhood experience questionnaire well. The findings point to clients who may be more likely to report discomfort and highlight an important association between client and provider discomfort.

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Do parents’ adverse childhood experiences influence treatment responses to Parent-Child Interaction Therapy? An exploratory study with a child welfare sample

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Blair, K., Topitzes, J., & Mersky, J. P. (2019).  Do parents’ adverse childhood experiences influence treatment responses to Parent-Child Interaction Therapy? An exploratory study with a child welfare sample. Child & Family Behavior Therapy, 41(2), 73-83.

Abstract

This exploratory study of 23 parent–child dyads receiving child welfare services examined the association between the number of adverse childhood experiences (ACEs) parents reported and their children’s externalizing behaviors. We also assessed whether the effects of Parent-Child Interaction Therapy (PCIT) on externalizing behaviors varied by parents’ ACE histories. Results indicated that parents’ ACE scores were associated with child externalizing symptoms at baseline, but not at a second postbaseline assessment. Although all parents reported reductions in child externalizing behavior from baseline to postbaseline, only reductions reported by parents with four or more ACEs were statistically significant. Implications for implementing PCIT with trauma-exposed families are discussed.

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Adverse childhood experiences and postpartum depression in home visiting programs: Prevalence, association, and mediating mechanisms

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Mersky, J. P., & Janczewski, C. E. (2018). Adverse childhood experiences and postpartum depression in home visiting programs: Prevalence, association, and mediating mechanisms. Maternal and Child Health Journal.

Objectives
In this study, we examined the prevalence of postpartum depression (PPD) and its association with select demographic factors and antenatal conditions. We also investigated whether greater exposure to adverse childhood experiences (ACEs) is associated with PPD, and if antenatal conditions mediate the ACE-PPD relationship.

Methods 
Data were collected from 735 low-income women receiving home visiting services. Descriptive and bivariate analyses provided estimates of PPD and its correlates, and nested path analyses were used to test for mediation.

Results 
We found that rates of PPD were high compared to prevalence estimates in the general population. Sample rates of antenatal depression were even higher than the rates of PPD. Omnibus tests revealed that PPD did not vary significantly by maternal age or race/ethnicity, although Hispanic women consistently reported the lowest rates. American Indian women and non-Hispanic white women reported the highest rates. PPD was significantly associated with increased exposure to ACEs. Nested path models revealed that the effects of ACEs were partially mediated by three antenatal conditions: intimate partner violence (IPV), perceived stress, and antenatal depression.

Conclusions for Practice 
Supporting prior research, rates of PPD appear to be high among low-income women. ACEs may increase the risk of antenatal IPV and psychological distress, both of which may contribute to PPD. The findings have implications for screening and assessment as well as the timing and tailoring of interventions through home visiting and other community-based services.

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Racial and Ethnic Differences in the Prevalence of Adverse Childhood Experiences: Findings from a Low-Income Sample of U.S. Women

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Mersky, J. P., Janczewski, C. E. (2018). Racial and Ethnic Differences in the Prevalence of Adverse Childhood Experiences: Findings from a Low-Income Sample of U.S. Women. Child Abuse and Neglect.

Objective
Despite great interest in adverse childhood experiences (ACEs), there has been limited research on racial and ethnic differences in their prevalence. Prior research in the United States suggests that the prevalence of ACEs varies along socioeconomic lines, but it is uncertain whether there are racial/ethnic differences in ACE rates among low-income populations.

Method
This study examined the distribution of ACEs in a sample of 1523 low-income women in Wisconsin that received home visiting services. Participants ranging in age from 16 to 50 years were coded into five racial/ethnic groups, including Hispanics and four non-Hispanic groups: blacks, whites, American Indians, and other race. Following measurement conventions, ten dichotomous indicators of child maltreatment and household dysfunction were used to create a composite ACE score. Five other potential childhood adversities were also assessed: food insecurity, homelessness, prolonged parental absence, peer victimization, and violent crime victimization.

Results
Results from bivariate and multivariate analyses revealed that, while rates of adversity were high overall, there were significant racial/ethnic differences. Total ACE scores of American Indians were comparable to the ACE scores of non-Hispanic whites, which were significantly higher than the ACE scores of non-Hispanic blacks and Hispanics. Whites were more likely than blacks to report any abuse or neglect, and they were more likely than blacks and Hispanics to report any household dysfunction.

Conclusion
The results underscore the need to account for socioeconomic differences when making racial/ethnic comparisons. Potential explanations for the observed differences are examined.

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Translating Evidence-Based Treatments into Child Welfare Services Through Community-University Partnerships: A Case Example of Parent-Child Interaction Therapy

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Mersky, J. P., Topitzes, J., & Blair, K. (2017). Translating evidence-based treatments into child welfare services through community-university partnerships: A case example of parent-child interaction therapy. Children and Youth Services Review.

