National Network to End Family Homelessness

Best Practices

Responding to Adverse Childhood Experiences

Earlier this summer The National Network to End Family Homelessness disseminated screening tools for for childhood trauma [1] that focused on adverse childhood experiences (ACEs) [2]. While screening for traumatic exposure is critical, providers also need tools to support children with high ACE scores. In this brief, we offer an overview of possible responses. This will be the first in a series of resources on this topic.

When do we intervene and how?
Childhood trauma impacts neurological development in a way that compromises bodily functioning and increases adverse long-term health outcomes. Responses to the prevalence and consequences of ACEs include primary prevention, exposure mitigation, and treatment for associated health, mental health, and behavioral health conditions. This resource focuses exclusively on primary prevention. Later resources will explore both mitigation and treatment.
Before suggesting possible interventions, it’s important to know what ACEs refer to. Although childhood trauma includes a wide range of adverse events, ten specific ACEs have been thoroughly studied and linked to increased risk for clinical depression, substance use disorders, suicidality, and numerous chronic health conditions including diabetes, cancer, cardiovascular diseases, and respiratory diseases. These ten ACEs are the focus of this series: emotional abuse, physical abuse, sexual abuse, emotional neglect, physical neglect, domestic violence, household substance abuse, household mental illness, parental separation or divorce, and having an incarcerated household member [3].
Primary prevention:
The best way to address childhood trauma may be to prevent it from happening in the first
place. Some interventions focused on primary prevention require larger societal shifts that
providers may not have the capacity to implement but could advocate for at local, state and federal levels. These include the following:
● Reducing incarceration by shifting from criminalization of drug use, poverty, and punitive
responses to nonviolent offenses towards more restorative approaches to justice and accountability.
● Supporting initiatives that combat intimate partner (or domestic) violence (IPV) before it occurs. Such initiatives require us to challenge societal norms that often underlie and justify IPV. To learn more, visit the National Sexual Violence Resource Center’sprevention page, and The Network/La Red’s anti-oppression principles.
● Increasing investments in low-income communities, where ACEs are more prevalent. This includes ensuring greater economic opportunity, affordable housing, food security, and access to health and mental health resources.
Other interventions are more feasible for implementation within shelter and service settings. Many of these interventions focus on resources, treatment, and support for caregivers to provide nurturing environments for children. These include the following:
● Bringing home visiting programs into shelter settings. Home Visiting is an evidence- based approach that connects trained providers to caregivers by meeting families wherever they live. Outcomes include prevention of child injuries, abuse, neglect, and maltreatment; reduced domestic violence; and increased referrals for community services and support.
● Offering positive parenting and other parenting support programs. Although there are many approaches to this type of programming, the goal is to ensure parents have tools to deal with parenting challenges. Most programs offer guidance on how to parent according to their child’s developmental stage as well as their own beliefs and values.
● Working with other organizations to establish a coordinated community support network [4]. It is impossible for one organization to provide children and families with everything they
need to thrive. Establishing formal partnerships with other service providers and working to alleviate barriers to needed treatment and resources has the potential to interrupt some of the underlying issues related to toxic stress and child neglect and maltreatment.
Preventing trauma before it occurs is an ideal response to addressing ACEs, but we know it’s not always possible. Stay tuned for resources on exposure mitigation and treatment.
References
1 Please visit the resource page in the Network’s membership portal for this publication and a list of screening tools for capturing ACE exposure:https://www.bassukcenter.org/national-network-membership/membership-login/
2 Watch pediatrician Nadine Burke Harris talk about the lifelong impact of adverse childhood experiences and why it’s so important for service providers to address childhood adversity: https://www.youtube.com/watch?v=95ovIJ3dsNk
3 Felitti, et. al. (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245-258.
4 This article explores how interorganizational coordination and flexible funding can interrupt health and social problems and lead to better outcomes for children and families:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3483862/