Trauma-Informed Care in out-of-School time Programs: A Strategic Response to Adverse Childhood Experiences (ACEs)

Abstract Children with multiple Adverse Childhood Experiences (ACEs) have been shown to be at greater risk of experiencing negative health and social outcomes as adults. Providing Trauma-Informed Care (TIC) to children with ACEs has been linked to better health outcomes later in life. Similarly, Out-of-School Time (OST) programs may also play an important role in supporting children who have experienced ACEs. However, few studies have examined the prevalence of ACEs among children attending OST programs specifically, or subsequently how TIC strategies can be implemented at OST programs to mitigate negative health effects. This study aimed to determine if youth who attend the studied OST Program had experienced a higher number of ACEs than the general pediatric population, and subsequently if TIC training had been implemented. An anonymous survey was developed, modeled after a template from ACEs Aware, which included ten ACEs questions (original ACEs) and nine Related Life Events questions (considered additional ACEs in this study). An optional demographics section was also included. Caregivers of children at the specified OST Program were asked to participate. Staff and volunteers were also surveyed regarding their history of training in TIC. Survey response rate was 81.3% ( n = 52). Of the completed surveys, the mean number of total ACEs experienced per child was 4.6, the median was 3, and the mode was 2. The maximum number of ACEs experienced by a child was 14. The median number of total ACEs for the OST Program population was found to be statistically significantly different (difference = 1, p = 3.522e-04) than that of the general pediatric population. The median number of original ACEs experienced per child at the OST Program was also found to be statistically significantly different (difference = 1, p = 3.348e-05) than that of the general pediatric population. 50% of the staff and volunteers surveyed ( n = 18, 100% response rate) had no formal TIC training. Children who attend the studied OST Program may experience on average a higher number of ACEs than the general pediatric population. Requiring training on ACEs and TIC for staff and volunteers may help better identify and respond to child behaviors linked to ACEs and improve downstream health outcomes.