Socio-Ecological Predictors of Child and Family Resilience in Children with Adverse Childhood Experiences

Overview: This secondary analysis examines socio-ecological predictors of child and family resilience in children with adverse childhood experiences (ACEs). Findings highlight the important role of parenting stress, school safety, safe and supportive neighborhood, and access to health care in promoting resilience in children with ACE exposures.Proposal text: Background
Adverse childhood experiences (ACEs) are of great public health interest in the United States (Felitti et al., 1998; Shonkoff et al., 2012). Despite theoretical and empirical data indicating that children with ACE exposures are more likely to suffer from negative developmental outcomes, there is growing interest in protective factors that promote successful adaptation despite the early exposure to the hardships (Bethell, Gombojav, Whitaker, 2019; Cicchetti, 2010; Masten & Barnes, 2018). To date, such research has mainly focused on individual-level characteristics with limited exploration of family- and community-level influences on outcomes for ACE-exposed children (Biglan, Ryzin, & Hawkins, 2017). To address this gap in research, this study aimed to identify socio-ecological predictors of child and family resilience in a nationally representative sample of school-aged children who had ACEs.

Methods
We conducted a secondary analysis of cross-sectional data from the 2019 National Survey of Children’s Health (NSCH) on a total of 8,377 children aged 6 to 17 years old. Parental reports of child flourishing and family resilience measures were used to create a categorical outcome variable with four different types of child and family resilience: neither child flourishing nor family resilience (reference group), child flourishing only, family resilience only, both child flourishing and family resilience. We used a multinomial regression model to identify socio-ecological predictors of child and family resilience among children who had ACEs, after controlling for cumulative ACEs exposures (i.e., 1 (reference group), 2, 3, and 4 or more). Given the complex sampling design of the survey, all analyses accounted for cluster and sampling weights.

Results
Among school aged-children with ACE exposures, 47.3% were classified as both child flourishing and family resilience; 28.2% were family resilience only, 10.5% were child flourishing only, and 14.0% were neither child flourishing nor family resilience. The results of the multinomial regression model indicate that compared to children who were in neither child flourishing nor family resilience category: 1) children in child flourishing only group less often reported a stressed parent (OR=0.15, p