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Background: The study sought to explore the under-researched areas of adversity, resilience, and wellbeing in female survivors of Domestic Abuse (DA). We employed a multi-phase mixed-methods research design comprising a cross-sectional online quantitative survey in phase one and qualitative remote interviews in phase two. Method: In phase one, a convenience sample of 119 adult female participants, 63 who had experienced DA and 56 in a control group, completed the Adverse Childhood Experiences (ACE) Questionnaire, the Short Warwick-Edinburgh Mental Well-being Scale, the Depression, Anxiety, and Stress Scale, and the Connor-Davidson Resilience scale. In phase two, 8 of the participants from phase one who had experienced DA were recruited for semi-structured interviews to explore their experiences in depth and these were analysed using thematic analysis. Results: In phase one, survivors of DA were found to have experienced significantly more ACEs and to have higher levels of anxiety and stress than the control group. Survivors of DA were more likely to have experienced emotional, physical, and sexual abuse and emotional neglect and be exposed to substance abuse or alcoholism and mental illness within their household in childhood than the control group. Resilience was found to moderate the relationship between ACEs and mental wellbeing, such that resilience is less protective against poor wellbeing in those with high ACEs. Resilience was also found to be a stronger predictor of mental wellbeing than ACEs. In phase two, the thematic framework included five major themes: Early life challenges and adversity, Coping strategies, Support and judgement, Resilience and development, and Psychological distress, health, and wellbeing. Conclusion: Results indicate that early life adversity is an additional concern for adult female survivors of DA. They also highlight the importance of resilience, coping, and support and indicate areas of psychological distress and need where services and helping professionals can support survivors.

Adverse childhood experiences (ACEs) is a term developed to define one of ten possible experiences that affect children as they are growing up that can lead to problems later in life. In the early stages of the PhD relatively little was known about how much ACEs cost society and how ACEs affect lifetime socioeconomic status and social mobility. Research published in 2020, however, estimated that ACEs cost the economy of England and Wales £48.2 billion. This thesis is in two parts. The first part deals with testing a methodology for attributing lifetime health costs to the presence or absence of ACEs across five main diseases in terms of expenditure (Chapters 2-3). This thesis proposes a novel approach to achieve this aim which can be broadly defined as performing an extrapolation of the data that is available or a prorata approach to estimate the missing data. The second part (Chapters 4-5) of the thesis addresses the issue of whether ACEs are associated with a degree of lifetime social mobility defined by wealth in adulthood compared with wealth in childhood. Both parts of the thesis employ systematic informed reviews of current evidence (Chapters 2 and 5). In part 1, looking at attributable health costs, a population attributable fraction (PAF) methodology is used (Chapter 3). In part 2, social mobility is explored using part of the ACEs dataset (which is a large survey dataset conducted in Wales, England, Blackburn with Darwen and southern England between 2012 and 2015 (N=13,130) of the general public asking them to reflect on their ACEs). The areas used in the analytical chapter were a subset of this broader dataset and was confined to Wales and Southern England (N=7,429) as only these areas had the variable 'wealth in childhood/adulthood' used to calculate social mobility. The two parts of the thesis are connected. It is posited that an increase in investment to tackle ACEs, the amount of which is identified in the costing section, leads to an increase in social mobility and hence a commensurate increase in tax revenues for the government that could, if the government were so inclined, be invested back into society to deal with the outcomes associated with ACEs. This thesis provides two novel findings. First, that it was possible to find lifetime attributable costs for mental health, cancer and circulatory disease but not the other two areas of musculoskeletal and genitourinary disease. This was because of a lack of information on odds ratios for ACE counts for musculoskeletal disease and a lack of data on odds ratios and costs for genitourinary disease. Secondly, with respect to social mobility, this thesis found a counter intuitive, but statistically significant outcome where increasing ACEs were associated with an increased likelihood of upward social mobility. This may be because access to health and social care increases as ACE counts increased. Another explanation may be that people become upwardly mobile despite ACEs by having access to a trusted adult and developing resilience. One way of preventing ACEs from being passed down the generations is through social mobility. The question will be asked if there are any enablers in terms of the promotion of resilience that aid social mobility in children who have experience of ACEs. This relationship is tested with the data in Chapter 5 and it is found that having a trusted adult is linked with upward social mobility given that the respondents have ACEs. That is children become upwardly mobile despite adversity given the help of a trusted adult. The second finding also gave rise to a research dilemma. I could not reject the counterintuitive result because it was significant and could not rejoice over the intuitive result as it was not significant. Suffice to say that the knowledge base of this field of study has been expanded by this thesis. In the final chapter, policy recommendations are offered based on the results of this thesis, around approaches to dealing with ACEs especially considering improving social mobility. Developing access to a 'trusted adult' is seen as key in providing children with an element of resilience against the harmful effect of ACEs. This thesis argues that if the role of trusted adults can be maintained and developed then this can protect children against the possibility of downward social mobility and even lead to upward social mobility. That is, children can 'move on up' despite having several ACEs, if given the right support with economic benefits both to themselves and the economy as a whole.

Childhood adversities, parental mental health and attachment style impact emotional regulation capacity and stress response. Individuals who have emotional regulation difficulties are increasing vulnerable to develop mental health disorders across their lifespan. Adolescence is a key developmental stage with increased levels of neuroplasticity. Mental health and wellbeing intervention and prevention at this age can reduce or mitigate the adverse health outcomes associated with biological vulnerabilities, adversities, and the social determinants of health such as poverty or social deprivation. Schools occupy a pivotal position within young people's lives and are well placed to support pupil emotional health and wellbeing development. However, the ability of post-primary schools in NI to offer mental health intervention and prevention resources was unclear before this research. The Department of Education (DE) did not monitor or oversee the school's role in this provision which hindered policy development. This thesis aimed to explore the NI ecological system's first and second-order networks that facilitated or prevented schools from offering mental health and wellbeing supports to pupils. Secondary analysis of the Ulster University Wellbeing study highlighted the impact of early childhood adversities, including bullying, on lifetime rates of psychopathology. It showed that when the type of adversity is repeated across environments, i.e. when a person is exposed to verbal bullying in school and emotional abuse at home, they are more likely to experience a major depressive disorder or engage in suicide behaviours when compared to students with higher prevalence of adversity. This study highlights the importance of classifying bullying as childhood adversity, increasing pressure on the school environment to mitigate against such effects. A small-scale qualitative study with young men highlighted how exclusionary sanctions in response to classroom behaviours could impact pupils attitudes toward education and their access to support within the school environment. Both studies adopted a person-focused approach to uncover elements of the current school environment that potentially negatively impact pupil wellbeing. The mental health and wellbeing provision in NI post-primary schools survey and a subsequent interview study with educators and education stakeholders demonstrated the resources and services available to NI schools when supporting pupil mental health and wellbeing. Taking an ecological approach, this research explored the first and second order networks linking the Education, Health and Community & Voluntary to young people's access to mental health and wellbeing support, highlighting how access is inconsistent across the region through schools. Recommendations of how NI can move toward a universal and easily accessible mental health and wellbeing model for young people emerged from this research. These recommendations informed the development of the Children and Young Peoples Emotional Health and Wellbeing in Education Framework (DE, 2021).

This study explores the complex interplay between Adverse Childhood Experiences (ACEs), resilience, perceived stress, and their collective impact on academic success among undergraduate students. It aims to assess the prevalence of Adverse Childhood Experiences (ACEs) and investigate how they correlate with academic outcomes. The research focuses on the mediating role of resilience and the moderating effect of perceived stress in this relationship. Utilizing a quantitative approach, this study seeks to provide a comprehensive understanding of these dynamics and their implications for educational policies and mental health interventions. The goal is to inform strategies that enhance resilience, reduce stress, and support academic success in students affected by ACEs.

The adverse childhood experience (ACE) questionnaire assesses the number of traumatic experiences during childhood and has been shown to predict negative health outcomes associated with more adverse events during childhood (Felitti et al., 1998; Mersky et al., 2013). While studies have examined the immediate impact of recent traumas on the individual’s physiology, few have examined the effect of administering questionnaires about past adverse events. This study utilized electrodermal activity to measure sympathetic nervous system activity while participants completed the ACE questionnaire compared to participants who completed a benign survey. Half of the ACE questionnaire participants were given a verbal prompt before completing the questionnaire. Participants who completed the ACE questionnaire without a prompt, participants who completed the ACE questionnaire with a prompt, and participants who completed the benign survey were compared by analyses of variance. Analyses found no significant differences between the three groups. Participants with low ACE scores (< 4) and high ACE scores (< 4) were compared on measures of EDA with an independent samples t-test. No significant difference was found between those with high and low ACE scores. Individuals who completed the ACE questionnaire also did not demonstrate a significant difference in their electrodermal activity while taking the questionnaire when compared with those who completed a presumably benign alternative task. These results provide no evidence that completing the ACE increased autonomic arousal. Generalizability is limited as the sample consisted of primarily White, Christian college students and only had six participants in the high ACE score group. However, the current study suggests the ACE questionnaire does not cause individuals significant distress and is psychologically safe to administer.

