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- Definition: Estimated percentage of women with a live birth who before age 14 experienced childhood hardships, by prenatal health insurance type (e.g., an estimated 4.7% of privately insured California women with a live birth in 2013-2014 experienced four or more childhood hardships).
- Data Source: California Department of Public Health, Maternal, Child and Adolescent Health (MCAH) Program, & University of California, San Francisco, Center on Social Disparities in Health, Maternal and Infant Health Assessment (MIHA) Survey (Mar. 2018).
- Footnote: This indicator reports the prevalence of seven childhood hardships: (1) basic needs not met, (2) parental drinking or drug problem, (3) parental legal trouble or incarceration, (4) parental divorce or separation, (5) family hunger, (6) relocation due to problems paying rent or mortgage, (7) foster care placement. MIHA is an annual population-based survey of California resident women with a live birth in the calendar year. Percentages are weighted to represent all women with a live birth in California and counties during the time period. Refer to the MIHA technical notes for information on weighting methods.
- Measures of Childhood Adversity and Resilience on Kidsdata.org
Childhood adversity and resilience measures on kidsdata.org originate from three separate data sources and provide a rich and conceptually-related perspective on childhood adversity. Taken together, they present a broad framework to look at child adversity across the lifespan and provide useful data to inform and facilitate interventions. However, due to differences in methodology, data from the three sources should not be compared. The data sources are:
- National Survey of Children's Health (NSCH)
- Maternal and Infant Health Assessment (MIHA)
- Behavioral Risk Factor Surveillance System (BRFSS)
Each of these separate data sources produces at least one overall index of childhood adversity. An overall index should be viewed as a more comprehensive measure than any one of its individual items alone because it captures the cumulative magnitude of experiencing hardships.NSCH data were collected by the U.S. Census Bureau on behalf of the Maternal and Child Health Bureau of the Department of Health and Human Services. NSCH uses a set of family, economic, and community adversity indicators to ask parents about current adverse experiences to which their children (ages 0 to 17) have been exposed. This is the most direct population-based survey measure of adversity among California children because it asks parents about the trauma their children have experienced while they are still children, compared to the more traditional methods of asking adults to recall their childhood experiences.
MIHA is a collaborative effort of the Maternal, Child and Adolescent Health Division and the Women, Infant and Children Division of the California Department of Public Health and the Center on Social Disparities in Health at the University of California, San Francisco. MIHA surveys postpartum women (15 years and older) who delivered a live birth about their own childhood hardships prior to age 14.
The BRFSS ACEs Module was adapted from the Adverse Childhood Experiences (ACEs) study by Kaiser Permanente and the Centers for Disease Control and Prevention. The data presented here were prepared by the Public Health Institute's Survey Research Group. They are based on adult recollections of their childhood experiences during the first 17 years of life and, thus, these retrospective data do not provide direct information about the current status of California’s children.
NSCH, MIHA, and BRFSS data, together, provide a comprehensive framework for understanding and addressing child adversity across the lifespan. Among these three data sources, the NSCH indicators are the most contemporary because they tap into parents’ views of their children’s current experiences. MIHA adds an intergenerational perspective by providing information about the childhood hardships experienced by mothers of newborns. BRFSS provides a well-established standard measure of adult retrospective reports of adverse childhood experiences. Both NSCH and MIHA include a wider range of potentially adverse experiences, such as exposure to extreme poverty, community violence, and food and housing insecurity, whereas the BRFSS ACEs Module focuses primarily on family dysfunction. Each source provides a unique but conceptually-related perspective on childhood adversity.
