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Childhood and adolescent/young adult (AYA) cancer survivors experience poor health outcomes in adulthood. Adverse Childhood Experiences (ACEs) also portend poor health outcomes for the general population. Resilience can mitigate effects of ACEs. We examined the feasibility of assessing ACEs and resilience in childhood/AYA cancer patients. We also described occurrences of ACEs, resilience, and poor health outcomes. Of 52 participants, most rated their study experience favorably, with privacy in answering sensitive questions. Half reported ACEs, and those with ACEs had lower resilience, X(2)(3,N=52)=9.4,p=0.02. Further investigations of ACEs and resilience in larger cohorts are warranted to delineate associations with long-term health outcomes.

Background Communities across the U.S. and globally confront the challenge of transforming negative social determinants of health (SDOH) into positive ones. To address this complex social problem, collective impact (CI) has promise but has been critiqued for insufficiently challenging structural inequities. Research applying CI to SDOH is limited. This mixed-methods study examined early adoption of CI in the 100% New Mexico initiative that aims to address SDOH population-wide in a state with strong cultural identity and assets but also persistent socio-economic inequality. | Methods. A web-based survey, interviews and focus groups were conducted with initiative participants in June and July 2021. Survey participants rated agreement with six items assessing CI foundation from the Collective Impact Community Assessment Scale. Interviews and focus groups centered on motivation to engage, progress in model components, CI core conditions, and contextual factors influencing experiences. Surveys were analyzed using descriptive means. Qualitative data were analyzed using thematic analysis, an inductive approach, stratified analyses, and co-interpretation. Results. Fifty-eight participants completed the survey, and 21 participated in interviews (n = 12) and focus groups (n = 9). Survey means were highest related to initiative commitment, and lower regarding shared ownership, having multiple perspectives and voices, and adequate resources. Qualitative results indicated the framework’s cross-sector emphasis helped motivate participation. Participants embraced the focus on leveraging community assets that characterizes CI and the current framework. Counties used unique engagement and visibility strategies including mural projects and book clubs. Participants reported communication challenges across sector teams which influenced feelings of accountability and ownership. Participants did not report challenges lacking relevant, available, and timely data or tension between funder-driven and community-driven desired outcomes, contrasting previous CI research. Conclusion. Multiple foundational conditions of CI were supported in 100% New Mexico, including evidence for support of the common agenda addressing SDOH, shared measurement framework, and mutually reinforcing activities. Results suggest that efforts to launch CI to address SDOH, which are by nature multi-sector, should include robust communication support for local teams. The use of community-administered surveys to identify gaps in SDOH resource access contributed to ownership and collective efficacy that may portend sustainability; however, relying on volunteers threatens sustainability.

Background Health care administrators must establish and promote effective partnerships with community agencies to address social determinants of health, including reducing exposure of infants and young children to chronic stress. Because infants’ experiences are inextricably tied to their caregivers, an important target for mitigating “toxic” stress exposure in early childhood is through reducing parents’ experiences of chronic stress in addition to protecting children from direct experiences of harm such as physical or sexual abuse. Conducting screening to identify when children are exposed to early life adversity is a first step; connecting families to needed support services is an essential component to addressing identified challenges. This paper presents the methodology of a three-year study of health care systems innovations designed to engage and support parents of infants to prevent and mitigate children’s toxic stress exposures. Methods Key study features included: 1) multi-component study in five U.S. communities and nine pediatric health care clinics and the families they serve, 2) a developmental evaluation approach to describe how innovations are experienced over time at three levels—community systems, pediatric providers, and families, and 3) rapid cycle feedback conducted with communities, clinics and families to co-interpret data and findings. Data sources included: 1) focus groups and interviews with community stakeholders, clinic staff, and families, 2) electronic health record and Medicaid services data extracted to assess health care quality, utilization, and financial impact, and 3) clinic-recruitment of 908 parents of infants in a longitudinal survey. Results. The sample is briefly characterized based on responses to the enrollment phase of the parent survey. Conclusions We discuss the study design elements’ contribution to generating evidence needed by innovators, communities, and clinics to modify and sustain investments in these innovations to prevent or mitigate the effects of exposure to toxic stress on young children.

