Content area
Full Text
ABSTRACT The ongoing longitudinal Adverse Childhood Experiences Study of adults has found significant associations between chronic conditions; quality of life and life expectancy in adulthood; and the trauma and stress associated with adverse childhood experiences, including physical or emotional abuse or neglect, deprivation, or exposure to violence. Less is known about the population-based epidemiology of adverse childhood experiences among US children. Using the 2011-12 National Survey of Children's Health, we assessed the prevalence of adverse childhood experiences and associations between them and factors affecting children's development and lifelong health. After we adjusted for confounding factors, we found lower rates of school engagement and higher rates of chronic disease among children with adverse childhood experiences. Our findings suggest that building resilience- defined in the survey as "staying calm and in control when faced with a challenge," for children ages 6-17-can ameliorate the negative impact of adverse childhood experiences. We found higher rates of school engagement among children with adverse childhood experiences who demonstrated resilience, as well as higher rates of resilience among children with such experiences who received care in a family-centered medical home. We recommend a coordinated effort to fill knowledge gaps and translate existing knowledge about adverse childhood experiences and resilience into national, state, and local policies, with a focus on addressing childhood trauma in health systems as they evolve during ongoing reform.
The Affordable Care Act (ACA) and associated health system transformation models-including the patient-centered medical home and accountable care organizations (ACOs)-promote a model of health and health care that focuses on "whole person" and "whole population" health and well-being.1,2 These reform models have emerged against the backdrop of a growing interdisciplinary consensus- supported by a critical mass of social science, health services, epigenetic, neurodevelopmental, and biological research3-14-that it is paramount to view health development in childhood and across life through the lens of childhood trauma and stress associated with adverse childhood experiences.2,15
Adverse childhood experiences were first assessed through the Adverse Childhood Experiences Study, a longitudinal study of adults conducted by the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente.8,16 These experiences include exposure to violence; emotional, physical, or sexual abuse; depriva- tion; neglect; family discord and divorce; parental substance abuse and mental health problems; parental death or incarceration;...