(PS4-B45) The Role of Adverse Childhood Experiences and Adaptive Skills in Treatment Engagement at a Rural Appalachian Child Advocacy Center

Adverse childhood experiences (ACEs) are events that occur before the age of 18 that are difficult or traumatizing (Felitti et al., 1998), including physical abuse, sexual abuse, and neglect. Few studies examine protective factors for maintaining high treatment engagement in the context of elevated ACEs. As trauma-focused child treatment has been shown to have numerous benefits including the reduction of depressive and posttraumatic stress symptoms (Peters et al., 2021; Silverman et al., 2008), is critical to further examine the role that ACEs play in child and family treatment engagement, especially within samples of children that may be at high risk for ACEs. The examination of risk and protective factors of treatment engagement is of prime importance as these findings may inform efforts to increase child attendance in therapy to allow them to fully benefit from trauma-focused services.

Thus, the current study aimed to evaluate the role of child ACEs in predicting attendance, explore differences in ACE prevalence within a highly traumatized sample, and explore the interaction between ACEs and adaptive skills in predicting attendance. A retrospective review of 85 charts was conducted for children receiving therapy services at a rural West Virginia Child Advocacy Center (CAC), an organization that facilitates comprehensive and child-friendly approaches to investigating and intervening in cases of child victimization (National Children’s Alliance, 2019). Demographics, ACE information, child adaptive skill levels on the Behavior Assessment System for Children, Third Edition, Parent-Rating Sale (Reynolds & Kamphaus, 2015), and attendance information were reviewed from charts of children who received at least 6 months of therapy services at the CAC. Child participants (62.4% female, Mage = 9.31 years) averaged 4.71 ACEs.

Child ACEs were significantly, negatively correlated to 6-month therapy attendance rates (r = -.281, p < .001). There was a significant interaction between ACEs and adaptive skills in predicting attendance (B = -.19, p = .020). At average and high levels of adaptive skills, child adaptive skills served as a significant moderator of the negative relation between child ACE score and attendance at 6 months (High: B = -4.71, p = .008; Average: B = -2.41, p = .003). Moderate and high adaptive skills in children appear to reflect resilience of children in the face of adversities, lessening a family’s engagement in their child’s therapeutic services.

Our findings suggest that adaptive skills may actually mask the difficulties that children with high ACE scores may be experiencing, resulting in decreased treatment engagement and premature treatment termination. It is critical for caregivers and children to receive psychoeducation about ACEs and the importance of staying engaged in trauma-focused therapeutic services that have been shown to improve long-term outcomes in traumatized children.