BackgroundHealth care administrators must promote effective partnerships with community agencies to address social determinants of health, including reducing exposure to chronic stress in early childhood. Important targets for mitigating “toxic” levels of young child exposures are through reducing parents’ experiences of chronic stress as well as protecting children from direct experiences of harm such as physical or sexual abuse. Conducting screening to identify when parents and children are exposed to early life adversity is a first step; bringing in or referring out families to needed support services is an essential component. This paper describes a multi-modal investigation of health care systems innovations to engage and support parents to prevent and mitigate children’s toxic stress exposures through pediatric primary care and community services partnerships.MethodsKey study features include: 1) multi-component, multi-site study in five U.S. communities of pediatric health care clinics and the families they serve, 2) a developmental evaluation approach that describes how systems innovations are experienced over time at three levels (community systems, pediatric providers, and families), and 3) rapid cycle feedback in partnership with communities, clinics and families to co-interpret data and findings. The methodology includes: 1) focus groups and interviews with community stakeholders, clinic staff, and families, 2) electronic health record and Medicaid services data extracted to assess health care quality, and 3) clinic-recruitment of 908 parents of newborns in a longitudinal survey.ResultsThe sample is briefly characterized based on responses to the enrollment phase of the parent survey.ConclusionsWe discuss the study design elements’ contribution to generate evidence needed by innovators, communities, and clinics to modify and sustain investments in these innovations.

Background and Aims: Childhood and adolescent/young adult (AYA) cancer survivors are at increased risk for emotional distress, chronic health conditions, and premature mortality compared to peers with no cancer history. Some, but not all, of this increased risk is explained by cancer- and treatment-related exposures. Because cancer treatment remains necessary to achieve cure, it is critical to identify and target other factors to reduce sub-optimal outcomes. Adverse Childhood Experiences (ACEs) are traumatic events occurring during childhood, such as experiencing violence and/or neglect, which are associated with poor mental health, chronic health conditions, and premature mortality in the adult general population. Little is known on how ACEs impact health in children and AYAs with cancer. Research indicates that otherwise healthy individuals exposed to ACEs experience fewer adverse health outcomes if they possess resilience, which can be learned. This provides a potential target for intervention. This pilot study aimed to identify demographic characteristics associated with ACEs and resilience as well as associations between ACEs, resilience, and the presence of chronic medical conditions, mental health issues, and substance abuse in children and AYAs with cancer. Methods: Childhood and AYA leukemia and lymphoma patients undergoing cancer treatment at the University of Chicago were included for analysis (N=38, 55.26% female, 50% non-Hispanic white, mean age at assessment 14.74±6.97 years). Participants ≤17 years old completed the study with one parent/caregiver. ACEs were measured using age-specific instruments adapted from the original ACEs study by Kaiser Permanente and the Centers for Disease Control and Prevention. Resilience was analyzed using age-specific instruments provided by the Resilience Research Centre, and resilience scores were categorized as low (≤62), moderate (63-70), high (71-76), and exceptional (≥77). For participants 0-11 years old, a parent/guardian completed the study on their behalf. 12-17 year old participants and their parent/guardian both completed the study, and participants over 18 completed the study alone. Descriptive statistics characterized demographic, biologic, treatment, and health behavior variables. The association between total scores for ACEs and resilience were measured using Pearson's correlation. Regression analysis assessed ACEs (logistic model) and resilience scores (linear model) adjusting for age, sex, race/ethnicity, household income, and insurance type. Participants were then stratified, and two sample t-tests compared potential outcomes based on ACE exposures. Results: 23 participants (60.53%) reported prior ACEs (mean total number of ACEs 1.45±1.77; range 1-7), and the mean resilience score for participants was 73.76±9.61 (range 49-85) indicating high resilience overall. Regression analyses showed the odds of reporting ACEs increased with age (OR: 1.18; 95% CI: 1.02-1.37), while resilience scores decreased with age (β=0.76; t(32)=-2.74, p=0.01) holding other variables constant. Sex, race/ethnicity, household income, and insurance type were not associated with ACEs or resilience scores. There was a strong negative correlation between the total number of ACEs and resilience, r(36)=-0.57, p Conclusions: ACEs were associated with endorsement of chronic medical conditions, mental health issues, and substance abuse in our sample of childhood and AYA patients currently receiving cancer treatment. As the total number of ACEs increased, resilience scores decreased for participants. The results of this study provide the groundwork for further investigations of ACEs and resilience in large cohorts of childhood and AYA cancer patients and survivors. This future work could provide valuable information for creating and implementing interventions designed for childhood and AYA cancer patients and survivors who have experienced ACEs, thus potentially reducing additional morbidity and premature mortality for these high-risk patients. Disclosures No relevant conflicts of interest to declare.