Objective
Children served by the child welfare system count among society’s most vulnerable members given their history of abuse, neglect, and other potentially traumatic experiences. Once they enter the system, however, these children seldom receive empirically validated interventions to mitigate the effects of trauma. This article highlights the promise of parent-child interaction therapy (PCIT), an evidence-based treatment (EBT) for trauma-exposed children in the child welfare system. Barriers to implementing PCIT and other EBTs in child welfare are discussed along with ways that community-university partnerships can help to navigate these barriers. Preliminary supporting evidence from a community-university partnership in Wisconsin is presented, followed by a set of recommendations for future work aimed at translating science into practice.

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Complementing SBIRT for Alcohol Misuse with SBIRT for Trauma: A Feasibility Study

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Topitzes, J., Berger, L., Otto-Salaj, L., Mersky, J.P., Weeks, F., Ford, J. (2017). Complementing SBIRT for alcohol misuse with SBIRT for trauma: A feasibility study. Journal of Social Work Practice in the Addictions.

Objective
Reducing alcohol misuse is a priority for U.S. health officials considering that misuse of alcohol is a leading preventable cause of morbidity and mortality. Consequently, health centers are routinely integrating Screening, Brief Intervention, and Referral to Treatment (SBIRT) for alcohol misuse within usual care. Although SBIRT is well validated among general patient samples, results have not generalized to drinkers with probable alcohol use disorder, and little is known about the efficacy of SBIRT with low-income, minority patients. Members of these groups are of particular concern because they are at risk for experiencing high rates of trauma exposure concurrent with high rates of alcohol-related problems. Therefore, innovative approaches to delivering SBIRT might be needed in order to enhance the efficacy of SBIRT with these high risk groups and to meet the Grand Challenge of reducing alcohol misuse.

Method
This study combined SBIRT with a model designed to address psychological trauma: T-SBIRT. With a sample of 112 adults, most of whom were African American or Latino/a and of low-income status, authors analyzed multiple indicators of feasibility: a) suitability of treatment, b) acceptability of treatment, c) patient compliance (also known as patient adherence), d) treatment integrity, and e) intended outcomes.

Results
Results indicated that T-SBIRT is suitable for and acceptable to patients accessing community-based health services, and that T-SBIRT can generate high rates of patient compliance. Moreover, behavioral health providers can implement T-SBIRT with high rates of model fidelity, and the model can promote high referral acceptance rates to specialty treatment, particularly among patients with probable alcohol use disorder.

Conclusion
It is feasible to implement T-SBIRT within community-based primary health clinics according to both patient and provider indicators of feasibility. T-SBIRT may prove a promising supplement to SBIRT particularly for service recipients at-risk of alcohol use disorder and/or for low income, ethnic racial minority patients.

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Rethinking the Measurement of Adversity: Moving Toward Second-Generation Research on Adverse Childhood Experiences

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Mersky, J. P., Janczewski, C. E., & Topitzes, J. (2017). Rethinking the measurement of adversity: Moving toward second-generation research on adverse childhood experiences. Child Maltreatment.

Objective
Research on adverse childhood experiences (ACEs) has unified the study of interrelated risks and generated insights into the origins of disorder and disease. Ten indicators of child maltreatment and household dysfunction are widely accepted as ACEs, but further progress requires a more systematic approach to conceptualizing and measuring ACEs.

Method
Using data from a diverse, low-income sample of women who received home visiting services in Wisconsin (N = 1,241), this study assessed the prevalence of and interrelations among 10 conventional ACEs and 7 potential ACEs: family financial problems, food insecurity, homelessness, parental absence, parent/sibling death, bullying, and violent crime. Associations between ACEs and two outcomes, perceived stress and smoking, were examined. The factor structure and test–retest reliability of ACEs was also explored.

Results
As expected, prevalence rates were high compared to studies of more representative samples. Except for parent/sibling death, all ACEs were intercorrelated and associated at the bivariate level with perceived stress and smoking. Exploratory factor analysis confirmed that conventional ACEs loaded on two factors, child maltreatment and household dysfunction, though a more complex four-factor solution emerged once new ACEs were introduced. All ACEs demonstrated acceptable test–retest reliability.

Conclusion
Implications and future directions toward a second generation of ACE research are discussed.

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Adverse Childhood Experiences, Health, and Employment: A Study of Men Seeking Job Services

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Topitzes, J., Pate, D., Berman, N., Medina-Kirchner, C. (2016). Adverse childhood experiences, health, and employment: A study of men seeking job services. Child Abuse and Neglect.

Objective
The present study explored factors associated with barriers to current employment among 199 low-income, primarily Black American men seeking job services.

Method
The study took place in an urban setting located within the upper Midwest region of the U.S., where the problem of Black male joblessness is both longstanding and widespread. Recent research suggests that Black male joblessness regionally and nationally is attributable to myriad macro- and micro-level forces. While structural-level factors such as migration of available jobs, incarceration patterns, and racism have been relatively well-studied, less is known about individual-level predictors of Black male joblessness, which are inextricably linked to macro-level or structural barriers. This study therefore examined relations between adverse childhood experiences (ACEs), health-related factors, and employment-related problems.

Results
Participants faced both specific and cumulative childhood adversities at much higher rates than men from more economically advantaged contexts. In addition, the physical, behavioral, and mental health of the study participants were, according to self-report survey results, notably worse than that of the general population or alternative samples.

