Adverse Childhood Experiences, Women Who Are Sex Trafficked, and Social Service Utilization: Implications for Social Work.

The aim of this study was to examine the associations between adverse childhood experiences (ACEs) and the high levels of social service usage by women who are sex trafficked. Fifty (N = 50) women who were sex trafficked were surveyed using purposive and snowball sampling methods. The ACEs score for respondents ranged from 2 to 10 with an average score of 7.4 (SD = 2.3). Emotional and sexual abuse tied at 88 percent as the most frequently cited ACEs among the women in this sample. The prevalence of ACEs was significantly higher in this sample compared with known estimates in similar populations, ranging from 20 percent to 54 percent (p < .001). Considering the well-established link between ACEs and poor health outcomes, these findings point to the need for innovative and targeted social service provisions to women who were formerly sex trafficked that take into consideration the high level of ACEs of the women. Given the sociodemographic diversity of this sample, there is a need for services that are trauma-informed, innovative, and culturally sensitive in a variety of social service settings.

Exploring the association between post-critical incident intervention preferences and self-reported coping self-efficacy among firefighters.

Critical incident stress debriefing (CISD) is a commonly utilized intervention in the fire service that aims to minimize psychological harm and adverse mental health outcomes after a potentially traumatic incident. This study aimed to explore firefighter preferences regarding CISD and alternative post-critical incident interventions in relation to firefighter coping self-efficacy (FFCSE) and trauma coping self-efficacy (CSE-T). Firefighters (N = 241) completed an online survey and provided complete data. Most participants were White (n = 203, 84.2%), non-Hispanic (n = 221, 91.7%) men (94.2%; n = 227). CISD was the most preferred intervention among firefighters (n = 113, 46.9%) as compared to informal peer support (n = 31, 12.9%), formal one-on-one counseling (n = 29, 12.0%), and no intervention (n = 68, 28.2%). Firefighters who preferred CISD had statistically significant lower levels of FFCSE, R2 = .033-.044, ps = .012-.030, and CSE-T, R2 = .035-.061 ps = .017-.024, compared to those who preferred no intervention. Firefighters who preferred formal one-on-one counseling had statistically significantly lower levels of FFCSE, R2 = .033-.044, ps = .003-.011, and CSE-T, R2 = .035-0.061, p < .001-p = .002, compared to those who preferred no intervention. The findings from this study may guide future research to increase knowledge on firefighter intervention preferences and the association between preference and coping self-efficacy.

Promoting permanency in families with parental substance misuse: lessons from a process evaluation of a multi-system program.

BACKGROUND: Families affected by substance misuse are at increased risk for child maltreatment and child welfare system involvement. The Enhancing Permanency in Children and Families (EPIC) program uses four evidence-based and informed multi-system practices to promote safety and permanency outcomes for children involved with the child welfare system due to parental substance misuse: 1) Peer Recovery Support (PRS), 2) Family Treatment Drug Court (FTDC), 3) Medications for Opioid Use Disorder (MOUD) and 4) Nurturing Parent Program (NPP) relational skill-building. The purpose of the current study was to identify barriers, facilitators, and lessons learned in the implementation of and client engagement with the main components of EPIC. METHODS: Seventeen key EPIC personnel participated in the study. Individual semi-structured interviews were conducted. Qualitative analysis involved the thematic coding of the interviews, and program facilitators and barriers were revealed. RESULTS: PRS were identified as a primary strength of the EPIC program, providing experiential connection to participating families and a valuable source of information. High turnover and matching PRS to families were barriers to PRS implementation. FTDC contributed to client success as judges developed interpersonal relationships with the clients that balanced support with accountability. Client attitudes toward court presented barriers to FTDC engagement. MOUD provided stabilization and was perceived by caseworkers as an engagement facilitator and a layer of client accountability; however, the lack of availability of MOUD service providers presented a barrier for some clients. Parental relational skill-building was not valued by clients and was perceived as conflicting with sobriety-focused activities. CONCLUSIONS: The EPIC program provides comprehensive, coordinated multi-system support and care to families affected by parental substance misuse. Continued efforts to improve recruitment and retention of PRS, reframing client perceptions of FTDC, and increasing access to MOUD may contribute to increased engagement in the program. Findings highlight the utility of tracking process outcomes in community-based interventions to promote participant engagement in programs set in complex systems. TRIAL REGISTRATION: NCT04700696 . Registered January 7, 2021-retrospectively registered.

Benchmarking Trauma in Child Welfare: A Brief Report.

Trauma exposure is common; however, considerably higher rates are reported in some vulnerable groups including adults and children involved in child welfare systems. In this context, early screening and service linkage may ameliorate its negative impact on the physical and mental well-being of adults and children alike. Using data from two Ohio-based child welfare interventions targeting co-occurring maltreatment and substance use (Ohio START1 and EPIC2), the purpose of this brief report was to first describe the rate of trauma exposure among participating adults (Adverse Childhood Experiences or ACEs, N = 402), children 0-5 years (CTAC, N = 271) and youth 6-18 years (CTAC, N = 177), and second to benchmark observed rates against reported rates in other child welfare or similar populations across the United States. Results show that adults were exposed to 4.2 ACEs on average, a 24% increase over previous child welfare estimates. While mean CTAC scores were not significantly different among young children ages 0-5, older children reported on average 5.6 exposures which is 27% higher than previously reported estimates. Our findings highlight the difference in risk profiles between families involved child welfare due primarily to substance misuse and those without substance misuse concerns, or where substance misuse was not the primary cause of entry. We discuss implications for service provision and time-sensitive child welfare requirements.