Objective To identify the clustering of adverse childhood experiences (ACEs) that best characterize child welfare-involved children with known complex health concerns. Data source Multi-informant data were obtained from Wave I of the National Survey of Child and Adolescent Well-Being (NSCAW II). Study design This study used a cross-sectional design and classification and regression tree (CART) analyses. Data collection Data were collected from families with children, aged birth to 17, investigated for child maltreatment and their child protective services caseworkers, including demographic characteristics of the children, their histories of adversity, and a wide range of health concerns. Principal findings Results indicate that for children between the ages of six and 17, experiences of physical abuse alone, as well as experiences of physical abuse combined with having a caregiver with mental illness, are most strongly associated with complex health concerns. For children aged 2-5 years, results suggest that caregiver mental illness is a key adverse experience associated with complex health concerns. Conclusions Identifying specific combinations of ACEs may be a critical next step for child- and youth-serving agencies to allow providers to better calculate risk of health problems among children exposed to adversity.

Children investigated for maltreatment are particularly vulnerable to experiencing multiple adversities. Few studies have examined the extent to which experiences of adversity and different types of maltreatment co-occur in this most vulnerable population of children. Understanding the complex nature of childhood adversity may inform the enhanced tailoring of practices to better meet the needs of maltreated children. Using cross-sectional data from the National Survey of Child and Adolescent Well-Being II (N = 5870), this study employed latent class analysis to identify subgroups of children who had experienced multiple forms of maltreatment and associated adversities among four developmental stages: birth to 23 months (infants), 2–5 (preschool age), 6–10 (school age), and 11–18 years-old (adolescents). Three latent classes were identified for infants, preschool-aged children, and adolescents, and four latent classes were identified for school-aged children. Among infants, the groups were characterized by experiences of (1) physical neglect/emotional abuse/caregiver treated violently, (2) physical neglect/household dysfunction, and (3) caregiver divorce. For preschool-aged children, the groups included (1) physical neglect/emotional abuse/caregiver treated violently, (2) physical neglect/household dysfunction, and (3) emotional abuse. Children in the school-age group clustered based on experiencing (1) physical neglect/emotional neglect and abuse/caregiver treated violently, (2) physical neglect/household dysfunction, (3) emotional abuse, and (4) emotional abuse/caregiver divorce. Finally, adolescents were grouped based on (1) physical neglect/emotional abuse/household dysfunction, (2) physical abuse/emotional abuse/household dysfunction, and (3) emotional abuse/caregiver divorce. The results indicate distinct classes of adversity experienced among children investigated for child maltreatment, with both stability across developmental periods and unique age-related vulnerabilities. Implications for practice and future research are discussed.

To identify the clustering of adverse childhood experiences (ACEs) that best characterize child welfare-involved children with known complex health concerns.Multi-informant data were obtained from Wave I of the National Survey of Child and Adolescent Well-Being (NSCAW II).This study used a cross-sectional design and classification and regression tree (CART) analyses.Data were collected from families with children, aged birth to 17, investigated for child maltreatment and their child protective services caseworkers, including demographic characteristics of the children, their histories of adversity, and a wide range of health concerns.Results indicate that for children between the ages of six and 17, experiences of physical abuse alone, as well as experiences of physical abuse combined with having a caregiver with mental illness, are most strongly associated with complex health concerns. For children aged 2-5 years, results suggest that caregiver mental illness is a key adverse experience associated with complex health concerns.Identifying specific combinations of ACEs may be a critical next step for child- and youth-serving agencies to allow providers to better calculate risk of health problems among children exposed to adversity.

This article describes a new measure designed to examine the process of implementation of child welfare systems change. The measure was developed to document the status of the interventions and strategies that are being implemented and the drivers that are being installed to achieve sustainable changes in systems. The measure was used in a Children's Bureau-supported national effort to assess the ongoing implementation of 24 systems-change projects in child welfare jurisdictions across the country. The article describes the process for measure development, method of administration and data collection, and quantitative and qualitative findings.