- Childhood Adversity and Resilience
- Children with Two or More Adverse Experiences (Parent Reported)
- Children Who Are Resilient (Parent Reported)
- Prevalence of Childhood Hardships (Maternal Retrospective)
- by Family Income (CA Only)
- by Maternal Age (CA Only)
- by Prenatal Insurance Coverage (CA Only)
- by Race/Ethnicity (CA Only)
- Basic Needs Not Met
- Basic Needs Not Met, by Family Income (CA Only)
- Basic Needs Not Met, by Maternal Age (CA Only)
- Basic Needs Not Met, by Prenatal Insurance Coverage (CA Only)
- Basic Needs Not Met, by Race/Ethnicity (CA Only)
- Parental Drinking or Drug Problem
- Parental Drinking or Drug Problem, by Family Income (CA Only)
- Parental Drinking or Drug Problem, by Maternal Age (CA Only)
- Parental Drinking or Drug Problem, by Prenatal Insurance Coverage (CA Only)
- Parental Drinking or Drug Problem, by Race/Ethnicity (CA Only)
- Parental Legal Trouble/Incarceration
- Parental Legal Trouble/Incarceration, by Family Income (CA Only)
- Parental Legal Trouble/Incarceration, by Maternal Age (CA Only)
- Parental Legal Trouble/Incarceration, by Prenatal Insurance Coverage (CA Only)
- Parental Legal Trouble/Incarceration, by Race/Ethnicity (CA Only)
- Parental Divorce or Separation
- Parental Divorce or Separation, by Family Income (CA Only)
- Parental Divorce or Separation, by Maternal Age (CA Only)
- Parental Divorce or Separation, by Prenatal Insurance Coverage (CA Only)
- Parental Divorce or Separation, by Race/Ethnicity (CA Only)
- Family Hunger
- Family Hunger, by Family Income (CA Only)
- Family Hunger, by Maternal Age (CA Only)
- Family Hunger, by Prenatal Insurance Coverage (CA Only)
- Family Hunger, by Race/Ethnicity (CA Only)
- Moved Due to Financial Problems
- Moved Due to Financial Problems, by Family Income (CA Only)
- Moved Due to Financial Problems, by Maternal Age (CA Only)
- Moved Due to Financial Problems, by Prenatal Insurance Coverage (CA Only)
- Moved Due to Financial Problems, by Race/Ethnicity (CA Only)
- Foster Care Placement
- Foster Care Placement, by Family Income (CA Only)
- Foster Care Placement, by Maternal Age (CA Only)
- Foster Care Placement, by Prenatal Insurance Coverage (CA Only)
- Foster Care Placement, by Race/Ethnicity (CA Only)
- Prevalence of Adverse Childhood Experiences (Adult Retrospective)
- Parent or Adult Caretaker Failed to Provide for Basic Needs
- Household Member Abused Alcohol
- Household Member Abused Street Drugs or Prescription Medications
- Household Member Was Sentenced to Serve Time in a Corrections Facility
- Household Member Was Depressed, Mentally Ill, or Suicidal
- Parents Divorced or Separated
- Witnessed Domestic Violence
- Experienced Physical Abuse
- Experienced Verbal Abuse
- Experienced Sexual Abuse
- Forced to Have Sex
- Made to Touch Someone Sexually
- Touched Sexually by Someone
- Characteristics of Children with Special Needs
- Child Abuse and Neglect
- Family Structure
- Food Security
- Intimate Partner Violence
- Housing Affordability
- Foster Care
- First Entries into Foster Care
- Children in Foster Care
- Length of Time from Foster Care to Adoption
- Median Number of Months in Foster Care
- Placement Distances from Home
- Placement Stability, by Number of Placements
- Re-entries into Foster Care
- Exit Status After One Year in Foster Care
- Exit Status After Four Years in Foster Care
- Why This Topic Is Important
Childhood adversity—such as child abuse, exposure to violence, family alcohol or drug abuse, and poverty—can have negative, long-term impacts on health and well being (1, 2). Nearly half of U.S. children have experienced at least one adverse childhood event (3). Early experiences affect brain structure and function, which provide the foundation for learning, emotional development, behavior, and health (4). The toxic stress associated with traumatic, and often cumulative, early adverse experiences can disrupt healthy development and lead to behavioral, emotional, school, and health problems during childhood and adolescence (2, 3, 5, 6). It also can lead to serious behavioral, emotional, and health issues in adulthood, such as chronic diseases, obesity, alcohol and other substance abuse, and depression (1, 2, 3). The more traumatic and toxic events experienced by a child, the more likely the impact will be substantial and long-lasting (7).
Resilience, an adaptive response to hardship, can mitigate the effects of adverse childhood experiences (6, 8). It is a process of adapting well in the face of adversity, trauma, threats, or other significant sources of stress. Resilience involves a combination of internal and external factors. Internally, it involves behaviors, thoughts, and actions that anyone can learn and develop. Resilience is also strengthened by having safe, stable, nurturing relationships and environments within and outside the family (6, 8, 9).For more information on childhood adversity and resilience, see kidsdata.org’s Research & Links section.