Enhancing Permanency in Children and Families (EPIC): a child welfare intervention for parental substance abuse.

BACKGROUND: Across Ohio, parental substance abuse has contributed to a marked increase in the number of children in foster care. Children exposed to parental substance use have a higher likelihood of physical abuse and neglect, and consequently a variety of physical, psychological and cognitive problems. The Enhancing Permanency in Children and Families (EPIC) program is a collaborative effort between the Ohio State University College of Social Work, two county offices of the Ohio Department of Job and Family Services, two juvenile courts and local behavioral health agencies. The goal of EPIC is to use three evidence-based and evidence-informed practices to reduce abusive and neglectful parenting, reduce addiction severity in parents, and improve permanency outcomes for families involved with the child welfare system due to substance abuse. METHODS: EPIC is a quasi-experimental study. Under the program, child welfare-involved adults who screen positive for substances are matched with a peer recovery supporter. Participants are also incentivized to participate in family treatment drug court, medications for opioid use disorders and home-based parenting supports. Participating adults (N = 250) are matched with comparison groups from counties participating in a separate intervention (Ohio START) and to those receiving treatment as usual, resulting in a final sample of 750 adults. Primary outcomes including addiction severity, child trauma symptoms, resilience, and attachment are assessed at baseline and at program completion. Additional outcomes include timely access to treatment services, length of placement in out-of-home care and recidivism into the child welfare system. DISCUSSION: This intervention formalizes cross-system collaboration between child welfare, behavioral health and juvenile courts to support families affected by addiction. The use of three evidence-based or evidence-informed strategies presents the opportunity to determine specific strategies that are most effective for reducing addiction severity. Lastly, the intervention combines several sources of funding to bolster sustainability beyond the life of the Regional Partnership Grant (RPG). TRIAL REGISTRATION: NCT04700696 . Registered January 7, 2021-retrospectively registered.

Racism and Structural Violence: Interconnected Threats to Health Equity.

In 2020, the continuing murder of Black Americans by police officers received widespread media attention and sparked global outrage. Public health responses to these events focused on discrimination by police and structural racism in broader society. However, police violence is but one of many forms of racialized violence propagated by structural racism and anti-Black racism in particular. We aim to expand the current public health dialogue by describing how structural racism and structural violence are deeply interrelated; embedded in institutions, systems, and processes; and threaten health, safety, and well-being across the life course for racialized minority groups. Structural racism and structural violence are threats to health equity and anti-racist public health work.

When Is Hope Enough? Hopefulness, Discrimination and Racial/Ethnic Disparities in Allostatic Load.

Hopefulness is associated with better health and may be integral for stress adaptation and resilience. Limited research has prospectively examined whether hopefulness protects against physiological dysregulation or does so similarly for U.S. whites, blacks and Hispanics. We examined the association between baseline hopefulness and future allostatic load using data from the Health and Retirement Study (n = 8,486) and assessed differences in this association by race/ethnicity and experiences of discrimination. Four items measured hopefulness and allostatic load was a count of seven biomarkers for which a respondent's measured value was considered high-risk for disease. A dichotomous variable assessed whether respondents experienced at least one major act of discrimination in their lifetime. We used Poisson regression to examine the association between hopefulness and allostatic load and included a multiplicative interaction term to test racial/ethnic differences in this association. Subsequent analyses were stratified by race/ethnicity and tested the interaction between hopefulness and discrimination within each racial/ethnic group. Hopefulness was associated with lower allostatic load scores, but its effects varied significantly by race/ethnicity. Race-stratified analyses suggested that hopefulness was protective among whites and not associated with allostatic load among Hispanics irrespective of experiencing discrimination. Hopefulness was associated with lower allostatic load among blacks reporting discrimination but associated with higher allostatic load among those who did not. Findings suggest that hopefulness plays differing roles for older whites, blacks and Hispanics and, for blacks, its protective effects on physiological dysregulation are intricately tied to their experiences of discrimination.

Problem Drinking and Marijuana Use as Risks for Unidirectional and Bidirectional Partner Violence.

