Adverse childhood experiences and mental and physical health disparities: the moderating effect of race and implications for social work

LaBrenz, Catherine A.; O’Gara, Jaimie L.; Panisch, Lisa S.; Baiden, Philip; Larkin, Heather

doi:10.1080/00981389.2020.1823547

Cited by 31 publications

(28 citation statements)

References 61 publications

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“…This study represented the first scoping review of the demographic backgrounds of participants in psychotherapy research conducted with clients with physical health conditions. This study focused only on psychotherapy research with clients with cancer, obesity, and diabetes in particular, given (a) the prevalence of cancer, obesity, and diabetes in the United States (National Health Council, 2014), (b) the extent of disparities in these conditions for various marginalized groups (Hoy-Ellis & Fredriksen-Goldsen, 2016; LaBrenz et al, 2020), and (c) the documented underrepresentation of marginalized groups in research on these conditions (Chen et al, 2014; Chow et al, 2012). As such, the focus of this review—on demographic reporting in psychotherapy studies with clients with cancer, obesity, and diabetes—investigated three of the most common physical health conditions that comprise some of the largest health disparities.…”

Section: The Present Studymentioning

confidence: 99%

“…Similar disparities in participation have been found for diabetes research (Chow et al, 2012). Gaining a better understanding of external validity of psychotherapies for clients with cancer, obesity, and diabetes is a social justice issue, as these conditions disproportionately impact historically marginalized populations (Hoy-Ellis & Fredriksen-Goldsen, 2016; LaBrenz et al, 2020). Delineating which populations are included in intervention research will provide a better understanding of for whom interventions are effective, with a critical focus on ensuring that interventions are effective for individuals from backgrounds that are underrepresented in health psychotherapy research and often overrepresented in prevalence rates of health conditions.…”

mentioning

confidence: 99%

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Psychotherapies for clients with physical health conditions: A scoping review of demographic reporting.

Kimber¹,

Ertl²,

Egli³

et al. 2022

Psychotherapy

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Recent research has highlighted the importance of investigating the efficacy of psychotherapeutic interventions for individuals with physical health conditions. To date, there is evidence that psychotherapeutic interventions are efficacious for a range of physical health conditions (e.g., cancer, obesity, and diabetes). However, less is known about for whom psychotherapeutic interventions for physical health conditions are effective. One reason for this might be pervasive underreporting of demographic data in research, despite the National Institute of Health's 2016 call to action to include such information. Specifically, studies that fail to report full demographic data of participants may reinforce inequities for historically and societally marginalized groups that are traditionally underrepresented in health research; function to restrict researchers from identifying nondiverse, unrepresentative samples; and limit the capacity for future research to address such limitations. To address this gap, we conducted a scoping review of reported demographic data in randomized clinical trials of psychotherapeutic interventions for cancer, obesity, and diabetes. We aimed to identify the frequency and type of demographic data in reported sample characteristics from 2016 to the present. Findings revealed that, on average, studies reported approximately 5 of the 8 demographic domains of interest (M = 5.1; SD = 1.24; range 3-7)age, sex assigned at birth, race and ethnicity, sexual orientation, gender identity, marital status, education, mental health status-suggesting that researchers are not reporting demographic data regularly or consistently. The current article discusses the implications of underreporting demographic data for external validity and provides suggestions for future research directions. Clinical Impact StatementQuestion: What is the frequency that clinical health researchers report demographic data in cancer, obesity, and diabetes psychotherapy research? Findings: Historically underrepresented groups are disproportionately underrepresented in health research, suggesting a lack of clarity on the validity and support of psychotherapy interventions for such groups. Meaning: Comprehensively reporting demographic data will illustrate the full extent of disparities in psychotherapy health research; thus, addressing such disparities stands to increase generalizability to underrepresented groups. Next Steps: Finalize reporting guidelines for psychotherapy health research and address barriers to reporting demographic data in research.

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Section: The Present Studymentioning

confidence: 99%

mentioning

confidence: 99%

Psychotherapies for clients with physical health conditions: A scoping review of demographic reporting.

Kimber¹,

Ertl²,

Egli³

et al. 2022

Psychotherapy

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“…Finally, findings related to cultural considerations in this study are key, given the disproportionate distribution of ACEs among communities of color and calls for culturally responsive approaches to all ACEs research, assessment, and intervention and prevention (Bernard et al, 2020; LaBrenz et al, 2020; Liu et al, 2019). Providers interviewed in this study spoke to key lessons learned for working with diverse, complex patient populations, including the importance of having multidisciplinary, multicultural, multilingual team members, and the importance of being family centered in approach.…”

Section: Discussionmentioning

confidence: 93%

“…Lastly, it is important to highlight that in this study, ACEs were collected as one piece of a comprehensive evaluation that also assessed for family and child context and strengths. Although a focus on this did not emerge in our results, research has demonstrated how positive childhood experiences and natural supports are associated with better health, even in the context of ACEs exposure, leading scholars to suggest that best practices for ACEs inquiry should jointly include assessment of protective factors, including within-child characteristics and contextual factors such as family and community characteristics (Bethell et al, 2019;Liu et al, 2019) Finally, findings related to cultural considerations in this study are key, given the disproportionate distribution of ACEs among communities of color and calls for culturally responsive approaches to all ACEs research, assessment, and intervention and prevention (Bernard et al, 2020;LaBrenz et al, 2020;Liu et al, 2019). Providers interviewed in this study spoke to key lessons learned for working with diverse, complex patient populations, including the importance of having multidisciplinary, multicultural, multilingual team members, and the importance of being family centered in approach.…”

Section: Considerations and Recommendationsmentioning

confidence: 93%

“…Recognizing how ACEs and racism are inextricably linked, scholars have called for culturally responsive approaches to all ACEs research, assessment, and intervention and prevention. Such approaches acknowledge racism as a root contributor to existing disproportionality in ACEs exposure and later health outcomes among youth of color, and recognize and endeavor to address the multiple barriers to health and health care faced by historically marginalized populations (Bernard et al, 2020;LaBrenz et al, 2020 In this study, we utilize a concurrent mixed methods strategy to evaluate the feasibility, acceptability, and utility of a culturally responsive collaborative practice model of ACEs routine inquiry.…”

Section: Important Future Directions and Study Aimsmentioning

confidence: 99%

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Pediatric ACES assessment within a collaborative practice model: Implications for health equity.

