Responding to ACEs With HOPE: Health Outcomes From Positive Experiences

Sege, Robert; Browne, Charlyn Harper

doi:10.1016/j.acap.2017.03.007

Cited by 162 publications

(146 citation statements)

References 42 publications

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“…These results are consistent with a recent study of the intersection between youth who ran away from home and those who experienced homeless, showing that those who had both run away and been homeless were at greater odds of mental health problems than either group alone (those who ran away had intermediate odds). 32 Overall, our findings affirm the protective nature of caregivers and families [33][34][35][36][37] and underscore the importance of ensuring that youth who have suffered adversity (e.g., maltreatment, neglect, or family dysfunction) are protected from becoming separated from supportive family members when faced with evictions or unsafe housing, humanitarian crises, disasters, war, or refugee/immigration policies that simultaneously threaten the integrity of families and the homes that allow health to thrive.…”

Section: Discussionsupporting

confidence: 62%

“…In addition to trauma-informed care, advocacy is needed for "resilience-informed care" that incorporates protective factors both in clinical practice and social policies. 37,53 Traditionally, policy work and medical care are focused on identifying and treating problems. Less attention is paid to what is going well, particularly in contexts of known risk, such as homelessness or ACEs.…”

Section: Discussionmentioning

confidence: 99%

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Health and Adverse Childhood Experiences Among Homeless Youth

Barnes

Gower

Sajady

et al. 2020

Preprint

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Background and Objectives Homelessness is associated with health problems and with adverse childhood experiences (ACEs). The risk of chronic health conditions for homeless compared to housed youth, and how this risk interacts with ACEs remains unclear. This study investigated the relationship between ACEs, housing, and child health, and whether: 1) ACEs and health vary by housing context; 2) ACEs and homelessness confer independent health risks; and 3) ACEs interact with housing with regard to adolescent health.Methods Using data from 119,254 8th-11th graders, we tested independent and joint effects of ACEs and past-year housing status (housed, family homelessness, unaccompanied homelessness) on overall health and chronic health conditions, controlling for sociodemographic covariates.Results The prevalence of ACEs varied by housing status, with 34.1% of housed youth experiencing ≥1 ACE vs. 56.3% of family-homeless and 85.5% of unaccompanied-homeless youth. Health status varied similarly. Homelessness and ACEs were independently associated with low overall health and chronic health conditions, after adjusting for covariates. Compared to housed youth, both family-homeless youth and unaccompanied-homeless youth had increased odds of low overall health and chronic physical and/or mental health conditions. All ACE x housing-status interactions were significant (all p<0.001), such that ACE-related health risks were moderated by housing status.Conclusions ACEs and housing status independently predict health status during adolescence beyond other sociodemographic risks. Being homeless unaccompanied is also riskier than being homeless with family, and every additional ACE increases this risk. Clinicians and health systems should advocate for policies that include stable housing as a protective factor.

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Section: Discussionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Health and Adverse Childhood Experiences Among Homeless Youth

Barnes

Gower

Sajady

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Similarly, Sege and colleagues (Sege and Browne 2017; developed and applied a framework called Health Outcomes for Positive Experiences (HOPE) in their research on childhood adversity and found that positive childhood experiences had long-term, salutogenic effects . In line with these findings, Crandall et al, (2019) conducted an on-line study of counter-ACEs (defined as exposure to positive experiences in childhood) and their role in predicting adult health behaviors and outcomes.…”

Section: Strengths Protective Factors and Resiliencementioning

confidence: 99%

Screening for Childhood Adversity: Contemporary Challenges and Recommendations

Bartlett

2020

ADV RES SCI

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Childhood adversity is prevalent in the USA, affecting at least half of all children and youth. Growing awareness of its prevalence and harmful effects on individual health and development over the lifespan has prompted considerable interest among policymakers, program leaders, and other stakeholders in screening individual children for adversity as a first step in preventing and mitigating its negative effects. Given the vulnerability of this population, concerted efforts first should be made to ensure screening for adversity is beneficial to children and minimizes potential harm. Of particular concern is widespread use of screening tools that define adversity narrowly, failing to account for social and structural inequities (e.g., poverty, discrimination, forcible separation from a parent) or to take a child's trauma symptoms, overall development, strengths, and culture into account. Furthermore, screening in the absence of a system for referral and treatment risks being ineffective, and even harmful, to children and their families. This paper reviews major challenges related to developing and selecting tools to screen for childhood adversity, and offers recommendations for a comprehensive, strengths-based, trauma-informed screening approach that incorporates sensitivity to a child's development, environment, and culture.

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“…In addition to trauma-informed care, advocacy is needed for "resilience-informed care" that incorporates protective factors both in clinical practice and social policies. 35,50 Traditionally, policy work and medical care are focused on identifying and treating problems. Less attention is paid to what is going well, particularly in contexts of known risk, such as homelessness or ACEs.…”

Section: Discussionmentioning

confidence: 99%

Health and Adverse Childhood Experiences Among Homeless Youth

Barnes

Gower

Sajady

et al. 2020

Preprint

View full text Add to dashboard Cite

Background and Objectives Homelessness is associated with health problems and with adverse childhood experiences (ACEs). The risk of chronic health conditions for homeless compared to housed youth, and how this risk interacts with ACEs remains unclear. This study investigated the relationship between ACEs, housing, and child health, and whether: 1) ACEs and health vary by housing context; 2) ACEs and homelessness confer independent health risks; and 3) ACEs interact with housing with regard to adolescent health. Methods Using data from 119,254 8th-11th graders, we tested independent and joint effects of ACEs and past-year housing status (housed, family homelessness, unaccompanied homelessness) on overall health and chronic health conditions, controlling for sociodemographic covariates. Results The prevalence of ACEs varied by housing status, with 34.1% of housed youth experiencing ≥1 ACE vs. 56.3% of family-homeless and 85.5% of unaccompanied-homeless youth. Health status varied similarly. Homelessness and ACEs were independently associated with low overall health and chronic health conditions, after adjusting for covariates. Compared to housed youth, both family-homeless youth and unaccompanied-homeless youth had increased odds of low overall health and chronic physical and/or mental health conditions. All ACE x housing-status interactions were significant (all p<0.001), such that ACE-related health risks were moderated by housing status. Conclusions ACEs and housing status independently predict health status during adolescence beyond other sociodemographic risks. Being homeless unaccompanied is also riskier than being homeless with family, and every additional ACE increases this risk. Clinicians and health systems should advocate for policies that include stable housing as a protective factor.

show abstract

Responding to ACEs With HOPE: Health Outcomes From Positive Experiences

Cited by 162 publications

References 42 publications

Health and Adverse Childhood Experiences Among Homeless Youth

Health and Adverse Childhood Experiences Among Homeless Youth

Screening for Childhood Adversity: Contemporary Challenges and Recommendations

Health and Adverse Childhood Experiences Among Homeless Youth

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