Childhood adversity has long-lasting negative effects across the lifespan including increased mortality risk. The love and support individuals receive from others, also known as social support, has shown to be a protective factor against ACEs. However, little research has investigated the amplifying effects of social conflict and strain that often accompanies social relationships. Utilizing data from the Midlife Development in the U.S. (MIDUS) study, I tested whether higher levels of social support would buffer the negative effects of adverse childhood experiences on mortality risk, and whether higher levels of social strain would amplify these associations. The sample included 6,150 participants (Mage = 46.89; Female = 88.99%; white = 90.33%) who completed wave 1 of the MIDUS study in 1995-96 and had available data on mortality. Early life adversity was computed using 20 retrospective items assessing emotional and physical abuse, socioeconomic disadvantage, familial instability, and early-life poor health. Social support and social strain were each computed using four-family, four-friend, and six-spouse items assessing the reliability and emotion availability from others, or the annoyance and disappointment from others. Vital status was indexed through National Death Index updates up until December 31, 2021 (26-year follow up period). During this time, 1,723 died (28.27%) and the mean survival time among those deceased was 15.40 years. I estimated a series of Cox proportional hazards models to test study hypotheses. It was found that higher levels of ACEs, higher social strain, and lower social support all uniquely predicted a significant increased risk of dying. Higher levels of social support interacted with ACEs, demonstrating a reduced mortality risk (buffering effect). Findings from this study suggest that intervention work should focus on improving social support in response to the experience of adversity.

Background: Research has found that Adverse Childhood Experiences (ACEs) have been shown to lead to a myriad of issues including struggling in school. The more ACEs a child experiences, the worse their outcome tends to be, including school outcomes. However, critics of ACE research have argued that not all ACEs weigh the same and intersectionality needs to be considered. Therefore, this study aims to analyze the relationship between ACEs and school outcome issues. These school outcome variables are analyzed, first with a binary ACE variable, then with ACE scale variable, to test whether more ACEs lead to worse outcomes. And, finally, the ACEs are run separately to test if they each have the same effect. An intersectional lens is used through the use of interaction terms. Method: This study utilized multiple years of the National Survey of Children's Health (N=50,899). Multiple logistic regression was used to predict the odds of ACEs affecting the school success variables. Results: Results show that having at least one ACE and the ACE scale were significantly related to all the school outcomes. Every ACE run individually in unadjusted models was significant, however, when added together into the adjusted model to control for each other, many of the ACEs lost their significance. Parental incarceration remained significant for predicting repeating a grade, material hardship and divorce remained significant for struggling to complete homework, and all three of these ACEs as well as experiencing/witnessing violence led to higher odds of the school calling home. Finally, intersectionality was not statistically significant, but should still be considered when advocating for change.

Black African American Men (BAAM) suffer disproportionately from trauma related challenges and have a higher risk of encountering trauma across the lifespan. The negative impact of trauma is a major public health concern in the United States, evidence suggests trauma negatively impacts the physical well-being, mental health, and mortality rate. BAAM have increased rates of trauma exposure and their traumatic experience is historically complex involving a variety of contemporary issues (i.e. Adverse Childhood Experiences (ACEs), depression, victimization and desensitization, stress). This research aims to explore the complex nature of their trauma-related challenges among a purposeful sample of BAAM participants in Arkansas using a generic qualitative inquiry. The study will use an adapted conceptual framework of Historical Trauma Theory (HTT) to anchor the researcher within the analyses the data to answer the question: “What are the challenges for BAAM who have experienced trauma?” Analysis of the descriptive data (e.g., interviews, observations, documents) aspires to expand the body of knowledge, to elucidate culturally congruent perspectives, and encourage improvement of trauma informed care among key stakeholders.

Students in every school and at every grade level have had, or continue to have, adverse childhood experiences (ACEs), which may be considered traumatic. These experiences inevitably interfere with students’ brain development and learning processes. First, it is important that teachers are informed of the effects that these experiences may have on the lives of their students. Awareness of the problem is the first step toward solving any issue. Second, with knowledge of these findings, teachers must find methods to reach these students. All students deserve an equal chance at a quality education. The purpose of this study is to examine the effects of ACEs and find the best methods to help these students learn most effectively.

Adverse childhood experiences (ACEs) pose significant health concerns in today's society, encompassing various forms of physical and emotional abuse, neglect, and dysfunctional household experiences during childhood (Beutel et al., 2017). Previous research has shown that childhood adversities are associated with negative outcomes, including severe physical and emotional distress. However, the literature suggests that some individuals may experience post-traumatic growth, leading to improved relationships, self-perception, and overall outlook on life (Kashdan et al., 2011). This study aimed to investigate the relationship between ACEs, coping strategies (approach and avoidance coping), intrinsic religiosity, and post-traumatic growth in a sample of 442 emerging adults residing in the United States who had experienced at least one form of childhood adversity. Participants completed online self-report measures via MTurk. Correlation analysis revealed that individuals with higher ACEs reported higher levels of both approach and avoidance coping, but no significant correlation was found with intrinsic religiosity. Hierarchical regression analyses indicated a marginal curvilinear relationship between ACES and post-traumatic growth. Both approach coping and avoidance coping significantly mediated the relationship between ACEs and post-traumatic growth. Although intrinsic religiosity was considered as a moderator of this relationship, it was not significant for approach coping and only marginally significant for avoidance coping with the mediation relationship strongest for those exhibiting low levels of intrinsic religiosity. This study highlights the complex interplay between the variables under investigation. Implications and recommendations for future studies to deepen our understanding of these relationships are considered.

The Center for Disease Control and Prevention (CDC) previously released a statement calling for researchers to undertake research initiatives that shed light on the effects of adverse childhood experiences (ACEs) on health and mental health outcomes and to work towards ACE prevention and treatment (Center for Disease Control and Prevention, 2020). ACEs have also been documented to predict symptoms of Post-Traumatic Stress Disorder (PTSD; Ferrara & Panlilio, 2020). One potential important implication of ACEs and PTSD is cognitive impairment. Extant literature suggests that experiencing ACEs predicts cognitive struggle. Aglan et al. (2010) demonstrated that individuals with a history of childhood sexual abuse displayed marked memory issues, and Malarbi et al. (2017) found that people with ACEs history had worse cognition than people who did not have a history of ACEs. Certainly, psychologists need to understand the effect of ACEs on college student experiences. In the present study, a meta-analysis was conducted to evaluate the association between ACEs and PTSD in undergraduate students. Further, this study investigates the measurement invariance of an extended ACEs measure, whether relational ACEs are more strongly associated with PTSD than non-relational ACEs, and relations between ACES, PTSD, grade point average (GPA), and working memory.

The goals of this study were to 1) determine the prevalence of adverse childhood experiences (ACEs) and their impact on health and health-risk behaviors and 2) assess body composition, salivary cortisol, and phase angle (PhA) with high, moderate, low, or no exposure to ACEs in college-aged Appalachian adults (≥18 y). Methods. College students completed an anonymous questionnaire (Phase 1) about ACEs, positive experiences, adult resiliency, perceived stress, food insecurity, and health. A subsample participated in the Phase 2 in-person portion to measure body composition, PhA, and resting/reactive cortisol. One-way ANOVAs and correlation analyses were used to analyze the sample. Results. In Phase 1 (N=611, 86.3% ≤25 y, 64.0% female, 81.0% Caucasian, 52.4% heterosexual), only 3.6% (n=22) reported no ACEs, while 34.7% (n=212) reported ≥8. Positive experiences (r=-0.62), perceived stress (r=0.37), resiliency (r=-0.53), and food insecurity (r=0.25) were significantly correlated with ACEs score (p0.05). Conclusions. The prevalence of ACEs is high amongst this sample of young adults and though significant physiological changes were not seen, health perceptions and behaviors were impacted. Future research should focus on a slightly older age group to identify when specifically physiological changes due to ACEs begin to manifest.

Research has shown an increase in African American students experiencing trauma due to adverse childhood experiences (ACEs). African American students are at a greater risk of disengagement, school failure, dropping out of school, and increased mental health disorders due to ACEs. Unfortunately, minority racial/ethnic groups are at a greater risk of exposure to trauma, particularly African American students. Implementing trauma-informed practices (TIP) into school systems can provide trauma training to teachers to decrease school failures, and reduce disengagement, leading to African American students dropping out of school. The purpose of this research is to assess the impact that ACEs have on the learning and disengagement of African American male students and the effectiveness of TIP programs in schools to help provide interventions to increase engagement, preventing student dropout.

