FROM SCARS TO STRENGTH: UNVEILING THE INTERSECTION OF ACES, SOCIAL DETERMINANTS, AND RESILIENCE IN ADULT INPATIENT REHABILITATION

Abstract

This dissertation explores the complex relationship between adverse childhood experiences (ACEs), protective and compensatory experiences (PACEs), and their influence on resilience in primary care contexts and among adult inpatient rehabilitation patients. While ACEs are known to be linked with negative health outcomes, little attention has been given to the care for patients following a screening of ACEs in primary care, and protective factors are rarely if ever, considered in healthcare contexts. Furthermore, the role of ACEs, PACEs, social determinants of health (SDoH), and resilience in adult inpatient rehabilitation contexts are relatively unknown. The primary objective of this research is to deepen the scientific understanding of how ACEs, PACEs, and SDoH interact to shape resilience when individuals face medical conditions requiring inpatient rehabilitation. By examining this dynamic, this dissertation investigates clinical practices, research methodologies, and health equity policies, ultimately enhancing strategies for screening, triage, and intervention in rehabilitation units. The dissertation employs a dual approach, combining systematic reviews with original quantitative empirical analysis. It is organized into six chapters: the first chapter introduces the concept of resilience in rehabilitation and its relationship to ACEs and PACEs. The second chapter provides a systematic review of ACE screening practices in adult primary care settings, focusing on the types of clinical responses (e.g., resources, referrals, interventions) that follow positive ACE screenings. The third chapter systematically investigates additional psychosocial factors, both protective and adverse, that are assessed alongside ACE screenings in primary care, framed through a socio-ecological resilience model. The fourth chapter details the methodology of the original quantitative research. The fifth chapter presents the results of the empirical study, which examines the interaction between SDoH, protective factors, resilience, and behavioral health in adult inpatient rehabilitation patients with a history of ACEs; and the sixth chapter synthesizes the key findings and their contributions to the field, focusing on the integration of protective experiences in ACE screening interventions. It employs data visualization techniques to analyze health disparities across North Carolina counties based on the study participants' sample, offering recommendations for improving patient care and health equity. The research ultimately advances an understanding of the interplay between childhood adversity, protective factors, and health outcomes, offering strategies for improving resilience and health equity in diverse inpatient rehabilitation populations.