The Case for Including Adverse Childhood Experiences in Child Maltreatment Education: A Path Analysis

The lifelong, negative consequences of exposure to adverse childhood experiences (ACEs) for individuals and their families are well established.

To demonstrate the importance of including ACE information in child maltreatment education curricula using path analysis.

Survey data examined the impact of child maltreatment education programs and knowledge about ACEs on medical practitioners' reporting habits and ability to detect maltreatment. A path diagram distinguished between the direct impact of education programs on outcome measures and the indirect effect that is mediated through knowledge of ACEs.

Medical practitioners' ability to detect child maltreatment and their number of referrals to Child Protective Services (CPS).

The optimized path diagram (χ²SB(3) = 3.9, p = 0.27; RMSEA-SB = 0.017; R² = 0.21, where SB is Satorra-Bentler coefficient and RMSEA is root-mean-square error of approximation) revealed the mediating variable "knowledge about ACEs" as the strongest structural effect (SB-β = 0.34) on the number of CPS referrals. It was almost twice as high as the second strongest effect of formal education programs (SB-β = 0.19). For workplace training programs, the total effect when including knowledge of ACEs was almost double as strong as the direct effect alone. Even when previous child maltreatment education was controlled for, practitioners familiar with the consequences of ACEs were significantly more likely to recognize and to report abuse to CPS.

This study documented the importance of specialized training programs on ACEs, and the essential role ACE knowledge plays in the effectiveness of provider education programs.