Liu¹,

Grimes²,

Creedon³

et al. 2021

American Journal of Orthopsychiatry

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It is now well understood that exposure to Adverse Childhood Experiences (ACEs) is negatively linked to health and well-being across the lifespan. In an effort to disrupt ACEs exposure and its effects, there is a nationwide movement to screen for ACEs in primary care, despite a lack of wellestablished guidelines for assessing and responding to risk within routine care. Additionally, developing culturally responsive models of ACEs assessment is imperative, particularly because racial and ethnic minority populations face disproportionate risk of exposure to ACEs and disparities in quality of health care. Using mixed methods, we explored the feasibility, acceptability, and utility of conducting ACEs routine inquiry with an ethnically and economically diverse pediatric population through a unique collaborative practice model (CPM) consisting of an integrated, multidisciplinary team within primary care. In the CPM study, 163 children from a safety-net health system were enrolled; of those, an ACEs questionnaire was collected from 158 (97%) study participants as part of their mental health evaluation. The sample was highly ACEs exposed, with 40% of children and 56% of teens having scores of four or more. There were significant associations between level of ACEs exposure and degree of mental health impairment in both children and teens. Providers viewed the ACEs assessment process as feasible, acceptable, and to have utility for the care of the study's diverse pediatric population. Findings highlight benefits, challenges, cultural considerations and recommendations for promoting health equity through a primary-care integrated ACEs assessment model. Public Policy Relevance StatementRacial/ethnic minority and low socioeconomic status populations face disproportionate exposure to ACEs and barriers to accessing treatment. Results of a mixed methods study found that a multidisciplinary, team-based approach to assessing ACEs in primary care is feasible, acceptable, and useful to providers working with diverse and highly stressed children and families. This model of routine ACEs inquiry can inform earlier recognition and individualized treatment to improve health and healthcare equity and outcomes for trauma-exposed youth. aaa A dverse childhood experiences (ACEs), historically defined as exposure to abuse, neglect, and household challenges, are common across the United States. Nationally representative findings from the 2011/12 National Survey of Children's Health (NSCH) indicate nearly one-half of U.S. children are exposed to at least one ACEs, with higher rates among older, lower-income, racial/ethnic minority, and uninsured or publicly insured youth (Bethell et al., 2017). An abundance of research with adults illustrates a robust dose-response relationship between This document is copyrighted by the American Psychological Association or one of its allied publishers.This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

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Assessment of Screening for Adverse Childhood Experiences and Receipt of Behavioral Health Services Among Children and Adolescents

et al. 2022

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ImportanceScreening for adverse childhood experiences (ACEs) in primary care settings has been increasing as a response to the overwhelming and consistent evidence of the deleterious associations between ACEs and later physical and mental health. However, there is little empirical guidance on the appropriate implementation of ACEs screening in pediatric primary care.ObjectiveTo test the use of a pilot intervention for ACEs screening and referral on the receipt of behavioral health care for children and adolescents within a large integrated health care delivery system.Design, Setting, and ParticipantsA retrospective cohort study was conducted in a large integrated health care system serving Southern California. Child and adolescent members of the target health care system younger than 18 years between July 1, 2018, and November 30, 2021, who received a positive screening for ACEs at the pilot clinic were included. This pilot clinic implemented an intervention that included additional screening questions and incorporated social workers into the process of evaluation and referral for behavioral health needs following ACEs screening.ExposuresACEs screening.Main Outcomes and MeasuresVisit to a behavioral health care service within 90 days of a positive ACEs screen determined as a score of 1 or higher and behavioral symptoms.ResultsThe cohort consisted of 4030 children (mean [SD] age, 9.94 [4.55] years) with positive ACEs screening, 48% adolescents (11-17.99 years), approximately equal gender (51% females), 73% Hispanic, and 33% with Medicaid insurance. After the intervention, children were more likely to have a behavioral health services visit within 90 days of the screening than before the intervention (from 4.33% to 32.48%; incidence rate ratio, 7.50; 95% CI, 1.55-36.2).Conclusions and RelevanceIn this cohort study, the implementation of a new ACEs screening and referral process was associated with increased receipt of behavioral health services among children with a positive ACEs screening. This could be useful strategy for other health care systems responding to state and local mandates to screen and provide care for children with ACEs.

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Adverse childhood experiences and mental and physical health disparities: the moderating effect of race and implications for social work

Cited by 31 publications

References 61 publications

Psychotherapies for clients with physical health conditions: A scoping review of demographic reporting.

Psychotherapies for clients with physical health conditions: A scoping review of demographic reporting.

Pediatric ACES assessment within a collaborative practice model: Implications for health equity.

Assessment of Screening for Adverse Childhood Experiences and Receipt of Behavioral Health Services Among Children and Adolescents

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