Sources for this narrative:
1. Centers for Disease Control and Prevention. (2016). About adverse childhood experiences. Retrieved from: http://www.cdc.gov/violenceprevention/acestudy/about_ace.html
2. Shonkoff, J. P., et al. (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1), e232-e246. Retrieved from: http://pediatrics.aappublications.org/content/129/1/e232
3. Child and Adolescent Health Measurement Initiative. (2014). 4 essential facts about lifelong health, school success and adverse childhood experiences among California’s children. Retrieved from: http://childhealthdata.org/docs/presentations-/californiadata.pdf?Status=Master
4. The Center for the Developing Child. (n.d.). Brain architecture. Retrieved from: http://developingchild.harvard.edu/science/key-concepts/brain-architecture
5. Moore, K., et al. (2014). Adverse childhood experiences and the well-being of adolescents. Child Trends. Retrieved from: http://www.childtrends.org/?publications=fact-sheet-adverse-childhood-experiences-and-the-well-being-of-adolescents
6. Bethell, C. D., et al. (2015). Adverse childhood experiences: Assessing the impact on health and school engagement and the mitigating role of resilience. Health Affairs, 33(12), 2106-2115. Retrieved from: https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2014.0914
7. Center for Youth Wellness. (2014). A hidden crisis: Findings on adverse childhood experiences in California. Retrieved from: https://app.box.com/s/nf7lw36bjjr5kdfx4ct9
8. The Center for the Developing Child. (2015). The science of resilience. Retrieved from: http://developingchild.harvard.edu/resources/inbrief-the-science-of-resilience
9. Pinderhughes, H., et al. (2015). Adverse community experiences and resilience: A framework for addressing and preventing community trauma. Prevention Institute. Retrieved from: https://www.preventioninstitute.org/publications/adverse-community-experiences-and-resilience-framework-addressing-and-preventing
- How Children Are Faring
Childhood adversity is common among California children, and many children experience multiple traumatic and negative events. The most timely assessment of childhood resilience and adversity comes from the National Survey of Children's Health (NSCH), in which parents report on the current status of their children. NSCH data from 2016 show that 52% of California children were resilient while 16% of children had experienced two or more adverse childhood events. According to the 2013-2014 Maternal and Infant Health Assessment (MIHA), 25% of postpartum women in California experienced two or more childhood hardships before age 14. The California Behavioral Risk Factor Surveillance System Adverse Childhood Experiences (ACEs) Module, combining data from 2008 to 2013, shows that 17% of adults in households with children experienced at least four ACEs before age 18.The percentage of postpartum women who experience two or more childhood hardships varies by poverty level and maternal age. According to 2013-2014 MIHA data, among poor women (i.e., those with family incomes up through 100% of the federal poverty guideline), 34% experienced two or more hardships as children, compared with 16% of higher-income women (i.e., those with family incomes over 200% of the federal poverty guideline). Furthermore, one-third of young mothers 15-19 years old experienced two or more hardship as children (33%), compared with less than one-fifth of mothers 35 years old and older (19%).
- Policy Implications
In recent years, policymakers, researchers, and advocates increasingly have focused on childhood adversity (e.g., physical or emotional abuse, chronic neglect, caregiver substance abuse or mental illness, exposure to violence, and/or the accumulated burdens of family economic hardship), recognizing that such experiences can have harmful, lifelong consequences (1, 2). For example, children exposed to multiple adverse childhood experiences (ACEs) are more likely to develop negative health behaviors and chronic diseases in adulthood (1). Unaddressed ACEs place strain on public systems, including child welfare, education, health care, and juvenile justice (1). Policymakers have a role in helping to prevent ACEs, as well as in ensuring early identification and intervention for parents and children affected by trauma. While California has made strides in these areas, continued efforts are needed to ensure that all families have the opportunity to help their children thrive and reach their full potential (1, 3).
Policy and program options to help prevent, interrupt, and mitigate the effects of childhood adversity include:
For more information related to ACEs, see kidsdata.org’s Research & Links section or visit the Center for Youth Wellness, the ACEs Connection Network, and the Prevention Institute. Also see Policy Implications in kidsdata.org's Child and Youth Safety and Emotional and Behavioral Health topics.
- Raising public awareness about ACEs and their negative, lasting effects on children and families (1)
- Ensuring effective prevention services are in place, including strength-based parenting education, family support, and home-visiting services for families in need (4)
- Promoting policies that help reduce family stress and increase stability for children, e.g., policies to improve the social safety net for families in need, support family-friendly business practices, and ensure quality child care is affordable and accessible (4)
- Institutionalizing trauma-informed policies and practices for public and private systems and organizations (designed specifically to address the consequences of trauma and facilitate resilience and healing), including screening and intervention with health reimbursement mechanisms (1, 3)
- Supporting formal workforce education about ACEs and trauma-informed approaches for professionals who work with families and children, such as administrators, doctors, nurses, educators, social workers, and juvenile justice staff (1, 3)
