Contents lists available at ScienceDirect Child Abuse & Neglect journal homepage: www.elsevier.com/locate/chiabuneg Adverse childhood experiences among youth reported to child welfare: Results from the national survey of child & adolescent wellbeing Antonio R. Garcia a, ⁎ , Meera Gupta b , Johanna K.P. Greeson a , Allison Thompson a , Christina DeNard a a School of Social Policy & Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA 19104, United States b Division of Transplant Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 2 Dulles, Philadelphia, PA 19104, United States ARTICLE INFO Keywords: Child abuse Adverse childhood experience Mental health Mental health service use Racial disparity ABSTRACT The negative influence of adverse childhood experiences (ACEs) on social, emotional, and be- havioral (SEB) outcomes are well documented. However, no research to date has examined the effect of ACEs on SEB outcomes in youth who received mental health services after reporting to the child welfare system. This study's analyses of data from the National Survey of Child and Adolescent Well-Being II revealed that the most prevalent ACEs included hospitalization for a medical condition, neglect, and exposures to domestic and community violence. Logistic re- gression of this data showed that the odds of being diagnosed with internalizing problems in- creased with age and when sexual abuse was reported. The results also showed that compared to Caucasian youth, Latinos were less likely to be diagnosed with externalizing behaviors, even when sexual abuse had been reported. Contrary to one of this study's hypotheses, mental health service use within the past 18 months increased the odds of being diagnosed with SEB problems. These findings highlight the persistence of SEB problems despite receipt of mental health ser- vices. Future research should assess the impact of interventions that aim to mitigate poor SEB outcomes due to ACEs, especially sexual abuse. 1. Introduction The CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study (Felitti et al., 1998) is one of the largest investigations of childhood trauma and its association with adult health and well-being. The original ACE Study included more than 17,000 adult participants, documenting seven adverse life events: psychological, physical, and sexual abuse; violence against mother; and living with household members who were substance abusers, mentally ill or suicidal, or ever imprisoned. Nearly two thirds of study participants reported at least one ACE, and more than one in five reported three or more ACEs. Additionally, an ACE score, or total sum of the different categories of ACEs reported by participants, was used to assess cumulative childhood stress. A dose-response relationship between ACEs and negative health and well-being outcomes (e.g., alcoholism/alcohol abuse, depression, illicit drug use, heart disease, and sexually transmitted infections) was observed across the life course, meaning that greater exposure to ACEs yielded a stronger effect on health and well-being outcomes (Centers for Disease Control and Prevention [CDC], 2016). Both the original ACE Study (Felitti et al., 1998) and replications (e.g., Anda et al., 2006; Briere, Kaltman, & Green, 2008; Brown http://dx.doi.org/10.1016/j.chiabu.2017.06.019 Received 28 January 2017; Received in revised form 15 June 2017; Accepted 17 June 2017 ⁎ Corresponding author at: School of Social Policy & Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA 19104-6214, United States. E-mail address: antgar@sp2.upenn.edu (A.R. Garcia). Child Abuse & Neglect 70 (2017) 292–302 0145-2134/ © 2017 Elsevier Ltd. All rights reserved. MARK