Despite evidence that most who perpetrate intimate partner violence (IPV) also report victimization, little is known about bidirectional IPV among Emergency Department (ED) patients and its association with problem drinking and marijuana use. We conducted an observational, cross-sectional survey among low- and moderate-acuity patients at a Northern California safety-net ED. Physical IPV was measured with the Revised Conflict Tactics Scale (CTS2). We recorded patient's frequency of intoxication and marijuana use. Spouse/partner's problem drinking and marijuana use were measured dichotomously. Odds Ratios [ORs] and 95% confidence intervals [CIs] were estimated using multinomial logistic regression models of unidirectional and bidirectional IPV. Among 1,037 patients (53% female), perpetration only, victimization only, and bidirectional IPV were reported by 3.8%, 6.2%, and 13.3% of the sample, respectively. Frequency of intoxication was associated with perpetration (OR 1.50; 95% CI 1.18 to 1.92) and bidirectional IPV (OR=1.34; 95% CI 1.13 to 1.58). Days of marijuana use were associated with bidirectional IPV (OR=1.15; 95% CI 1.03 to 1.28). Patients whose partners were problem drinkers were at risk for victimization (OR=2.56; 95% CI=1.38, 4.76) and bidirectional IPV (OR=1.97; 95% CI 1.18, 3.27). Among patients who reported any past-year IPV, most experienced bidirectional aggression. ED staff should consider asking patients who are married, cohabiting, or in a dating relationship about their experience with past-year IPV and inquire about their substance use patterns and those of their romantic partner, to share information about potential linkages. Medical and recreational marijuana legalization trends underscore the importance of further research on IPV and marijuana.

Investigating Relationships Between Drinking Venues, Drinking Companions, and Corporal Punishment of Children.

Limited evidence suggests that how much a parent drinks in a particular venue, such as a bar, restaurant, or a friend's home, is associated with use of corporal punishment. However, these relationships could differ depending on their drinking companions (e.g., spouse or friends). In this study, weighted zero-inflated Poisson models were used to examine whether the relationships between venue-specific drinking frequency, heavier drinking, and corporal punishment are moderated by drinking companions in a mixed-mode sample of parents ( n = 1,599). The relationships between drinking frequency, heavier drinking, and corporal punishment varied by drinking companions, with some combinations being protective and others conferring risk. While most alcohol screening tools focus on individual alcohol use, more nuanced assessment examining where and with whom parents are drinking could be helpful in understanding risk of physical discipline.

Examining the Impact of Child Adversity on Use of Preventive Health Care among Children.

Child adversity has a negative impact on child and adult health. The present study aimed to determine whether adverse family experiences (AFEs) were associated with use of preventive health care (PHC) among children and whether insurance status affected this association. This study examined data from the 2011-2012 National Survey of Children's Health (N = 88,849) and included responses for children ages zero to 17 years. Logistic regression models were used to estimate odds of using PHC from AFEs. Results were stratified by insurance status and confounders were accounted for. Among the entire sample and the insured, most AFEs were not associated with use of PHC. Among the uninsured, several AFEs-lived with parents or guardians who were separated, lived with parent or guardian who was incarcerated, witnessing or experiencing violence in the household, and living with anyone who had substance abuse problems-and the sum of AFEs were associated with increased use of PHC. Findings are consistent with newer research showing that some disadvantage or adversity is associated with more optimal use of PHC. In addition, uninsured children with a history of AFEs would benefit from insurance, given their increased use of PHC.

Introducing Technology in Child Welfare Referrals: A Case Study.

Access to social services is important for the safety of children and ultimately for reunification of families involved in the child welfare system. The process of linking families to services however, varies by caseworker and can be cumbersome and time-consuming. The DCFS Needs Portal is an internet-based intervention to improve the timing and quality of social service referrals in Los Angeles County We used a case study approach including in-depth interviews, direct observations and user feedback obtained from the Needs Portal to 1) determine perceived benefits and barriers to adopting the Needs Portal and 2) report how the flow of information between users and developers was used to adapt to user needs. Our analyses revealed four major barriers: 1) caseworker apprehension regarding new technology, 2) variation in communication styles by user type, 3) lack of technological infrastructure and 4) competing workplace demands. Information sharing between developers and users has the potential to better meet the needs of users and ultimately maximize utilization of new technology. Although internet-based interventions are designed to inexpensively and effectively coordinate services, emerging interventions may require in-person assistance and modifications in order to succeed.

Childhood trauma and health outcomes in adults with comorbid substance abuse and mental health disorders.

This study describes the prevalence of childhood traumatic events (CTEs) among adults with comorbid substance use disorders (SUDs) and mental health problems (MHPs) and assesses the relation between cumulative CTEs and adult health outcomes. Adults with SUDs/MHPs (N=402) were recruited from residential treatment programs and interviewed at treatment admission. Exposures to 9 types of adverse childhood experiences were summed and categorized into 6 ordinal levels of exposure. Descriptive analyses were conducted to assess the prevalence and range of exposure to CTEs in comparison with a sample from primary health care. Logistic regression analyses were conducted to examine the association between the cumulative exposure to CTEs and adverse health outcomes. Most of the sample reported exposure to CTEs, with higher exposure rates among the study sample compared with the primary health care sample. Greater exposure to CTEs significantly increased the odds of several adverse adult outcomes, including PTSD, alcohol dependence, injection drug use, tobacco use, sex work, medical problems, and poor quality of life. Study findings support the importance of early prevention and intervention and provision of trauma treatment for individuals with SUDs/MHPs.