- Promoting increased collaboration across organizations and systems (e.g., local and state government, education, health care, juvenile justice, child welfare, and nonprofits) to address systemic barriers to preventing or treating trauma and toxic stress, including improving service coordination, sharing data, and aligning measures of success (1, 4)
- Supporting ongoing strategies to provide accessible, culturally competent, trauma-informed, and resilience-building systems of mental health, substance abuse treatment, and other community services (1, 3, 5)
- Expanding data collection related to ACEs and resilience to study and advance effective interventions aimed at preventing and reducing the impacts of trauma on children, families, organizations, systems, and communities (1, 3)
Sources for this narrative:
1. Center for Youth Wellness. (2015). Children can thrive: A vision for California’s response to adverse childhood experiences. Retrieved from: https://app.box.com/s/fd9gnls5rsswzo2biepbfiz8m23jy1uk
2. Child and Adolescent Health Measurement Initiative. (2014). 4 essential facts about lifelong health, school success and adverse childhood experiences among California’s children. Retrieved from: http://childhealthdata.org/docs/presentations-/californiadata.pdf?Status=Master
3. Bradshaw, J. (2015). Helping children heal: Promising community programs and policy recommendations. Children's Defense Fund - California. Retrieved from: http://www.cdfca.org/library/publications/2015/helping-children-heal.pdf
4. National Center for Injury Prevention and Control. (2017). Essentials for childhood: Steps to create safe, stable, nurturing relationships and environments. Centers for Disease Control and Prevention. Retrieved from: http://www.cdc.gov/violenceprevention/childmaltreatment/essentials.html
5. California Department of Social Services, & California Department of Health Care Services. (n.d.). Pathways to mental health services: Core practice model guide. Retrieved from: https://humanservices.ucdavis.edu/programs/resource-center-family-focused-practice/pathways-mental-health-services/pathways
- Websites with Related Information
- ACEs Connection Network
- California Dept. of Social Services: Office of Child Abuse Prevention
- California Essentials for Childhood Initiative, California Dept. of Public Health
- Center for Youth Wellness
- Center on the Developing Child, Harvard University
- Child and Adolescent Health Measurement Initiative: Childhood Trauma and Positive Health
- Child Welfare Information Gateway, U.S. Dept. of Health and Human Services, Children’s Bureau
- National Child Traumatic Stress Network
- Robert Wood Johnson Foundation: Adverse Childhood Experiences
- Substance Abuse and Mental Health Services Administration (SAMHSA): Adverse Childhood Experiences, U.S. Dept. of Health and Human Services
- Key Reports and Research
- 4 Essential Facts About Lifelong Health, School Success and Adverse Childhood Experiences Among California’s Children, 2014, Child and Adolescent Health Measurement Initiative
- A Hidden Crisis: Findings on Adverse Childhood Experiences in California, 2014, Center for Youth Wellness
- Adverse Childhood Experiences (ACEs): California Update, 2011-2013 Data, 2016, California Dept. of Public Health
- Adverse Childhood Experiences and the Well-Being of Adolescents, 2014, Child Trends, Moore, K., et al.
- Adverse Childhood Experiences: Assessing the Impact on Health and School Engagement and the Mitigating Role of Resilience, 2014, Health Affairs, Bethell, C. D., et al.
- Adverse Community Experiences and Resilience: A Framework for Addressing and Preventing Community Trauma, 2015, Prevention Institute, Pinderhughes, H., et al.
- Adverse Family Experiences among Children in Nonparental Care, 2011–2012, 2014, National Health Statistics Reports, Bramlett, M. D., & Radel, L. F.
- Barriers to Success: Toward a Deeper Understanding of Adversity’s Effects on Adolescents, 2017, America’s Promise Alliance, Porche, M. V., et al.
- Changing Minds and Creating Trauma-Informed Communities, 2016, Children Now & Futures Without Violence
- Children Can Thrive: A Vision for California’s Response to Adverse Childhood Experiences, 2015, Center for Youth Wellness
- Essentials for Childhood Framework: Steps to Create Safe, Stable, Nurturing Relationships and Environments for All Children, 2017, Centers for Disease Control and Prevention
- Evaluating Community-Based Family Support Networks to Reduce Adverse Childhood Experiences, Mathematica Policy Research
- Overview of Adverse Child and Family Experiences among U.S. Children, 2013, Child and Adolescent Health Measurement Initiative
- Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults, 1998, American Journal of Preventive Medicine, Felitti, V. J., et al.
- The Prevalence of Adverse Childhood Experiences (ACE) in the Lives of Juvenile Offenders, 2014, Journal of Juvenile Justice, Baglivio, M. T., et al.
- The Prevalence of Adverse Childhood Experiences, Nationally, by State, and by Race/Ethnicity, 2018, Child Trends, Sacks, V., & Murphey, D.
- County/Regional Reports
- 2016-17 California County Scorecard of Children's Well-Being, Children Now
- Connecting the Dots: Snapshots of Child Well-Being in Los Angeles County, Children's Data Network
- Data Briefs on Adverse Childhood Events Among California’s Children, 2014, Child and Adolescent Health Measurement Initiative
- More Data Sources For Childhood Adversity and Resilience
- Adverse Childhood Experiences (ACE) Study, Centers for Disease Control and Prevention & Kaiser Permanente
- Child Trends Databank: Adverse Experiences
- Maternal and Infant Health Assessment (MIHA), California Dept. of Public Health & University of California, San Francisco
- National Survey of Children's Health: Adverse Childhood Experiences, Child and Adolescent Health Measurement Initiative
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