Last month, the National Network to End Family Homelessness shared resources on how to respond to adverse childhood experiences (ACE’s) through primary prevention strategies. In upcoming publications, we share approaches that center exposure mitigation and treatment. Here we focus specifically on the importance of assessing childhood development as a necessary step in supporting children with high ACE scores. Understanding a child’s developmental needs is a critical step in exposure mitigation, as it helps providers understand what resources children need to build resiliency and other protective factors.

What is exposure mitigation?
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 [1], exposure mitigation, and treatment for associated health, mental health, and behavioral health conditions.

Exposure mitigation refers to services that help children already exposed to ACEs. Although the consequences of childhood trauma are significant, research has shown that the brain can be “rewired” in response to new learning and experiences—a process called neuroplasticity—which suggests that early interventions with children have the potential to reverse harmful effects.

Why assess childhood development?
Children experiencing homelessness often have high ACE scores and face physical, cognitive, and social-emotional threats to their development. These threats directly impact their ability to build the resiliency tools needed to navigate stress and trauma [2]. Childhood development is influenced by risk [3] and protective factors [4], stemming from both environmental and individual characteristics.

Risk factors include housing instability, untreated caregiver depression, untreated caregiver substance use, insecure attachment, poor peer relationships, and a history of violence or trauma. Services that mitigate the harmful effects of ACEs may directly address the risk factors present in a child’s life. For example, if a child’s mother suffers from depression, identifying treatment options for her is one way to mitigate that particular risk factor.

Protective factors include a stable, supportive environment as well as skills related to resilience, self-regulation, and other executive functions:

● Resilience refers to a child’s ability express greater cognitive abilities, in addition to emotional and behavioral regulation, higher self-esteem, and adapting to traumatic situations.

● Self-regulation refers to a complex set of abilities for a child to achieve goal-directed behaviors, manage feelings, and function adaptively [5]. It is a key component in assessing the emotional needs of children experiencing homelessness, and an opportunity for children to build resilience in response to their trauma. Self-regulation is vital when viewing the resilience of children living in poverty.

● Executive functions refer to a set of skills that can help us plan and organize, delay impulses, know how to solve problems, and have good judgment [6]. Though executive functions develop from ages 0-80 years old, the most dramatic development occurs during the ages of 3-5, which is why this function is crucial in assessing childhood development.

Tools for assessing childhood development:
In an upcoming publication, we will explore how to support children in the development of positive self-regulation and resilience skills. Here we share resources you may use to assess the development of the children you serve. Assessing childhood development is a critical step to understand the specific areas of support and resources a child may need from your program. Assessments should capture self-regulation, resilience, and executive functioning, as they are critical components of the emotional and psychosocial well-being of children experiencing homelessness. There are many tools providers can use to assess child development. Here are a few places to start:

● The Ages and Stages Questionnaire, Third Edition (ASQ-3) [7] : The ASQ-3 identifies developmental progress in children between the ages of 1 month to 5 ½ years and is easy for parents and paraprofessionals to administer. Different questionnaires are used for different age groups. Each questionnaire addresses give key developmental areas: communication, gross motor, fine motor, problem solving, and personal-social skills. The questionnaires are 30 items each and take 10 to 20 minutes to administer and no more than 3 minutes to score.

● The Ages and Stages Questionnaire: Social-Emotional, Second Edition (ASQ:SE-2) [8]. The ASQ:SE-2 is the most commonly used childhood development screener. It assesses self-regulation, compliance, social-communication, adaptive functioning, autonomy, affect, and interaction with individuals in 6-month intervals [9]. It is important to know that the ASQ:SE-2 is administered to parents or caregivers. It can also be self-reported in the form of a questionnaire.

● The BRIGANCE Early Childhood Screens III [10]: The BRIGANCE uses different forms to assess children age 0–35 months, 3–5 years, and in kindergarten and first grades. The BRIGANCE screeners assess children’s physical development, language, academic/cognitive skills, self-help, and social-emotional skills. Each Screen has at least 32 sections. Each section contains between 2 and 24 items. The screens take only 10–15 minutes per child. They are available for use by clinicians and paraprofessionals and include observation and parent report (Enright, 1991).

