(PS13-D92) High Aces in Individuals with Early Psychosis Associated with Lower Client-reported Family Functioning: Preliminary Data from the California EPI-CAL Project

Background: California’s EPI-CAL project (https://epical.ucdavis.edu) joins 6 university- and 15 community-based early psychosis (EP) programs to create a sustainable learning health care network as part of the NIMH EPINET project. Our qualitative data highlighted how adverse childhood experiences (ACEs) impact the lives of individuals experiencing psychosis; however, few EP programs currently evaluate or treat trauma using empirically supported approaches. Intensity of traumatic experiences throughout childhood could represent a modulating factor of psychotic symptoms and overall functioning, including family functioning. Beyond psychosis, family functioning can have a moderating effect on the negative impact of ACEs on emotional well-being. This literature suggests a strong association between ACES, mental health difficulties, and family functioning, though these relationships have been minimally examined in the context of early psychosis. The current analysis examines the relationships between client ACEs and family functioning as reported by both clients and primary support persons (PSP) in EPI-CAL. 

Methods: Individuals with first episode affective or nonaffective psychosis (FEP) or at clinical high risk for psychosis (CHR) completed self-report surveys at enrollment in EPI-CAL. Participants completed the Pediatric ACEs Screening and Related Life-events Screener (PEARLS) and the SCORE-15. In order to draw clinical interpretations, all analyses utilized a subset of items reflective of the original ACES-10. Adults were asked to rate experiences prior to age 18. ACEs scores of 4+ are considered high risk for poor outcomes, and higher SCORE-15 scores indicate worse family functioning. Descriptive analyses and Pearson’s correlations summarize client’s ACEs and SCORE-15; demographics were examined.  

Results: At enrollment, 217 clients (Ages 12-32, M=19.04, SD=4.28; 71% FEP, 21% CHR, 8% Diagnosis unconfirmed), completed the PEARLS version of the ACEs-10 (M = 3.52, SD = 2.74). They identified as 50.5% female sex at birth; 42% female gender; 73% non-White; 41% Hispanic/Latinx; and 7% were not born in the US. 47% respondents had an ACEs score of 4 or higher and are considered high risk for poor outcomes. Clients’ self-reported SCORE-15 total scores (n=103, M=33.68) was positively correlated to their ACEs scores (r = 0.295, p=0.002). Conversely, PSP SCORE-15 total (n=71, M=30.13) and subdomain scores were not significantly related to their associated client’s ACEs score (r = 0.19, p=0.11). The same pattern was found in each of the three SCORE-15 subdomains (strengths and adaptability, overwhelmed by difficulties, and disrupted communication). Exploration of matched pairs between client and PSP will be examined as more data is collected.  

Conclusions:  ACEs are common for individuals receiving care in EP programs. These experiences are associated with worse family functioning per client report. Given the importance of family treatments as an evidence-based approach for FEP, and the negative impacts of ACEs on client outcomes, these data suggest that EP programs should identify and treat individuals who experience traumatic events and to target areas of family functioning, with the goal of improving outcomes.