Men are subject to a variety of physical, mental, and social challenges (Garside & Klimes-Dougan, 2002; Lawson et al., 2015; O’Neil, 1981; Pleck, 1995, Centers for Disease Control and Prevention, 2018). Adverse childhood experiences (ACEs) have also been a major predictor of negative health outcomes (Felitti et al., 1998, p. 251). While many studies have observed the correlation of masculinity and these negative health outcomes, few have sought to understand the relationship between masculine presentation and ACEs. Religious coping has been seen to reduce distress and contribute to posttraumatic response (Pargament et al., 2000; Prati & Pietrantoni, 2009; Fallot & Heckman, 2005). This study utilized a survey approach to gather data on masculine trait presentation, ACEs, and positive and negative religious coping styles among college-age men at a private, Christian university. Results indicated a relationship between some subscales of masculine traits and ACEs and supported evidence of a relationship between religious coping style and masculine trait presentation among men who endorsed ACEs.

As the number of Americans living with Alzheimer’s disease and related dementias (AD/ADRD) continues to grow rapidly, there has been a concerted effort to better understand what potential modifiable risk factors account for ADRD across the life course. Despite the growing literature on modifiable risk factors for dementia, minimal research has focused on how exposure to adversity in early and midlife can affect cognitive functioning and dementia risk over the life course. More research is needed to identify how the long arm of adversity in childhood and adulthood affects cognitive functioning trajectories after age 50. The broad goal of this research is to examine the association between exposure to adverse life events in childhood and adulthood and cognitive functioning outcomes after age 50. This dissertation aims to (1) identify the relationship between household adverse childhood experiences (household ACEs) and mid- to late-life cognitive functioning, (2) identify the relationship between adverse adult experiences (AAEs) and cognitive functioning in mid-to late life over five waves of data (2010–2018), and (3) determine how the relationship between adverse life events (ALEs) in both childhood and adulthood impacts cognitive functioning over five waves of data (2010–2018). Previous research has paid particular attention to how two of the three categories of ACEs (i.e., abuse and neglect) impact physical and mental health outcomes. Few studies have explored how a third category of ACEs—household dysfunction—impacts cognitive health in later life. In addition to the additive effect of exposure to household ACEs and AAEs on cognitive functioning after age 50. The outcomes examined in this research are two indicators of cognitive functioning: the Langa-Weir classification of cognitive function (i.e., normal; cognitively impaired, not dementia (CIND); and dementia) and total recall (indicator of cognitive decline). Longitudinal survey data is examined from the Health and Retirement Study (HRS) along with the 2018 tracker file; the Cross-Wave 2015–2017 Life History Mail Survey (LHMS): Harmonized and Aggregated Public Data Resource; the Cross-Wave Childhood Health and Family Aggregated Data; and the Langa-Weir Classification of Cognitive Function (1995–2018). The empirical chapters use two statistical analysis approaches. Multinomial logistic regression is used to examine the relative risk for cognitive decline. Latent growth curve modeling is used to observe individual-level patterns of cognitive functioning trajectories and change over time. Results from the second chapter show that exposure to one household ACE was not statistically significantly associated with a higher relative risk for CIND, while exposure to two or more household ACEs was significantly associated with a higher relative risk for CIND. Exposure to one ACE and two or more household ACEs was significantly associated with a higher relative risk for dementia. The third chapter reports that exposure to one or more household ACEs is associated with statistically significantly lower cognitive functioning over an eight-year period (across five waves of data). As discussed in the fourth chapter, exposure to one or more AAEs is significantly associated with lower cognitive functioning over an eight-year period (across five waves of data). Exposure to one or more adverse life events (ALES) is associated with significantly lower cognitive functioning over an eight-year period (across five waves of data). Understanding how ALEs influence cognitive functioning over the life course can inform the development of interventions that could potentially mitigate this impact among individuals who have experienced ALEs.

Adverse childhood experiences (ACEs) represent types of adversity (e.g., abuse, household dysfunction) that occur in childhood. These experiences are linked to a variety of negative consequences including increased mortality, disability, and participation in risky behaviors (Campbell et al., 2016; Felitti et al., 1998). While risky behaviors are associated with maladaptive coping, hardiness is related to adaptive coping and personal growth. However, it is unclear how possessing hardiness may impact the relationship between ACEs and risky behaviors (Bethell et al., 2014). Moreover, a gap in the literature exists and in-depth examinations of risky behaviors (e.g., risky sex, substance use) are less prevalent than research on health issues (e.g., diabetes) related to ACEs. Therefore, this study aimed to fill these gaps and explore the relationship between ACEs and risky behavior and how hardiness may moderate this relationship. A convenience sample of participants completed self-report measures of these constructs. It was hypothesized that experiencing ACEs predicts engagement in risky behavior, increased hardiness predicts less engagement in risky behavior, and hardiness weakens the relationship between ACEs and risky behavior. Simple linear regressions showed ACEs is a significant predictor for risky behavior, while hardiness is not a significant predictor for risky behavior. Non-rural participants reported experiencing more ACEs and expecting to engage in more risky behaviors in the future. Women and genderqueer participants reported more ACEs than men. Women, who reported less hardiness than men, showed higher levels of hardiness than genderqueer participants.

Dr. Vincent Filetti's landmark 1998 study exposed the impact of adverse childhood experiences (ACEs) on children and adults. His analysis determined that childhood traumatic experiences could strongly correlate to serious health issues in adults. Exposure to childhood adversity has been shown to correlate not only with mental health issues such as depression, suicide, and substance abuse but also with chronic, life-threatening health issues such as cardiovascular disease, diabetes, cancer, and immune system issues. This DMin study aims to address the impact of ACEs on adult clients of the pastoral counseling ministry of Victory Church, a large non-denominational Christian church located in Middlefield, Connecticut. To adequately address client needs related to the impact of ACEs, the pastoral counseling team of Victory Church must be adequately trained. This DMin action research project will result in the development of a pastoral counseling training module that explicitly targets client ACE issues identified in the counseling process. Training will be provided to raise the pastoral counseling team’s level of understanding and counseling ability related to ACEs. A secondary purpose of this project is to examine the pastoral counseling process that incorporates the training that will be conducted as a result of the primary objective. The pastoral counseling process will be reviewed to determine its strengths and opportunities for improvement to assist the counselors in identifying critical risk and protective factors so they may work toward the prevention of future ACEs and improved outcomes for counseling clients.

Prior to the advent of the COVID-19 pandemic that began in 2020, children with traumatic or adverse childhood experiences were prevalent in P-12 education systems across the United States (National Survey of Children’s Health, 2012). Since the onset of the pandemic, the number of children exposed to trauma has risen significantly (Crosby et al., 2020). Trauma-informed practices in schools are increasingly needed to address the needs of trauma-affected students. The effects of trauma can impact a child’s physical, emotional, and mental health as well as significantly affect a child’s ability to learn, develop, and grow (Carrion & Wong, 2011; Cole et al., 2009; Goodman et al., 2012; Illinois ACEs Response Collaborative, 2018; Izard, 2016). Even though schools across the United States are teeming with trauma-affected students, training on how to serve trauma-affected students is generally not a part of the standard curriculum in teacher preparation programs and pre-service teaching experiences (Thomas et al., 2019). In response to the lack of education regarding trauma and trauma-informed practices, there has been a plethora of resources created to address the needs of students affected by trauma (Thomas et al., 2019). However, there is a lack of consistency in how educators are trained as well as how trauma-informed practices are implemented which makes the effectiveness of employing these practices as well as the observable and quantifiable benefits of trauma-informed practices difficult to measure (Thomas et al., 2019). There have been few studies published that have demonstrated the effects of these practices which make the touted benefits of trauma-informed practices hypothetical (McInerney & McKlindon, 2014). Additionally, there is a lack of education from within the field of education that supports the use of trauma-informed practices (Thomas, 2019). The purpose of this study is to ascertain educator perspectives on the effectiveness of trauma-informed practices in schools as well as educator perspectives as to the perceived benefits and barriers associated with implementing these practices. Additionally, this study aims to determine the trauma-informed practices most frequently utilized by Minnesota K-12 educators. This study will add to the limited body of research currently available surrounding trauma-informed practices in schools.

Despite the abundant literature demonstrating the negative consequences of adverse childhood experiences (ACEs) across the lifespan, there is little known about the specific nuances in how children experience adversity. Using longitudinal data from the Fragile Families and Child Wellbeing Study, this thesis examined associations between adolescent wellbeing and the various ways in which they experienced ACEs earlier in life. Results indicated that ACEs are related to poor adolescent mental health and negative behaviors. ACEs at age nine had particularly strong associations with negative adolescent outcomes over and above ACEs that occurred at earlier ages. In addition, the impacts of individual ACEs varied according to how they were experienced earlier in life, including the single occurrence, severity, and chronicity of each type of adversity. These results suggest that the developmental timing, type, severity, and chronicity of ACEs are important considerations for both future research and intervention efforts.