● BASC-2 Behavioral and Emotional Screening System (BASC-2 BESS) [11]. This screener offers a reliable, quick, and systematic way to determine behavioral and emotional strengths and weaknesses of children and adolescents in preschool through high school. The BASC-2 BESS consists of brief forms (25-30 items each) that can be completed by teachers, parents, and students allowing for a range of observations about a child’s behavior. They require no formal training, and a single total score reliably and accurately predicts a broad range of behavioral, emotional and academic problems.

● Behavior Rating Inventory of Executive Function (BRIEF) [12]. For children 5-18 years, the Behavior Rating Inventory of Executive Function (BRIEF), consists of a parent/teacher/provider questionnaire designed to assess behavioral regulation (Gioia et al., 2000). Children scoring in the clinical range on the BRIEF will require additional mental health and educational supports.

● Behavior Rating Inventory of Executive Function Preschool Version (BRIEF-P) [13]. This version of the BRIEF is for children between the ages of 2 years and 5 years 11 months, the Behavior Rating.

● The American Academy of Pediatrics Screening and Technical Assistance Resource (STAR) Center. The STAR Center offers additional information on the importance of childhood development screening, and some suggestions on which tools to use [14].

● Division for Early Childhood (DEC): Recommended Practices on Assessment [15]. The DEC provides practices that teachers, home visitors, coordinators, and other caregivers can use to improve learning outcomes for children at risk of developmental delays. The DEC is also crucial when assessing children who are suspected of developmental delays and/or disabilities. An example of an assessment practice through the DEC may include: Obtaining information about a child’s skills in daily activities, routines, and environments such as home, center, and community [16]

References

1 To read more about primary prevention, please visit the resource page in the Network’s membership portal. There you will find the first publication in the series about Responding to ACEs: https://www.bassukcenter.org/national-network-membership/membership-login/
2 Children are more likely to develop asthma, respiratory problems, and other chronic health conditions than low-income housed children.
3 Risk factors are conditions or variables that are related to poorer outcomes.
4 Protective factors are conditions or variables that enhance a person’s ability to tolerate stress and promote resilience.
5 Buckner, J. C., Mezzacappa, E., & Beardslee, W. R. (2009). Self-regulation and its relations to adaptive functioning in low income youths. American Journal of Orthopsychiatry.
6 T3: Think, Teach, Reform. (2018.) Trauma in the Lives of Vulnerable Children and Youth- Risk and Resilience.
7 The Ages and Stages Questionnaire, Third Edition (ASQ-3): https://products.brookespublishing.com/Ages-Stages- Questionnaires-Third-Edition-ASQ-3-P569.aspx
8 The Ages and Stages Questionnaire: Social-Emotional, Second Edition (ASQ:SE-2):

9 Bricker, D.D. & Squires, J. (1999). The Ages and Stages Questionnaire – a parent-completed child monitoring system. Baltimore, Maryland: Brooks Publishing Company.
10 The BRIGANCE Early Childhood Screens III: https://www2.curriculumassociates.com/products/detail.aspx?title=BrigEC-Screens3
11 BASC-2 Behavioral and Emotional Screening System (BASC-2 BESS):
https://www.pearsonclinical.com/products/100000661/basc-2-behavioral-and-emotional-screening-system-basc-2-bess.quick.html
12 Behavior Rating Inventory of Executive Function (BRIEF): https://www.parinc.com/Products/Pkey/23
13 Behavior Rating Inventory of Executive Function Preschool Version (BRIEF-P): https://www.parinc.com/Products/Pkey/26
14 The American Academy of Pediatrics Screening and Technical Assistance Resource (STAR) Center: https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Screening/Pages/default.aspx
15 Division for Early Childhood (DEC): Recommended Practices on Assessment: http://www.dec-sped.org/dec-recommended-practices
16 Early Childhood Learning and Knowledge Center. (2018.) Implementation Guide: Using the ELOF to Inform Assessment.