1. Adverse childhood experiences and Self Sufficiency Problems among serious, violent and chronic offenders Menno Segeren, Thijs Fassaert, Arne Popma, Matty de Wit AD

2. Adverse Childhood Experiences (ACEs)
abuse, neglect, sexual abuse, domestic violence, loss of a parent, parental addiction problems, parental mental illness, detention family member
ACE associated with many (seperate) negative outcomes in adulthood
psychiatric disorders, physical illness, unhealthy life style, risk-taking behaviors
Dose-response relationships between ACE and single outcomes
Elevated ACE prevalence in vulnerable populations
Are ACEs associated with problematic functioning in several life domains simultaneously?
Het woord graded is geen inhoudelijke toevoeging tov een dose – response relatie. Voor beide geldt hoe hoger de exposure, hoe hoger de uitkomst.
Graded benadrukt alleen het onderscheid met een quantal dose-response. Daarbij is de uitkomst ja/nee, afhankelijk of de exposure-treshhold wordt overschreden.
Bij (graded) dose-response is de uitkomst continu.
Laatste bullet eventueel naar sheet 4: research questions?

3. Context: diversion program (Top 600)
Serious violent and chronic offenders (SVC)
Selection of mostly young adults (Mage = 26) who commit high impact crimes (i.e. violence)
Combined approach from law enforcement and public health
Social psychiatric screening
By a social psychiatric nurse
Evaluation by a psychiatrist / clinical psychologist
Voluntary
Permission for collection of (medical) file information
Results in:
Advice to other parties involved
Referral to care / social support
Feedback to client
- Voorbeelden law enforcement = tit-for-tat; fast-lane through court procedures; police ‘stalks’ Top600-individuals, monitors their whereabouts
- Screening wordt uitgevoerd door mensen met een aantekening psychodiagnostiek: SPV, forensic pedagogues, psychologists, psychiatrists
- Evaluation: Of een working diagnosis wordt geformuleerd door een psychiater/klinisch psycholoog

4. Research questions
Prevalence, diversity and accumulation of ACES in the childhood of SVC offenders?
Outcomes in young adulthood:
Problems in functioning in several life-domains
Prevalence of psychopathology and addiction
Associations:
childhood young adulthood
ACES problems in functioning in multiple life domains
psychopathology and addiction

5. Methods: ACEs  file study
2/3 history of youth care in A’dam
Juvenile probation files of a sample
Structured scoring of criminogenic factors with “Juvenile Forensic Profile” (FPJ)*
9 FPJ-items represent the ‘big ten ACEs’
Big ten ACEs bevat uitspliting abuse in physical and emotional abuse. In FPJ zit alleen fysieke mishandeling. Emotionele mishandeling hebben we niet.
Maar wel emotionele verwaarlozing
*Brand & van Heerde, 2004

6. Methods: outcomes in young adulthood
Based on social psychiatric screening
Problems in self-suffiency problems
Psychopathology:
Axis 1 disorders and/or personality disorders
Substance use disorders exluded
Addiction:
substance abuse or dependency
Differential diagnoses excluded
Psychopathology = Axis 1 disorder, substance use disorders excluded, and/or personality disorder. Differential diagnoses excluded
Addiction = substance abuse/dependency disorder. Differential diagnoses excluded

7. Self-sufficiency problems (SSP)
An acceptable level of functioning
in the essentials domains of daily life
if nessecary by organizing appropriate support
A photo of the situation
Outcome of personal and environmental attributes
Such as: skills, motivation, economic situation, infrastructure, formal and informal support
Instrument SSM-D (self-sufficiency matrix-Dutch; Fassaert et al 2014)
SSM-D referentie benoemen, en dat het een matrix is?

8. Prevalence of ACEs (n=146)
Average # ACE’s: 2,6
no ACE: 20%
4 ACEs or more: 33%

9. Self-sufficiency problems (n=293)
Misschien nog een vergelijking met andere groepen presenteren? Maar welke dan?
Was jij nog van plan de grafiek te vervangen door eentje met de percentages erin?
Domains are dichotimised: barely self-sufficiency or less (-3)= problem
Law and order excluded
Average number of problem domains: 5.6 (sd = 2.3)

10. Psychopathology & addiction; young adults
Only confirmed diagnoses were included in the analyses, since a high level of uncertainty was seen for several diagnoses but especially personality disorders.
Outcome measures used in study:
Psychopathology = Axis 1 disorder, substance use disorders excluded, and/or personality disorder. Differential diagnoses excluded
Addiction = substance abuse/dependency disorder. Differential diagnoses excluded
Addiction problems mostly cannabis (38%), alcohol (18%) en cocaine (1%)

11. Associations childhood - young adulthood (SS and psychopathology)
96 persons with data from both sources
(logistic) regression analyses:
Predictor = diversity of ACEs
Outcome: self-sufficiency problems, psychopathology and addiction
Association ACE and self sufficiency problems
Diversity of ACES are associated with a diversity of problems domains
Strongest association of ACE with problems in Finances (OR = 1,80) and Housing (OR = 1,44)
ACE positively associated with psychopathology (OR = 1.26)
ACE positively associated with addiction (OR = 1.24)
Predictor = ACE  sumscore of 9 dichotomous (absent vs. present) ACEs  indicates diversity in ACE exposure
Outcoms = SSP  sumscore of 10 dichotomoized SSM-D domains  indicates diversity in problematic functioning in important life domains
Misschien aardig om de OR voor psychopathologie bij het gemiddeld van 2.6 ACEs te vertalen in een kans.

12. Conclusion Questions:
High prevalence of multiple ACEs in this group of severe, violent and chronic offenders
Many problems in young adulthood
ACE associated with
problems in self sufficiency in several domains
Psychopathology and addiction
ACES in childhood can lead to an overall problematic level of self sufficiency, reflected in a wide array of domains
Interventions for svc in young adulthood should be sensitive for personal histories and alert on multiproblems situations
Structural support on the full range of life domains might be necessary
Questions:
Menno Segeren