5288 El Cajon Blvd. #3, San Diego CA 92115 servessandiego@gmail.com 619.627.1315

Adverse Childhood Experiences

Adverse Childhood Experiences: A Three Tier Approach to Loving Our Children in San Diego

By: Gabriel Davis, Jaime Bisbee, and Gio Tabares

Why our child’s brain development, trauma, and education matter

Research indicates that anywhere between 50 and 75 percent of children undergo trauma during their school-age years (Felitti et al., 1998), and approximately 26 percent of all children in the United States will witness a traumatic event before the age of four (Karr-Morse & Wiley, 2012).

The first most critical stage in human brain development occurs before age 5 (Center on the Developing Child at Harvard University, 2011), with further peak developmental phases occurring during the early childhood and adolescence years (Anderson & Teicher, 2008).  Areas of the brain heavily involved in memory development and learning, such as the hippocampus, are rapidly developing during early childhood, and the area that regulates emotions, attention, and thoughts – the prefrontal cortex – matures during the adolescent years (Weber & Reynolds, 2004).  These patterns of brain development highlight the serious harm trauma can have on the brain when a child experiences harm during these sensitive periods (Pechtel & Pizzagalli, 2011).  These harmful neurological effects are often related to a cascading list of adverse outcomes.

Studies have shown children who experience trauma have a higher risk of grade retention and are more likely to have inconsistent attendance and academic difficulties than their peers (Shonk & Cicchetti, 2001).  Children who have experienced trauma related to violence have difficulties in peer relationships and are more likely to withdraw socially or participate in acts of bullying their peers (Van der Kolk, 2003).  Those who experience the trauma of physical abuse in particular, are typically more negative and aggressive in their interactions with their peers (Margolin & Gordis, 2000).

 

Science has shown us there is a strong relationship between trauma experiences in early childhood and very serious issues later in life including a higher risk for suicide attempts (Dube et al., 2001), physical and mental health challenges (Copeland et al., 2007; Felitti et al., 1998), substance use (Dube et al., 2003), and involvement in the criminal justice system as adolescents and adults (Weeks & Wisdom, 1998; Smith, Leve, & Chamberlain, 2006).

This extensive research points to a need for more trauma-based interventions within schools.

 

Rationale for Evaluation of San Diegan Children and Education Systems

As a result of the high prevalence of early childhood trauma, many systems serving children have begun to address this issue by developing and implementing trauma-competency approaches to service delivery.  These systems include those related to medical treatment, child welfare, and the court.  A few schools across the nation have integration of trauma-inform services including schools in Washington, Massachusetts, and Illinois (McInerney & McKlindon, 2014), but none of these utilize a comprehensive approach like we are proposing.

Our innovative school-center trauma-literate intervention is pivots on a three tier approach to service delivery, thus being an extremely comprehensive program that serves the entire student population.  This is a new way of providing trauma-literate services within the school setting, which we hope will have far-fetching and positive impact on all students who experience the intervention.

Because this intervention is new, we need to evaluate its outcome to determine its effectiveness.

 

Objectives and Description of Child Trauma Evaluation

Social Workers will implement an outcome evaluation in order to evaluate the effectiveness of the intervention

By monitoring key indicators across time, we aim to show that this type of comprehensive intervention is effective at addressing trauma experiences, successfully decreasing adverse consequences, and increasing positive outcomes. As a result of our evaluation, we intend to show that this type of comprehensive, three-tier framework of trauma-informed service should be implemented by all schools across the country to better support our student population in the United States.

 

Monitor Health Indicators On an Ongoing Basis

California Healthy Kids Survey scores → This survey identifies level of feeling a connection to the school, caring relationships with school staff, academic motivation, perceptions of safety at school, violence and victimization, verbal harassment, gang involvement, mental health, and substance use (Health and Human Development Program at WestEd, 2015).

Children’s Hope Survey scores → These scores reflect an individual’s beliefs involving their capacity to clearly plan goals, generate clear strategies to achieve those goals (known as pathways thinking), and successfully initiate and maintain the pursuits to support those specific strategies (referred to as agency thinking) (The Hope Survey by Edvisions, 2010).

Flourishing Scale scores (will obtain in the beginning of the Fall, Spring, and Summer semesters) → These scores reflect an individual’s perception of success in relationships, self-esteem, purpose, and optimism (Diener et al., 2009).  In addition, we will obverse, attendance rates, suspension rates, expulsion rates, high school graduation rates, and academic achievement, as determined by California Assessment of Performance and Progress (CAASPP) scores.

 

Child Wellness Intervention Objectives

Short-term objectives:

Improvements on California Healthy Kids Survey scores which indicates the level of felt connectedness to school, the presence of caring relationships with school staff, academic motivation, perceived safety at school, violence and victimization, verbal harassment, gang involvement, mental health, and substance use (Health and Human Development Program at WestEd, 2015).