Sex offenders in the United States invoke a negative reaction in a majority of people. Often, there is a stigma about the character and personality of an individual who would commit such acts. These perceptions have largely kept the development of treatment modalities limited when compared to other psychological problems. One area that continues to need research is in the factors that contribute to the outcomes of treatment for sex offenders. The present study investigated the relationships between perceived historical trauma, personality, and treatment completion in an outpatient group of sexual offenders. We hypothesized that (1) sexual offenders who completed treatment would have reported fewer historical traumatic experiences, as measured by the Adverse Childhood Experiences (ACEs) questionnaire; (2) individuals who completed treatment would exhibit different personality characteristics, as measured by the Personality Assessment Inventory (PAI) Aggression, Antisocial, Borderline and Dominance scales; and (3) ACEs and PAI scores would predict treatment completion in a combined model. A preliminary analysis consisting of several independent samples t-tests was conducted to identify variables for the final prediction model. Statistically significant differences between individuals who completed and did not complete treatment were observed on the ACEs, PAI Aggression, PAI Borderline, and PAI Antisocial indices. When modeled together, both ACEs and PAI scales were predictive of treatment completion, χ2 = 19.02, p < .001, Nagelkerke R2 = .30. The PAI Antisocial index was the only statistically significant PAI scale that contributed to predicting treatment outcomes. Overall, our results facilitate distinguishing among individuals who will benefit and individuals who are unlikely to be amenable for treatment. Further research is necessary to establish generalizability to other populations and modalities. Given the present results, treating clinicians should ponder the use of the ACEs and the PAI as instruments administered to all patients during intake. These tools will assist in the identification for patients amenable to treatment.

Adverse Childhood Experiences (ACEs) are associated with a variety of negative outcomes, including criminal and violent behaviors (Milaniak & Widom, 2015). Prior research indicates that antisocial personality traits such as callousness may play a mediating effect on the relationship between ACEs and criminality (Baglivio et al., 2020). Further, the developmental period in which childhood maltreatment occurs may be related to greater criminality (Thornberry et al., 2010). This research project aims to examine how ACEs relate to criminality in emerging adults, with consideration of antisocial personality traits and the developmental period of experiencing childhood abuse. This study hypothesizes: (A) Both higher reported maltreatment ACEs and household dysfunction ACEs will uniquely relate to criminal activity. (B) A prevalence of antisocial traits (i.e., callousness and cold-heartedness) will mediate the relationship between maltreatment ACEs and criminality, relating to an increased engagement in criminality. (C) Among those who experienced physical, psychological, or sexual abuse, the age of onset of abuse will moderate the relationship between maltreatment and criminality, with adolescent occurring abuse leading to a higher engagement in criminal activity and violence. Through online data collection of emerging adults (N=343), results indicated that maltreatment ACEs associated with higher criminality, however, this study failed to establish a mediation model of antisocial traits between maltreatment ACEs and criminality. Among individuals who experienced emotional abuse, the developmental period of experiencing abuse moderated the relationship between maltreatment and criminality, with those experiencing childhood-limited abuse and low-maltreatment being at the lowest risk for engaging in crime. Researchers should continue to examine how the combination of specific ACEs may contribute to criminal outcomes. Future research should also explore the development and psychometric properties of antisocial trait measures with non-incarcerated samples. Finally, researchers should continue to examine how to classify and code one’s experience of maltreatment to maximize our understanding of ACEs and allocate resources to those at a greater risk.

The growing prevalence and severity of both clinical and subclinical eating disorders resulted in the inclusion of a Healthy People 2020 objective aimed at reducing the proportion of individuals who engage in disordered eating behaviors. At the same time, survivors of intimate body trauma (childhood abuse, sexual assault, dating violence, etc.) are coming forward with their own violence narratives at unprecedented rates thanks to global support movements such as #MeToo. Research on the development of disordered eating behaviors after the experience of recurrent intimate body trauma (IBT) over the life course is limited but has been linked in compensatory &/or coping mechanistic ways. This dissertation explored the relationships that may exist between poor body image, a range of maladaptive eating behaviors, comorbid mental health issues, and experiences of IBT over the early life course. This research specifically utilized secondary data analysis from a large, nationally representative sample of U.S. men and womxn followed over 24 years (1994-2018) to expand on the methodology and findings from previous clinical, small-scale studies. Drawing on sociological theories related to cumulative disadvantage, stress proliferation, and toxic socialization this dissertation systematically explored the impact(s) of IBT over the early life course. A sociological understanding of the cumulative impact trauma has on the body is necessary to evaluate who may be at most risk for future revictimization and their associated mental health outcomes. Findings from this dissertation revealed that survivors of recurrent IBT experiences are roughly 2 to 4 times more likely to suffer from a range of mental health issues as compared to those who have not experienced sexual violence. Additionally, according to analysis results, queer IBT survivors are at risk of developing maladaptive mental health outcomes at a rate of 2 to 3 times that of heterosexual survivors. Analysis results also revealed that being a survivor of childhood abuse significantly increased an individual’s likelihood to experience both sexual violence and dating violence in the future. Finally, this dissertation is the first known sociological study to find income to serve as a protective buffer between repeat sexual violence experiences and the development of mental health issues. Findings from this study can be used to substantiate future policy and public health work that aims to better treat and prevent the cyclical nature of body image disturbance, intimate body trauma experiences, mental health issues, and disordered eating.

Approximately 11-20% of school aged US children are estimated to have mental health problems. Despite their impairment and associated societal cost, these concerns are largely untreated. Although it is known that children from disadvantaged backgrounds, especially those who have experienced adverse childhood events (ACEs), tend to have higher rates of psychological symptoms and lesser rates of treatment utilization, few models exist that consider the complex interplay of factors that to date have only been examined independently of one another. To address this knowledge gap, data from the National Health Interview Survey (NHIS) regarding 5899 US children ages 6 though 17 were used in the present study through structural equation modeling to look at the interrelationships between income, ACEs, internalizing/externalizing symptoms, and mental health service use based on the Andersen Behavioral Model. The hypothesized model was first tested with an overall sample of all 5899 target children and then examined using multigroup comparison by race. Good model fit was observed across the entire sample as well as with three of the four racial/ethnicity groups, suggesting that the model generalizes across race and ethnicity. Nevertheless, differences in the magnitude of several hypothesized pathways were found during comparison of racial/ethnic groups, suggesting unique differences between certain racial/ethnic backgrounds, which are further discussed.

Few studies have studied the impact of trauma on academic performance and even fewer have studied Black students. Black college students are usually from a lower socioeconomic class which puts them at a greater disadvantage and a higher risk for dropping out of college. This study is a mixed-method research design. Participants included 44 undergraduate students recruited from a university in the Southern U.S. Phase 1 included paper-pencil surveys, and Phase 2 consisted of an open-ended questionnaire, which allowed for a deeper understanding of the lived experiences. This study used a Spearman Correlation to measure the strength of association between ACEs, resilience, and higher GPAs. Results from the statistical analysis indicated that there was no significant relationship between ACEs and academic performance, as measured by first-year GPA. On the contrary, resilience was correlated with both ACEs and GPA. The correlations between ACEs, GPA, and resilience suggests that resilience might be a buffer between childhood adversity and academic performance. Support, faith, and a sense of independence may contribute to academic success for students who had adverse childhood experiences. Furthermore, the results suggest that faith-based programs, positive relationships with staff, and resilience education may promote academic success and long-term professional development.

Over the past two decades, public health research has demonstrated that Adverse Childhood Experiences (ACEs) are associated with significant and prolonged physical and mental health problems (Campbell et al., 2016; Felitti et al., 1998; Gilbert et al., 2015; Greif Green et al., 2010; Horwitz et al., 2001; Mersky et al., 2013), demanding investigation into factors that may mitigate such poor outcomes. One potential factor that may attenuate the negative impact of ACEs on individuals’ mental health is social support. An important source of social support is sibling relationships (Furman & Buhrmester, 1985; Goetting, 1986; Lempers & Clark-Lempers, 1992; Scholte et al., 2001; Wellman & Wortley, 1989). The purpose of the current study was to examine if the perceived quality of sibling relationships may moderate the negative impact of ACEs on wellbeing in adulthood. Data was collected from a total of 439 participants (Mage = 35.06, SD = 11.20; 73.6% White or European American; 62.4% male). Results revealed that sibling relationships characterized by higher perceived warmth—and, interestingly, higher perceived conflict and rivalry—attenuated the negative impact of ACEs on wellbeing in adulthood. Additionally, higher ACE-IQ scores predicted lower wellbeing when participants’ overall sibling relationship was characterized by relatively high, but not low, perceived quality. Future research should consider the nuances in the measurement of conflict and rivalry in the context of sibling relationships, and conceptualize overall sibling relationship quality accordingly. Such research will help determine whether overall sibling relationship quality is a factor that can mitigate the negative impact of ACEs on wellbeing.

Research reflects correlations between trauma history and motivation to pursue a career in clinical psychology and mental health professions. Professional longevity is a concern for clinicians in general, especially for clinicians with a trauma history who work with people suffering with trauma conditions. Trauma histories measured by adverse childhood experiences (ACEs), are likely to be present within students of doctor of psychology training programs, and may influence doctoral trainee readiness and ability to engage clients in clinical work. Self-care is thought to not only support overall well-being, but to also mitigate the negative consequences of stress associated with clinical work. A survey to evaluate the prevalence of vicarious trauma within doctoral trainees, self-care practices, and program curriculum was distributed via electronic survey to graduate students in three Doctor of Psychology programs in the United States. Results were analyzed using descriptive statistics, comparison of means, analysis of variance (ANOVA), and hierarchical linear regression. Overall results indicated that doctoral trainees experience vicarious trauma in the course of their clinical training, and trainees with trauma histories may be more likely to experience vicarious trauma in the course of their training.

