Making the Case for Two-Generation Programs to Prevent Intergenerational Trauma

• In Event: 3-149 - Taking Evidence-Based Home Visiting to Scale: Lessons Learned From MIECHV-Funded Evaluations

Integrative Statement

It is well established that greater exposure to adverse childhood experiences (ACEs) increases the risk of dysfunction, disorder, and disease. Given the mature state of this literature, the field is increasingly turning to second-generation questions that promise to usher in a new era of ACE science. One question that remains unanswered is whether the costs of adversity and trauma can be passed across generations. Scholars have long speculated that this is so, yet the body of corroborating evidence is remarkably thin. Another lingering question is whether knowledge from ACE research can be translated into effective prevention and intervention strategies.
The current study aims to address these gaps. We use data from the Families and Children Thriving (FACT) Study to test whether maternal ACE scores are associated with child developmental delays. We then discuss how these findings have informed a universal home visiting program in Racine, Wisconsin that aims to concurrently prevent trauma and mitigate its impact.

The FACT Study is a longitudinal investigation of low-income families that received evidence-based home visiting services in Wisconsin. The present study includes 597 mothers who completed a post-baseline assessment one year after enrollment, at which time they rated their youngest child’s social-emotional development on the Brief Infant-Toddler Social Emotional Assessment (BITSEA). Participant ACE histories were recorded by home visiting staff using the Childhood Experiences Survey (Mersky, Janczewski, & Topitzes, 2017). Ten dichotomous indicators of child maltreatment and household dysfunction were summed to form a total ACE score.
Descriptive analyses were performed to assess the prevalence of maternal ACEs and child developmental delays. We conducted multivariate regression analyses to test associations between maternal ACE scores and child social-emotional development outcomes while controlling for sociodemographic characteristics (e.g., age, race/ethnicity, education status).

Descriptive analyses showed that 83.2% of mothers reported at least one ACE, and 67.5% reported multiple ACEs. Results also showed that mothers often rated their children as having social-emotional difficulties. For example, 44.7% and 56.1% of children were rated as having multiple externalizing or dysregulation symptoms, respectively. Multivariate Poisson regression analyses demonstrated that maternal ACE scores were significantly associated with child social-emotional difficulties, including externalizing (EXP_B = 1.05; p <.001) and dysregulation (EXP_B = 1.03, p =.004) problems.

This statewide analysis reinforces previous results from a local evaluation in Racine, Wisconsin, which linked maternal ACEs to child developmental delays among families receiving long-term home visiting services. Drawing on these findings, the Racine health department introduced a brief, universal home visiting program, Family Connects, which is a promising maltreatment prevention model (Dodge et al., 2013). We will describe the model and how it has been enhanced by incorporating a Trauma Screening, Brief Intervention, and Referral to Treatment (T-SBIRT) protocol. Research indicates that T-SBIRT is a feasible and acceptable means of increasing access to mental health services for adults who screen positive for trauma exposure and symptoms (Topitzes et al., 2017). We conclude that this integrated Family Connects with T-SBIRT program is a promising two-generation approach to trauma prevention and intervention.

Authors

• Joshua Patrick Mersky, University of Wisconsin-Milwaukee
  Presenting Author

• Colleen Emily Janczewski, University of Wisconsin-Milwaukee
  Non-Presenting Author

• Chien-Ti Lee, University of Wisconsin-Milwaukee
  Non-Presenting Author

• James Topitzes, University of Wisconsin-Milwaukee
  Non-Presenting Author