Search

Adverse childhood experiences (ACEs) have been associated with increased mental health difficulties across a lifespan. Given increased health disparities among Indigenous populations compared to non-Indigenous populations, screening for ACEs is particularly relevant as it can inform future preventative care and treatment approaches. There has been no literature to date about how to best integrate these practices into routine psychological assessment with Indigenous clients. We describe five recommendations for assessing ACEs with Indigenous clients that are based on anecdotal research and clinical practices but aligned with standard evidence-based assessment practices. The preliminary recommendations for ACE assessment are: (1) determine the relevance of the assessment, (2) convey a sense of purpose and meaning during assessment, (3) use therapeutic assessment techniques, (4) use the ACE model for further client psychoeducation, and (5) use culturally relevant measurement techniques. These suggestions may provide a more meaningful and culturally relevant psychological assessment, but research is needed to support them.

Health concerns in Indigenous people are often greater in comparison to those in non-Indigenous populations, including increased rates of chronic diseases and mental health concerns. Adverse childhood experiences (ACEs) may be an explanatory variable for such heightened rates of mental and physical health difficulties for Indigenous populations as these communities have experienced a lack of adequate health care due to remoteness, historical traumas, cultural insensitivity, racism, and perpetuating systemic discrimination. To date, relatively few studies have examined ACEs within an Indigenous population and their relevance to both physical and mental health outcomes. The present study explored existing ACE literature relevant to Indigenous populations and mental or physical health outcomes by retrieving and organizing available ACE literature. A systematic review was conducted using 14 electronic databases of peer-reviewed literature and 18 grey literature databases. Twenty-one publications investigating general health outcomes and prevalence of ACEs met eligibility criteria. ACEs were reported to be higher in Indigenous populations when compared to non-Indigenous population. Higher ACE scores for Indigenous participants were associated with increased rates of suicidality and psychological distress. Protective factors to reduce the impact of ACEs were cultural identity and connectedness, education, social support, and psychological resilience. Future research may further explore the relationship between ACE scores and protective factors, varying prevalence within specific sub-populations, and consistent reporting of outcomes across studies. Ongoing research has the potential to clarify existing dose–response relationships between early traumatic experiences and current health disparities experienced within some Indigenous communities.

Examining treatment outcomes of nonresidential and residential treatment programs may suggest best practices for Indigenous communities delivering treatment services. A systematic review of peer-reviewed and gray literatures comparing treatment outcomes for Indigenous populations was completed. Three studies compared treatment outcomes and reported varying results. Reported outcomes were retention and relapse rates, cultural knowledge, and participant treatment duration. Most retrieved studies described residential treatment outcomes, but it was unclear whether this modality is the best option for Indigenous people seeking treatment. Further research describing treatment modalities, across a continuum of care, situated within culturally developed treatment frameworks is required.

Resilience within public health is conceptualized to be fostered through individual, community, and systemic initiatives that promote capacity through interconnected primary, secondary, and tertiary health interventions. Within community public health settings, particularly for Canadian Indigenous communities, an emphasis on interconnected, multisystemic interventions that promote resilience can be particularly useful. Fostering resilience within Indigenous health seeks to prioritize unique needs of individuals and communities, through both process- and outcome-based measurement. Given that Indigenous individuals’ needs may differ from non-Indigenous populations in Canada, careful consideration of how to best conceptualize, measure, and promote resilience is required. Tools such as the Native Wellness Assessment and the First Nations Mental Wellness Continuum Framework can be helpful to both measure and conceptualize resilience, as they can provide insight on what is considered to be best practices to increasing wellness within Indigenous communities. Such tools continue to prioritize the multisystemic promotion of resilience.

Background The relationship between adverse childhood experiences (ACEs) and detrimental poor mental health outcomes has been increasingly explored within scientific literature since the original ACE study was published by Felitti et al. (1998). Given that deficits in executive functions (EF) are prominent in most forms of psychopathology across the lifespan, there is utility in considering how ACEs relate to EF outcomes. Objective To consolidate the research to date on the relationship between ACEs and EF outcomes among child samples. Methods A systematic review was conducted that included 16 scientific databases and 17 grey literatures. Results Across 36 studies, many examined EF related to forms of maltreatment (e.g. abuse, neglect, and exposure to intimate partner violence) and found a strong relationship between maltreatment and EF deficits among children. Similarly, family member mental illness (maternal depression in particular) was associated with poor EF outcomes. The relationship between other ACEs and EF outcomes have not been uniquely examined, including intimate partner violence and family member incarceration. Conclusions This review acts as a preliminary step towards broader understanding of outcomes related to early childhood experiences through the consideration of EFs. Through documentation of such relationships, it is possible to consider how prevention and treatment approaches may be improved.