Background: Adverse Childhood Experiences (ACEs) are a group of potentially traumatic events that occur in the first 18 years of life. ACEs are divided into three categories, abuse, neglect, and household challenges, each of which has additional subcategories. A set of standardized questionnaires exist addressing the ACE categories and a score ranging from 0-10 is traditionally provided as a result. ACE scores greater than 2 have been shown to increase all-cause mortality of individuals over their lifetime. ACEs have been shown to have a strong relationship with chronic diseases including obesity, hypertension, diabetes, and hyperlipidemia, as well as risky behavior choices and high-risk sexual behaviors (HRSB) (Brown et al., 2009). HRSBs include early coitarche, unprotected intercourse, having multiple sexual partners, use of recreational drugs and a history of sexually transmitted infections (STIs) including chlamydia, gonorrhea, trichomonas, Human Immunodeficiency Virus, Human Papilloma Virus, and Herpes (Tariq & Gupta, 2020). Patients with an ACE score of 2 have a 61% increased risk and ACE >4 have a 107% increased risk of contracting an STI compared with those with and ACE score of 0 (London et al., 2017). The identification of patients with elevated ACE score in combination with adult health outcomes will help to provide a more well-rounded approach to mental and physical health. Given this, it is important to consider several factors which may lead to inaccuracy of screening.Further, many adults do not have a primary care provider and utilize easy access clinics for urgent/emergent care needs (Alcala et al., 2017). Identifying patients with elevated ACE score in combination with adult health outcomes will help to provide a more well-rounded approach to mental and physical health. Objectives: The primary objectives are to determine if women ages 18-40 with an ACE score >2 are at an increased risk for high-risk sexual behaviors (lifetime sexual partners, self-reported history of STI diagnosis, self-reported EC visits for vaginal health complaints) compared with those with an ACE score ≤ 2. Additionally, the project seeks to determine if women ages 18-40 with an ACE score >2 are less likely to access an established Primary Care or Gynecology provider for routine health care compared with those with an ACE score ≤ 2.Methods: This quality improvement project has a correlational design approach. Descriptive statistics were utilized to compare the independent variable (ACE score) with the dependent outcome variables (lifetime sexual partners, self-reported history of STI diagnosis, self-reported EC visits for vaginal health complaints, and lack of PCP or GYN for routine care) to evaluate the relationship between childhood trauma and adult HRSB outcomes. Results : Overall, data analysis shows that there is a relationship between ACE score and having an established care provider, number of lifetime sexual partners, and frequency of presentation to the express care department for vaginal health complaints. It was determined that there was no relationship between history of STI diagnosis and adverse childhood experience score. Additional data analysis shows that there was no statistical significance between history of STDs and express care visits, or between history of STDs and number of lifetime sexual partners.Conclusion: The DNP project has served as a quality improvement study with a focus on feasibility of identification of ACEs in the EC setting, as well as identifying the prevalence in the population of interest. Additionally, the project has identified a gap in established PCP/GYN providers and an increased utilization of EC for vaginal health complaints. The correlation between ACE score and HRSB, lack of PCP/GYN care team, and utilization of EC services was be demonstrated. The project has both identified these women and provided education to them and the healthcare community. Using a simple 10-question ACE screening tool and 10 question demographic data sheets, the project has identified women at increased risk for HRSB secondary to their childhood experiences. Offering all women with an ACE of

According to the 2020 United States (US) Census, Multiracial people - those who identify as two or more races - grew faster than any other racial group in the US. Despite this trend, research, scholarship, and knowledge on the health and well-being of this population has struggled to keep pace with this growth, and the health of Multiracial people is still not well-understood. Early research from psychology and sociology focused on risk and resilience factors associated with individuals' Multiracial identities. However, patterns emerging from both national health statistics as well as etiologic health research suggest that Multiracial people experience elevated rates of poor cardiometabolic, respiratory, mental, and behavioral health compared to monoracial (single-race) groups. In California, the state with the largest Multiracial population, they are more likely than monoracial White people to be living in poverty, disabled, and lacking health insurance. In addition to these health outcomes, descriptive studies of large nationally-representative datasets show that Multiracial people have the highest mean adverse childhood experiences (ACEs) score. ACEs, also sometimes referred to as childhood or early life adversity, are traumatic events occurring during childhood or adolescence, and are associated with numerous physical, mental, and behavioral health outcomes. Several of these outcomes disproportionately affect Multiracial people, and are leading causes of death in the United States. The goal of this dissertation is to marry knowledge and methods from disparate disciplines in describing the epidemiology of childhood adversity, while centering the health experience of Multiracial Americans. In chapter 2 of this dissertation, I examine whether the high mean ACE score in the Multiracial population is driven primarily by Multiracial people with American Indian/Native American (AI/NA) ancestry, the largest subgroup of Multiracial people. AI/NA populations also have a high mean ACE score, possibly reflecting the legacy of occupation of Indigenous land and structural racism affecting generations of AI/NA peoples — what I call the "land occupation" hypothesis. This study found that estimates of mean ACE scores and risk of most ACE components were not significantly higher for Multiracial people with AI/AN ancestry than those without. These results suggest that the high mean ACE score is likely due to factors independent of the land occupation hypothesis. Further research should investigate causes of the disparities in ACEs between Multiracial and monoracial groups. Chapter 3 of this dissertation investigates racial differences in the association between ACEs and some of the health outcomes disproportionately affecting Multiracial people, including metabolic syndrome, hypertension, asthma, anxiety, depression, suicidal ideation, and problematic drug use. Like in other interaction analyses, a goal of this study is to identify populations most affected and thus most urgently in need of intervention. Associations between ACEs and mental and behavioral health outcomes were strongest across racial groups. While Multiracial people do experience stronger associations between ACEs and anxiety than other racial groups, overall, the strength and direction of association varies by outcome, group, and interaction scale, with no group uniformly experiencing stronger associations than others. Chapter 4 discusses some limitations to interaction analyses such as the one in chapter 3, and offers stochastic substitution methods as an alternative approach with some important benefits for health disparities research. I simulate a stochastic health equity intervention that provides an answer to the question: "how many cases per 100 of depression would be averted in the population if the ACEs distribution of each racial group approximated that of the White group?" Results from this simulation show that the Multiracial group would benefit the most from such an intervention, a finding that would be masked if only interaction effects were considered. Childhood adversity contributes significantly to poor health among the Multiracial population. Prevention of ACEs could be an important and effective health equity strategy to reduce disparities affecting this group. More research is needed to identify why Multiracial children are predisposed to experiencing adversity, as is greater attention to the patterns of socially-constructed risks that contribute to the unique health experience of Multiracial people in the US.

The purpose of this study was to determine whether the ACEs questionnaire could be a viable screener tool for identifying children in need of neuropsychological testing. This study consisted of a sample of child participants aged 8-17 years (N=53) who were divided into a no ACEs group or the ACEs group (1 or more ACEs) depending on parental responses to the ACEs questionnaire. Participants completed a series of virtual neuropsychological tests that assessed overall neurocognitive functioning, memory, and attention. No significant differences between the no ACEs group and the ACEs group in performance of the overall Neurocognitive Index, Composite Memory Index, or Complex Attention Index emerged. While no significant differences were found in this study, the demographic make-up of the sample could in part explain the absence of significant findings. The sample for this study included highly educated parents who resided in a higher SES bracket. These and other limitations are discussed. While this study did have limitations, several future directions were identified that would strengthen this area of research.

Heavy alcohol use during college can result in numerous negative outcomes (e.g., accidents, worse academics, risky sexual behaviors, etc.). Understanding the risk-factors associated with elevated alcohol use in college are needed so prevention and/or interventions can be implemented to inhibit such dangerous behavior. Adverse childhood experiences have been identified as one key factor in the initiation and escalation of alcohol use, but there is limited research on samples that are in emerging adulthood. Specifically, the transition to college is a time when many students escalate drinking and can form the basis for longer term drinking patterns. It is not yet clear how adversity impacts this critical transition in terms of alcohol use patterns. Thus, the goal of this study was to identify these alcohol use behaviors among college freshmen already at risk for higher levels of alcohol use. The current study utilized data from the College Student Transition Study at a large Mid-Atlantic university to examine alcohol use trajectories of college freshmen across their first year of university. Seven hundred and sixty-nine participants (Mage = 18.61 years, SD = 0.33, range = 18.09 – 20.11; 50.71% female; 90.25% White), mostly from the Appalachian region, completed an online Qualtrics survey assessing demographic information, their experience of childhood adversity, and average alcohol use, among other variables. Unconditional and conditional latent growth curve models were assessed in Mplus to examine change across four waves of data, and whether the experience of childhood adversity predicted elevated alcohol use at baseline and steeper increases in use over the first year of college. There was significant variability in intercept, slope, and curvature. The typical pattern was an increase in alcohol use during the immediate transition to college, but then there was a significant decline during the end of the spring semester. Results suggested that adversity significantly predicted variability in the quadratic effect (curvature), showing that those with higher adversity experienced a sharper decrease in alcohol use during the spring semester. Findings can be used to inform alcohol use awareness programs for those who have faced higher levels of childhood adversity.