Increase in Children’s Hope Survey scores which reflect an individual’s beliefs involving their capacity to clearly plan goals, generate clear strategies to achieve those goals (referred to as pathways thinking), and successfully initiate and maintain the pursuits support those specific strategies (referred to as agency thinking) (The Hope Survey by Edvisions, 2010).

Increase in Flourishing Scale scores which reflect an individual’s perceived success in relationships, self-esteem, purpose, and optimism (Diener et al., 2009).  Importantly, we expect an increase in daily attendance rates, decreases in disciplinary action (suspension and expulsion rates), increase in high school graduation rates, and increases in academic achievement, as determined by California Assessment of Performance and Progress (CAASPP) scores.

 

Long-term objectives

  • Improve health outcomes
  • Decrease crime rates
  • Improve mental health outcomes (decrease number of mental health conditions in the district, including but not limited to, depression, anxiety, PTSD)
  • Increase in university, community college, and/or trade school attendance and graduation rates
  • Increase in employment attainment
  • Increase in long-term employment stability

 

Methods

Evaluation Design

  • To evaluate our intervention, we will use a delayed treatment time series design:

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  • This design will enable us to gather data many times throughout the six-year evaluation in order to closely monitor changes across time.
  • We will implement the intervention in group A after taking baseline measurements for one year.
  • Group B will be utilized as our comparison group by delaying the implementation of our intervention for two years after the intervention is initiated with group A.
  • As a result of this delay, during these two years that group A is receiving our intervention and group B is not, we will be able to make comparisons between the intervention group and comparison group on specific indicators at any point in time.

Data Collection

We will use four surveys to collect some of our data.  These include the Children’s Hope Scale, the Adverse Childhood Experience (ACE) Survey, the Flourishing Scale, and California Healthy Kids Survey (CHKS).

We will utilize existing agency records to obtain the remaining data that we need.  We will obtain attendance records, CAASPP scores, CHKS scores from the Lemon Grove School District and suspension rates, expulsion rates, and demographic data from the California Department of Education.

 

Target Sample

A convenience sample will be used in our study.  This sample consists of the 2,907 students, ranging from kindergarten through eighth grade, who attend school in the Lemon Grove School District.

-Intervention Group – “Group A” → San Altos Elementary, Mount Vernon Elementary, and Monterey Heights Elementary (with a total of 1,115 students)

-Comparison Group – “Group B” → Lemon Grove Academy, Vista La Mesa Academy, and San Miguel Elementary (with a total of 1,792 students)

Instruments and Measures

We are using standardized surveys to obtain our data.  Thus, all of this data will be quantitative.  We are also using secondary data analysis, as we are utilizing quantitative data gathered by the Lemon Grove School District and the California Department of Education.

 

California Healthy Kids Survey (CHKS)

This survey identifies level of felt connectedness to school, caring relationships with school staff, academic motivation, perceived safety at school, violence and victimization, verbal harassment, gang involvement, mental health, and substance use (Health and Human Development Program at WestEd, 2015).

Previous psychometric research studies have demonstrated the high reliability of the CHKS scales.  In addition, current research suggests that the answers given by students when surveys are based on confidentiality, such as the CHKS, have demonstrated a high degree validity (Health and Human Development Program at WestEd, 2015).

 

The Children’s Hope Survey

The Children’s Hope Survey allows school administrators to measure students’ perception in regards to their self-determination, school connectedness, goal orientation, and their disposition toward academic success and learning engagement (The Hope Survey by Edvisions, 2010).

Snyder and colleagues (1997) have concluded that the Children’s Hope Scale has met the psychometric and construct validity standards for self-reported instruments.

The Adverse Childhood Experiences (ACE) Survey

According to the Center for Disease Control, the ACE survey uses questions from instruments that have been validated to measure the frequency of adverse experiences that occurred in one’s childhood (Centers for Disease Control and Prevention, 2010).

The Flourishing Scale

The Flourishing Scale evaluates competency and mastery with regards to an individual’s perceived success in relationships, self-esteem, purpose, and optimism with high reliability and convergence with other psychological well-being scales (Diener et al., 2010; Silva & Caetano, 2013).

 

Results

Due to the fact that this intervention has not yet been implemented, we are unable to present results.  We can however, present expected outcomes, and explain how we will utilize our results to adjust our intervention when used with different populations.

After implementing our intervention, we expect to see an increase in some or all of the following indicators: California Healthy Kids Survey scores, Hope Survey scores, Flourishing Scale scores, attendance rate, high school graduation rate, and academic achievement.  We expect to see a decrease in the number of office referrals.  We expect these outcomes to appear within the first year of implementation and to strengthen over time.

Within thirty years following our intervention, we expect to see positive outcomes within the community as a whole.  These expected outcomes include an increase in the employment rate and long-term employment stability, an increase in attendance and completion of higher education programs, improved physical and mental health outcomes, and a decrease in crime rates.

We will utilize the results of our evaluation to help inform the way we implement our intervention with different populations.  We will analyze outcomes across ethnicity and gender to determine how best to tailor our intervention in the future, based on the varying demographics of the populations served.

 

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