Defense Date


Document Type


Degree Name

Master of Science



First Advisor

Heather A. Jones, Ph.D.

Second Advisor

Bruce Rybarczyk, Ph.D.

Third Advisor

Sunny Shin, Ph.D.


The prevalence of adverse childhood experiences (ACEs) has created a significant public health concern in the United States. A vast body of literature examining adult populations has displayed a dose-response association between cumulative ACEs and chronic illnesses (Chapman et al., 2004; Felitti et al., 1998). ACEs research conducted with children and adolescents has indicated higher ACE scores associated with learning and behavioral problems (Burke et al., 2011), health risk behaviors (Garrido et al., 2018), and mental health challenges (Mackner et al., 1997). However, ACEs research and subsequent interventions have largely relied upon retrospective data retrieved from adults (Felitti et al., 1998) and national datasets (Centers for Disease Control and Prevention, 2019; Greeson et al., 2014). Given the growing literature on ACEs in children and adolescents, the goal of the thesis project was to investigate the ACEs, psychosocial functioning, and healthcare utilization of youth presenting to a pediatric integrated primary care clinic (IPC) in an urban community. Participants were patients who complete an initial visit with the Pediatric Behavioral Health Team (Peds BHT) at VCU’s Children’s Hospital of Richmond. This IPC clinic serves a low income, racially diverse pediatric population (ages 3-17). This study utilized clinical data obtained from caregivers of patients presenting to the Peds BHT. Measures of cumulative childhood adversity (Adverse Childhood Experiences Questionnaire), child mental health (Pediatric Symptom Checklist-17), and demographic characteristics were examined. The present study utilized descriptive statistical analyses and linear regression models to examine relations between ACEs, mental health, and healthcare utilization in a pediatric sample presenting to IPC. The results indicated 81.3% of participants experienced at least 1or more Original ACEs (an ACE score ≥ 1), and 58.7% experienced ≥ 2 or more Original ACEs. For children in the 3-12 age group, Original ACE scores predicted overall mental health, (p =.008). The results also indicated a relationship between medical diagnoses and healthcare utilization. The results underscore the importance of screening for ACEs and mental health in pediatric primary care as early childhood stressors emerge.


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