Over the last 40 years, China implemented many socioeconomic policies, among which the “open-door” and “single-child” policies were two of the most noteworthy. Therefore, in China, the study of child maltreatment requires understanding the impact of family constellation changes that resulted from national policies. This study sought to examine adverse childhood experiences (ACE) differences among Chinese adults who grew up as left- behind children (LBC) and single-children (SC). In addition, as a response to the Ho et al. (2019a) call for “further investigations on cultural specific patterns of ACEs” (p. 187), this study examined patterns of ACEs among the Mainland Chinese participants. The sample consisted of 140 Chinese adults (ages 18 - 44 years) residing in Mainland China, with 70 identified as LBC and 70 as SC. Of the participants, 68 were male, and 72 were female. Participants were recruited via a Mechanic Turk. Each participant received monetary remuneration for completing demographic questionnaire and the Adverse Childhood Experiences International Questionnaire (ACE-IQ). The results did not support the hypothesis that people who grew up as LBC experience more ACEs than those who grew up as SC. The results highlighted that SC are just as vulnerable as LBC in experiencing childhood adversities. In addition, this study revealed three distinct ACE class patterns within this sample. The first class, with the lowest ACEs, showed a pattern of parental discord in which people who experienced parental death, separation, or divorce were also likely to report experiencing emotional neglect. The second class revealed a pattern of environmental discord in which people who frequently witnessed collective violence also had a high probability of experiencing emotional and physical neglect. The last class accounted for the smallest percentage of participants and demonstrated a pattern of elevated ACEs across multiple categories. Except for the last class, the first two classes differ significantly from the Ho et al. (2019a) findings. The ACE patterns from this Mainland Chinese sample shed light on the unique history of Mainland China for the past four decades and its impact on childhood adversities.

The connection between childhood traumas and subsequent detrimental adult behavioral issues has been well documented. In recent times, both the medical and psychological fields have turned their attention toward specific criteria of childhood traumas labeled Adverse Childhood Events, or ACEs. A threshold of ACE factors shows a significant connection to the later physical and mental health of individuals who have participated in such studies. Due to the connection between childhood traumas, mental health, and interactions with law enforcement, this study attempts to define the relationship, if such a relationship exists, between ACE factors and interactions with the criminal justice system. This study combines original research compiled through an anonymous self-report containing qualitative and quantitative data and archived data about prior research concerning ACE factors and the criminal justice system. Findings in this study do indicate a relationship between a higher sum of ACE factors and involvement with the criminal justice system, however, ACE factors alone do not guarantee continued interactions with the criminal justice system. Further research connecting individuals directly to perceptions of trauma and later involvement in the criminal justice system are needed in order to further identify this connection.

Vicarious trauma refers to exposure to another person's traumatic experience. Professionals working within the criminal justice system, policing, courts, or mental health are regularly exposed to traumatic events. The idea or expectation that a person can be exposed to this every day and not be affected is unrealistic. A new approach to mitigating and preventing exposure to adverse impacts of vicarious trauma is vital to these employees' mental health. This article focuses on attorneys who work with vulnerable populations and how vicarious trauma affects their everyday professional and personal lives. This paper will discuss the Adverse Childhood Experiences (ACEs), what they are, the importance of understanding them, how they can make an induvial more susceptible to the negative effects of vicarious trauma. This study will shed light on preventative training that can help decrease the risk of one developing vicarious trauma, along with educational programs to teach healthy coping mechanisms to mitigate the negative effects of vicarious trauma.

This qualitative content analysis sought to determine whether any existing models of trauma-informed education could be utilized by schools serving diverse groups of students who may have experienced trauma, including both ACES related trauma and racial trauma. As an administrator in a high school made up of many diverse students who have been impacted by trauma, this topic is of extreme interest to me, as I am always looking to remove barriers and seeking methods that increase student well-being and success. Because trauma is common, it is important that schools and educators address it through utilization of trauma-informed educational practices. However, it can be difficult for educators to sift through the many available models to determine which is most appropriate for their population of students and why. Utilizing care ethics as a theoretical framework and culturally relevant pedagogy as a conceptual framework, data was analyzed first through an inductive coding process, and then through a deductive coding process where the categories of culturally relevant pedagogy were applied. This study determined that none of the models of trauma-informed education studied are suitable for use with students of color who may have experienced multiple types of trauma. However, the study also found that some of the models studied were more suitable than others, and could likely be adjusted for use in such schools. Additional research is needed to gather empirical evidence around trauma-informed education, and more specifically, how it intersects and works in coordination with culturally relevant pedagogy. Implications for practice include the need for a greater emphasis on theory as a foundation for what works in education, avoiding centering whiteness and deficit-based thinking in trauma-informed education, and advocating for policy change in order to prevent trauma that occurs as a result of systemic racism.

Childhood trauma has a profound effect on students’ academic, behavioral and social-emotional growth and development, negatively affecting their success in school and adulthood. Students who have had a traumatic past may have extreme difficulties functioning in the school setting, culminating in disciplinary reactions that include office referrals, detentions, suspensions, and in many cases expulsion. With over 50% of children reporting being exposed to traumatic events and its effects, educators need to be more sensitive in how they handle these situations and deal with these students. Strategies and interventions need to be implemented at schools to help students overcome the effects of trauma.Much of the research has been on defining trauma, trauma effects, and trauma informed care. There is a gap in the literature that examines educational leaders’ capacity for trauma-informed care and their ability to implement effective practices. This study provides the foundation for future research on administrators’ attitudes toward the trauma-informed care model and the impact it has on their readiness to implement intervention strategies such as restorative practices.The researcher used the Attitudes Related to Trauma Informed Care (ARTIC-45) scale and five qualitative questions to survey principals in the first ring districts of northeast, Ohio to determine their level of trauma informed care and perceptions of restorative practices. Overall, administrators had favorable attitudes about trauma-informed care. The findings reveal racial factors that impact Black students and Black administrators. The findings also reveal the need for system-wide supports, collaboration, resources, training, and personal support for the implementation of restorative practices. Best practices for implementation of restorative practices are included in this study.

Youth who are in foster care or are homeless—those who reside in at-risk living conditions—face increased risk for difficulties in school including poor grades and mental health issues such as suicidality and depression. Previous research has shown that youth who are in foster care or who are homeless have, by definition, experienced adverse childhood experiences or trauma, increasing their risks for poor outcomes. Protective factors in schools can have a significant and meaningful impact on reducing the rates of depression, suicidal ideation, and failing grades. Schools that provide environments in which caring relationships between students and adults are established, high expectations are held for the students, and students are given an opportunity for meaningful participation, are environments in which youth can thrive despite having faced adversity. There is a dearth of literature delineating school-specific risks and supports for students who have experienced the adverse childhood experiences related to residing in at-risk living conditions. This study examines the results of a large self-report survey on behaviors and resiliency of students in California, the California Healthy Kids Survey. Results of a hierarchical logistic regression model showed supportive relationships between adults and students and high expectations may significantly and profoundly reduce suicidal ideation, depressive symptoms, and failing grades in students residing in at-risk living conditions. This study provides evidence that students in foster care or homelessness are a unique population with distinct experiences and needs, and school practices that aim to support all students must consider the unique needs of this population.

In this mixed methods dissertation study, I used design-based research (DBR; Brown, 1992; Cobb et al., 2003; The Design-Based Research Collective, 2003) to develop and refine a Tier 1 professional development (PD) intervention in trauma-informed teaching practices. This intervention was implemented with all full-time educators at one school and focused on Tier 1 practices to be implemented for and applicable to all students. I engaged in ongoing collaboration with educators at Oakdale Elementary School, a suburban Massachusetts school, to study and refine this intervention. I conducted ongoing qualitative and quantitative data collection and analysis, which informed both the intervention design and study of process and outcomes. This study investigated how and why the intervention evolved over time, the acceptability of the intervention, shifts in thinking and teaching practices, and how those shifts were facilitated. Over the course of implementation, 10 collaborative design decisions were made to create an intervention that addressed the needs and desires of Oakdale’s educators as well as the structural affordances and constraints of PD implementation at Oakdale. The intervention contained three after-school PD trainings: (1) Secondary Traumatic Stress and Self-Care, (2) Trauma 101: Supporting Students who Have Experienced Trauma, and (3) Educational Impacts of the Opioid Epidemic. Educators rated the intervention favorably: 88% of year-end survey participants were very satisfied with the trainings and 94% felt that the trainings would be very useful in other schools. In addition, Oakdale’s educators reported shifts in their thinking (e.g., increased empathy) and teaching practices (e.g., enacting proactive strategies) that they attributed to the trainings. Finally, based on the data collected in this study, I developed a theoretical model of how to support educators’ learning and implementation of trauma-informed teaching practices. This theoretical model identifies contextual, relational, and procedural elements of the intervention that participants reported to facilitate learning. This model can be tested in future studies of trauma-informed teaching PD and, if substantiated, used to guide additional intervention design. Implications for policy and practice are discussed.