Conclusion
Finally, results indicated that exposure to ACEs may have helped to undermine the men’s ability to attain current employment and that drug problems along with depression symptoms helped explain the link between ACEs and employment barriers. Theoretical and practical implications of results are explored.

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Impacts of Adverse Childhood Experiences on Health, Mental Health, and Substance Use in Early Adulthood: A Cohort Study of an Urban, Minority Sample in the U.S.

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Mersky, J.P., Topitzes, J., Reynolds, A. (2013). Impacts of adverse childhood experiences on health, mental health, and substance use in early adulthood: A cohort study of an urban, minority sample in the U.S. Child Abuse and Neglect.

Objective
Research has shown that adverse childhood experiences (ACEs) increase the risk of poor health-related outcomes in later life. Less is known about the consequences of ACEs in early adulthood or among diverse samples. Therefore, we investigated the impacts of differential exposure to ACEs on an urban, minority sample of young adults.

Method
Health, mental health, and substance use outcomes were examined alone and in aggregate. Potential moderating effects of sex were also explored. Data were derived from the Chicago Longitudinal Study, a panel investigation of individuals who were born in 1979 or 1980. Main-effect analyses were conducted with multivariate logistic and OLS regression. Sex differences were explored with stratified analysis, followed by tests of interaction effects with the full sample.

Results
Results confirmed that there was a robust association between ACEs and poor outcomes in early adulthood. Greater levels of adversity were associated with poorer self-rated health and life satisfaction, as well as more frequent depressive symptoms, anxiety, tobacco use, alcohol use, and marijuana use. Cumulative adversity also was associated with cumulative effects across domains. For instance, compared to individuals without an ACE, individuals exposed to multiple ACEs were more likely to have three or more poor outcomes (OR range = 2.75–10.15) and four or more poor outcomes (OR range = 3.93–15.18). No significant differences between males and females were detected.

Conclusion
Given that the consequences of ACEs in early adulthood may lead to later morbidity and mortality, increased investment in programs and policies that prevent ACEs and ameliorate their impacts is warranted.

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Adult Resilience Among Maltreated Children: A Prospective Investigation of Main Effect and Mediating Models

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Topitzes, J., Mersky, J.P., Dezen, K., Reynolds, A. (2013). Adult resilience among maltreated children: A prospective investigation of main effect and mediating models. Children and Youth Services Review.

Objective

Studies examining resilience to child maltreatment reveal that maltreatment victims can achieve adaptive functioning in several areas of development; however, few of these individuals persistently demonstrate resilience across multiple domains. The majority of these investigations define adjustment with a limited number of outcomes measured proximal in time to the maltreatment experience. In contrast, this study measured adjustment across a diverse set of domains during early adulthood (ages 16–24), a number of years after the occurrence of childhood maltreatment (ages 0–11).

Method

Main effect and mediation analyses were conducted. Data were derived from the Chicago Longitudinal Study, an examination of 1539 minority individuals born in low-income Chicago-area neighborhoods in 1979 or 1980. Study participants were followed prospectively from birth through age 24. Maltreatment data originated from official court and child protective service records. Parent report, self report, and administrative sources informed covariate, mediator and outcome measures.

Results

Results from multivariate probit regression revealed that childhood maltreatment significantly and negatively predicted adult resilience. Exploratory and confirmatory mediation analyses showed that the following adolescent indicators helped explain the long-term association between childhood maltreatment and young adult adjustment: school moves and out-of-home placement, reading ability, acting out behavior, social skills, juvenile delinquency, commitment to school, and expectation to attend college.

Conclusion

Implications of results are explored.

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Adult Well-Being of Foster Care Alumni: Comparisons to Other Child Welfare Recipients and a Non-Child Welfare Sample in a High-Risk, Urban Setting

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Mersky, J.P., Janczewski, C.E. (2013). Adult well-being of foster care alumni: Comparisons to other child welfare recipients and a non-child welfare sample in a high-risk, urban setting. Children and Youth Services Review.

Objective
Research has shown that children placed in foster care fall below population norms on many indicators of well-being. Yet few studies have been designed to distill the effects of foster care from conditions that precede foster care. Based on the available evidence, it is also uncertain whether the purported effects of foster care are lasting. This study used data gathered prospectively from an economically disadvantaged, urban cohort to examine whether foster care is associated with decreased educational and economic attainments as well as increased criminality in adulthood.

Method
Individuals who were placed in foster care after an indicated allegation of maltreatment were compared to three naturally occurring groups: (a) maltreatment victims who did not reside in foster care, (b) individuals without an indicated maltreatment allegation who were raised in a household with a Child Protective Services (CPS) record, and (c) individuals without an individual or household record of CPS involvement.

Results
Using multiple estimation procedures, we found that all participants with a CPS record fared worse in adulthood than their peers without a CPS record. Despite their poor outcomes, foster children functioned as well as other CPS recipients who did not reside in foster care.

Conclusion
Our findings indicate that caution is warranted when attributing dysfunction observed in foster children to the effects of foster care. Implications for prevention and intervention within the context of child welfare are discussed.

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