Early life experience and environmental context “gets under our skin,” playing a role instress reactivity and affecting health over one’s life (Corburn, 2017; McEwen, 2012; Shonkoff et al., 2012). The body’s physiological response to strong, frequent, or prolonged adversity in the absence of supportive adult relationships during childhood development is toxic stress (Shonkoff et al., 2012). It can result in impaired development that impacts health and wellbeing over the life course (Burke Harris, 2018; Center on the Developing Child at Harvard University, n.d.; Purewal Boparai et al., 2018; Shonkoff et al., 2012). Increased likelihood of chronic conditions such as diabetes and hypertension, increased likelihood of mental health issues such as depression and anxiety, and the development of negative coping mechanisms are associated with toxic stress (Burke Harris, 2018; Center on the Developing Child at Harvard University, n.d.; Purewal Boparai et al., 2018; Shonkoff et al., 2012).A growing body of literature recognizes the need for greater exploration of toxic stressoutside of clinical and social service settings, a movement upstream to situate toxic stress research in an ecological context (Burke Harris, 2018; Corburn et al., 2014; Ellis & Dietz, 2017; Shonkoff et al., 2012). My dissertation research is part of this growing area of toxic stress research. In this dissertation, I have three aims: 1) to identify concepts and frameworks in the academic and professional literature that situate toxic stress within an ecological context, 2) to understand toxic stress and healing at the community level through a case study of a community-driven process as collective healing, and 3) to explore youth perspectives of and experiences with toxic stress and adversity. I will achieve these aims through the completion of a narrative literature review, case study, and youth Photovoice project.

Sexual violence (SV) is a significant public health problem in the United States, specifically among undergraduate college students. Experiencing adverse childhood experiences or ACEs is also a significant public health problem and may act as a potential risk factor for perpetrating SV later in life. This study investigated whether ACEs was associated with an increased likelihood of SV perpetration, and whether several other risk factors for SV perpetration (hypermasculinity, hostility towards women, and binge drinking) acted as mediators between the relation between ACEs and later SV perpetration in adulthood. This study also tested whether perceptions of social norms moderated these relationships in male undergraduate students. Secondary data was drawn from the Freshman of Georgia study (FoG), a longitudinal CDC-funded study. A total of 1,144 male college freshmen enrolled at one of 30 participating colleges and universities in Georgia were included in this study via online survey completion. Statistical analyses were performed using SAS 9.4 software through SAS Studio University Edition. Three separate moderated mediation analyses were conducted via Hayes PROCESS macro model 14. Results showed that hypermasculinity and binge drinking mediated the relationship between ACEs and later SV perpetration, and also that perception of social norms was a significant moderator. These findings contribute to the growing body of literature surrounding SV perpetration and provide further understanding of the ACEs – SV perpetration relationship among male college students. SV prevention and education programming for this population should target the modifiable SV perpetration risk factors of hypermasculinity, binge drinking, and perceptions of social norms.

No known research has been conducted on whether Moral Reconation Therapy (MRT) actually reduces criminogenic thinking. Similarly, no known research has been conducted to identify factors associated with dropout from the MRT program (i.e., choosing to leave the group before completion/release). Therefore, the purpose of this study was twofold: (a) to discover whether MRT reduces criminogenic thinking, and (b) to determine if criminogenic thinking, ACEs, cognitive abilities, and personality traits, particularly impulsivity, psychoticism, and antisocial traits, influence dropout. If significant effects in one or more of the aforementioned areas are discovered, individuals predicted to have the same profile as past participants who dropped out could potentially receive additional supports to decrease their probability of dropout, subsequently improving recidivism rates. The results of this study confirmed that significant reductions in criminogenic thinking were found from pre-test to post-test, suggesting that MRT is effective in reducing criminogenic thinking. In addition, criminogenic thinking, ACEs, cognitive abilities, and assessed personality traits did not significantly influence dropout, suggesting that other factors, such as intrinsic (e.g., motivation, self-esteem, self-confidence) and relational dynamics may be at play.

Many school leaders have found that to reach an environment that encompasses the toolsand supports for student success, a whole child approach is required to address academic, socialand emotional obstacles that many students face. In recent years, the development of earlywarning intervention and monitoring systems (EWIMS) in urban high schools serve as a strategyfor educators to apply interventions through multi-tiered systems of supports (MTSS). Researchnotes that almost half of today’s students enter school having experienced at least one adversechildhood experience (ACE), such as abuse, neglect, and other household dysfunctions. Thetrauma from ACEs may impede a child’s progress in school. Therefore, it is imperative thatschool leaders guide the staff in creating a trauma-sensitive environment (TSE) to help studentsovercome trauma, and focus on academics. Studies have revealed that transformational leadersare favored in the effort to effectively set a clear vision and motivate stakeholders to focus on theindividual needs of the students and their academic achievement. The purpose of this study wasto examine the success of an EWIMS on the identification of students who display the potentialto drop out of school. A quasi-experimental posttest only comparison group design, includedfour statistical analyses. A chi-square of association justified the use of the selected cohort. Anindependent samples t-test compared a sum of student days in attendance and a logisticregression analysis examined predictive factors of on-time graduation. The findings of the t-testin this study did not show a statistically significant difference in the means of students receivingintervention. The researcher speculated factors that may have contributed to the lack ofsignificance included a low rate of student participation or a dearth of fidelity in implementation.Conversely, the findings of the analysis of the logistic regression test revealed a predictive relationship between students who received intervention and obtained on-time graduationsuccess. In addition, grape point average (GPA) and socioeconomic status (SES) were strongpredictors of on-time graduation success. GPA proved to be the strongest predictor of on timegraduation; the higher the GPA the higher the likelihood of on-time graduation. A post-hocanalysis of GPA revealed a lack of significance. Overall, literature and the findings of predictiverelationships on graduation rates suggest that effective implementation of multi-tiered systems ofsupports and over time, interventions contribute to the success of students.

Historically, human beings and human behavior and health have been viewed through the lens of disease and dysfunction, rather than a lens of wellness and growth (Seligman, 2000). Mental health care and health care in general, still widely utilize the medical model, which focuses on illness (Seligman & Csikszentmihalyi, 2000). When examining mental health care and overall health, it is valuable to utilize a holistic approach that focuses on positive psychology and growth. This exploratory, cross-sectional study utilizes a positive psychology approach and examines adverse childhood experiences (Felitti et al., 1998), psychological capital (Luthans, Youssef, & Avolio, 2007), and students’ subjective well-being and mental health (Keyes, 2002). Adverse childhood experiences, or ACEs, are measured utilizing the adverse childhood experiences (ACE) questionnaire which is comprised of 10 yes or no questions and assesses traumatic events in childhood. The PsyCap consists of four measures which include Hope, Efficacy, Resilience, and Optimism (HERO), which are assessed through the PsyCap Questionnaire (PCQ) (Luthans, Luthans, & Jensen, 2012). Mental health and subjective well-being are measured utilizing Keyes Mental Health Continuum-Short Form (MHC-SF) which includes a mental health score, well-being clusters, that include emotional, social, and psychological, and mental health categories that range from languishing to flourishing (Keyes, 2009).The objectives of the study included evaluating the relationship between adverse childhood experiences (ACE), psychological capital, mental health, and well-being. Further objectives included to evaluate the relationship between psychological capital and mental health, to determine variability in psychological capital utilizing the adverse childhood experiences score as a predictor, and to determine variability in mental health and well-being by utilizing the ACE score as a predictor. Descriptive statistics, correlations, and one-way ANOVAs were utilized to explore and report research objectives. Results indicated ACE group 0-3 and total MHC-SF score were negatively correlated, with statistical significance. ACE group 0-3 and total PsyCap score had no correlation. Total PsyCap and total MHC-SF scores were positively correlated, and there was statistical significance.The mean PsyCap score (M = 104.45, SD = 13.95) for ACE group 0-3 was higher than the mean PsyCap score (M = 101.80, SD = 15.28) of ACE group 4-10. Thus, the higher the ACE score, the lower the psychological capital score. The effect size as elucidated by Cohen’s d, is a small effect size (d = 0.18). The mean MHC-SF score (M = 46.49, SD = 14.16) for ACE group 0-3 was higher than the mean MHC-SF score (M = 38.05, SD = 15.04) of ACE group 4-10. The effect size as elucidated by Cohen’s d is a medium effect size (d = 0.58). These results align with research in the field that suggests higher ACEs are associated with negative physical and mental health outcomes. Based on the findings of this study, conclusions and recommendations are provided for counselors, counselor educators, counselor supervisors, healthcare providers, early educators and early interventionalists, and higher education administrators.

Zero-tolerance discipline policies have been in use in U.S. schools for almost 25 years. Since their enactment in the 1990s, researchers have found that zero tolerance disciplinary policies and practices can cause students to enter the school-to-prison pipeline. The purpose of this qualitative case study was to understand the perceptions of middle-school male students of color regarding the discipline process on a campus that supplemented zero-tolerance discipline with restorative practices (RPs). Additional intents of this study were to discover the challenges students encountered when they returned from a disciplinary alternative education program (DAEP) and determine whether RPs helped or hindered their transition to the home campus. Six middle-school male students of color who were placed at the district's DAEP and returned to their home campus participated in the study. The conceptual framework was based on Braithwaite's concept of stigmatized shame following an exclusion and Nathanson's human reactions to shame. The study yielded seven major themes: (a) student perceptions of exclusion, (b) behaviors related to exclusion from school, (c) human reactions to shame—attacking others, (d) human reactions to shame—avoidance, (e) the need for reintegration and acceptance, (f) traumatic events, and (g) dissonance in the discipline process.

Mental illness has become increasingly prevalent among adolescents in the United States, with anxiety and depression occurring the most commonly. A growing literature has established that adolescents with more adverse childhood experiences (or ACEs) tend to have more disadvantaged mental health outcomes. Although there is significant state variation in the prevalence of both adolescent mental illness and childhood adversities, research has not yet investigated how state context (e.g., social policies, economic conditions) may modify the relationship between ACEs and adolescent mental health. Because of the functional support families receive from various state policies and economic features, adolescents residing in states with more generous social welfare policies and stronger economic conditions may be less likely to experience mental health problems, net of individual and family characteristics. This study investigates these relationships from a social-ecological perspective using the 2017/2018 National Survey of Children’s Health (NSCH), merged with state policy and economic data obtained from multiple sources (n=21,068 adolescents). Using multilevel logistic regression, a significant relationship was found between one state contextual indicator and the mental health of adolescent girls. Contrary to expectations, girls living in states with low levels of income inequality had higher odds of mental health problems than their counterparts in high-inequality states. Other measures of state context were not found to have significant effects on mental health for girls or boys. Finally, there was no evidence that state economic and policy context moderates the dose-response relationship between cumulative ACEs and adolescent mental health.

As a result of adversity, trauma, or maltreatment, a child’s primary defense is to engage in self-blame in order to maintain a belief in a safe world. Without intervention, these adaptive strategies may continue to shape the way survivors relate to themselves and make meaning out of negative events. This study hypothesized that participants with adversity in childhood have an increased likelihood of low self-compassion (indicating tendencies towards self-judgment, overidentification, and isolation). This study further hypothesized a positive correlation between posttraumatic growth, resilience and hardiness. Participants in this study were adults recruited from three online sites (social networking, online forum, and a local university); participants ranged in age from 18-64, sexually and ethnically diverse. The majority of participants were white, United States born, female, and were between the age of 18-24. Participants were surveyed using the Adverse Childhood Experience survey, Self-Compassion Scale- Short Form, Connor Davidson Resilience Scale, Hardiness Questionnaire, Posttraumatic Growth Inventory, and two one-item scales measuring religion and attachment. Results were analyzed using a Pearson correlation and path analysis. Self-compassion was not significantly correlated to ACEs, and a strong correlation was observed between resilience and self-compassion. Resilience and posttraumatic growth had a moderate correlation, resilience and hardiness had a strong correlation, and there was no significant correlation observed between hardiness and posttraumatic growth. The results from the path analysis found that resilience mediates the relationship between adversity and the development of posttraumatic growth. Moreover, adversity in childhood had a small negative correlation to religion, resilience, self-compassion, and hardiness.

Experiences during childhood play a crucial role in adolescents’ health outcomes. Previous research has documented the negative impact of Adverse Childhood Experiences (ACEs) on adolescents’ physical health, mental health and health risk behaviors (Bielas et al., 2016; Brown & Shillington, 2017; Isohookana et al., 2016). Although Latino adolescents may experience a higher prevalence of ACEs (Llabre et al., 2017), they have been largely overlooked in the research literature. Not all adolescents who experience adversity develop negative outcomes. Previous research has found emotion regulation, religious meaning-making, self-efficacy, locus of control, purpose, community support, family cohesion, and social support to promote resilience among individuals who experience adversity (Bellis et al., 2017; Cardoso & Thompson, 2010; Culpin, Stapinski, Miles, Araya & Joinson, 2015; Day & Kearney, 2016; Hamby, Grych & Banyard, 2018; Roh et al., 2015; Schweizer et al., 2016). Despite this, ACEs research has focused on negative outcomes instead of identifying protective factors that may help adolescents build resilience. In order to address these gaps, the present study sought to (1) determine the relation between ACEs and Latino adolescents’ subjective well-being (SWB) and (2) identify protective factors that could moderate that relationship. Eighty-eight Latino adolescents completed measures of ACEs, SWB, emotion regulation, religious meaning-making, self-efficacy, locus of control, purpose, community support, family cohesion and social support. Results suggest that the more ACEs adolescents experienced, the lower their SWB. Moreover, external locus of control, internal locus of control, family cohesion and purpose moderated the association between ACEs and SWB. The results suggest that helping Latino adolescents build a high sense of purpose, a high family cohesion, a low external locus of control and a high internal locus of control can promote a higher SWB despite experiencing ACEs.

INTRODUCTION: Beginning with the original Adverse Childhood Experiences (ACE) study, there has been increasing understanding and appreciation for the powerful relationship between traumatic experiences during childhood and subsequent health and life outcomes. Nearly half of all adults in the United States have experienced at least one adverse experience during childhood. The exposure to ACEs, traumatic events occurring prior to age 18, has been linked to chronic health conditions as well as social, emotional, physical, and cognitive problems. AIM: The purpose of this thesis was to examine the relationship between ACE exposure and chronic disease outcomes, specifically heart disease, asthma, and depression. METHODS: Logistic regression was used to assess the association between specific chronic disease outcomes and ACE exposure using secondary data from the 2016 Georgia Behavioral Risk Factor Surveillance System (BRFSS). The analysis looked at three different categories of ACE exposure; those due to household challenges, childhood abuse, and total ACEs. RESULTS: Depression had the strongest association with ACE exposure in all three categories. Significant associations were observed between each chronic disease outcome and abuse. DISCUSSION: The results indicate that exposure to a single ACE is associated with higher risk of having depression. The strength of the association between chronic diseases and ACEs varies by chronic disease outcome.

According to the National Survey of Children's Health (NSCH), nearly 35 million children in the United States have experienced one or more types of significant childhood trauma. In the average public school, this statistic translates to as many as half of the students in a given teacher's classroom. Children exposed to the toxic stress of trauma often experience negative consequences that affect their academic, psychological, social-emotional, and behavioral health. To aid educators in addressing this reality, trauma-informed care practices have increasingly begun to be translated into professional development opportunities for educators. One such training, Compassionate Schools, has been recently evaluated using the Attitudes Related to Trauma-Informed Care (ARTIC) scale. Comparing pre and post-test scores in a previous study on the ARTIC, researchers found a significant change in the attitudes of participating educators of a standard deviation. In an effort to clarify and contextualize these results, the current qualitative study involved conducting follow-up semi-structured interviews with ten participants of the Compassionate Schools training who were public school teachers in a southeastern school district in the United States. Findings added to the nascent literature evaluating the impact of trauma-informed care training, by exploring perceptions of changes in knowledge, attitudes, and behavior of educators who attended the Compassionate Schools training, and by providing recommendations for improvement and additional needed resources to support implementation of the trauma-informed care practices.

Adverse childhood experiences (ACEs) are a certain set of abuse household dysfunction experiences that many children in the United States experience. Children who experience multiple ACEs are more likely to have negative mental and physical health issues as they grow older. These outcomes include ADHD, depression, cancer, heart disease, and early death. In this study, I examined the effectiveness of child centered play therapy (CCPT), a developmentally appropriate treatment modality, with children who have experienced two or more ACEs and who are also demonstrating inattention and impulsivity symptoms. Participants were 34 students from five Title 1 elementary schools in the southwest United States (28 males and 6 females; age range 5-8 years old with a mean age of 6.12). In the sample, participants were comprised of 29.4% African American (n = 10), 38.2% Caucasian (n = 13), 17.6% Hispanic/Latino (n = 6), and 14.7% identified as biracial (n = 5). Participants were randomly assigned to a treatment group that received 16 CCPT 30-minute sessions twice a week (n = 17) or a waitlist control group (n = 17) that received treatment at the conclusion of the study. Using a factorial ANOVA, results indicated statistically significant improvement of CCPT treatment group over waitlist control group on the ADDES-4 School Total and the DOF Attention Deficit/Hyperactivity Problems scale indicating that CCPT was an appropriate treatment model for children who have experienced ACEs and inattention and impulsivity symptoms.

The Impact of Birth Order on a Child’s Educational Experience/Meeting the Social-Emotional Needs of Students Through Implementation of Responsive Classroom Frame-working