Hennepin County Research Articles

Effect of administration sequence of induction agents on first-attempt failure during emergency intubation: A Bayesian analysis of a prospective cohort.

Emergency tracheal intubation is associated with a risk of clinical adverse events, including the risk of first-attempt failure. Induction agents usually include a sedative and a neuromuscular blocking agent (i.e., paralytic). Whether the order of administration (i.e., sedative vs. paralytic given first) is associated with first-attempt failure or adverse events is unknown. This study analyzed data from a single-center prospective cohort collected from 2021 to 2024 at Hennepin County Medical Center, which included all patients undergoing orotracheal intubation in the emergency department. Patients with no detail on administration sequence order were excluded. A Bayesian logistic regression analysis was used to measure the effect of drug sequence order (sedative first vs. paralytic first). The primary outcome was first-attempt failure. The key secondary outcome was peri-intubation hypoxemia (SpO2 < 90%). We estimated the odds ratio (OR), 95% credible interval (CrI), and the probability that the OR was inferior to 1 (existence of an effect) and inferior to 0.9 (significant effect). Frequentist analysis and reanalysis with various priors were performed as sensitivity analyses. A total of 2216 patients were included for analysis. The most frequently used sedative and paralytic agents were etomidate (88.9%) and rocuronium (77.8%), respectively. The paralytic was given first to 56.6% of the patients. After adjustment for age, sex, body mass index, and sedative and paralytic agents, the OR for a paralytic-first strategy for first-attempt failure was 0.73 (95% CrI 0.46-1.02). The probability that the OR was less than 1 was estimated at 95.7% and less than 0.9 at 87.6%. There was a 33.5% and 8.0% probability that administering the paralytic first resulted in an OR < 1 and OR < 0.9 for the risk of hypoxemia, respectively. Sensitivity analyses were consistent with the main results. In this Bayesian analysis a paralytic-first drug sequence was associated with reduced first-attempt failure during emergency tracheal intubation.

Lasting Legacy: The Enduring Relationship Between Racially Restrictive Housing Covenants and Health and Wellbeing.

Racially restrictive covenants in housing deeds, commonplace in Minnesotafor houses built from the 1910s to the 1950s, provided a foundation for the myriad of policies that made it difficult for people of color to obtain housing. Though covenants were ruled illegal in 1968, their legacy continues to shape neighborhoods. The Mapping Prejudice Project's efforts in Hennepin County, Minnesota, produced the first systematic documentation of racially restrictive covenants. We use this novel data set to explore the relationship between historic covenants and current health and wellbeing outcomes. Using regression analysis to control for neighborhood level covariates, we compare previously covenanted neighborhoods to neighborhoods without covenants. Today, previously covenanted neighborhoods have higher life expectancy and lower rates of obesity, diabetes, coronary heart disease, and asthma than neighborhoods without racially restrictive covenants. Additionally, previously covenanted neighborhoods have less upward mobility for children from poorer households, and there are larger gaps in upward mobility between white and Black children. These findings contribute to a growing literature that shows racist policies, even decades after they are legally enforceable, leave an imprint on neighborhoods. Using the novel data from the MappingPrejudiceProject, we provide statistical analysis that confirms qualitative and anecdotal evidence on the role of racial covenants in shaping neighborhoods.

An analysis of risk factors for child suicide in three centres from 2008 to 2017.

As a part of a study of suicide in children aged 17 years and under in three centers-Hennepin County in the United States (US), Auckland in New Zealand (NZ), and South Australia in Australia (AUS) from 2008 to 2017 it was decided to characterize potential risk factors and to determine whether these differed by jurisdiction. Reviewed data included a history of psychiatric illness, symptoms prior to suicide, events preceding suicide, previous suicidal ideation or suicide attempts, and communication of suicidal intent. The most common events preceding suicide were arguments with family/friends and relationship issues; in addition depression with or without expressed suicidal ideation, self-harming behavior, sadness, distress, drug/substance abuse, and anorexia were documented. Suicidal intent was on occasion communicated via technological means. In 79.5% of cases in South Australia decedents had a previously diagnosed psychiatric illness, with 62% in Hennepin County. This compared to a much lower proportion of cases in Auckland (23.8%). Whether this reflects more limited access to psychiatric services or a reluctance to seek support and therapy in Auckland is unclear. It does, however, demonstrate that risk factors for child suicide are not uniform among communities and so extrapolation of data from one area to another may not be appropriate. Disturbingly parents/carers were not aware of the decedent's suicidal intent in 84-87.2% of cases.

Practitioners for Change

Julie Rud is the community corrections field services area director for Hennepin County (Minneapolis). Only five states have more people on probation than Minnesota, yet Hennepin County is a leader in reforms to supervision, including eliminating fees and cutting the use of drug testing in half since 2017. Below is an edited and condensed version of remarks delivered by Rud as a panelist at the “Drug Testing and Community Supervision: Interrogating Policy, Practice, and Purpose” convening in Columbus, Ohio, in November 2023.

Abstract 15511: Predictors of Polymorphic Ventricular Tachycardia and Ventricular Fibrillation in Patients With Stress Cardiomyopathy

Introduction: Polymorphic ventricular tachycardia (PVT) and ventricular fibrillation (VF) are life-threatening complications of stress cardiomyopathy (SCM) that occur in 2-10% of patients with SCM. Hypothesis: To identify which social and medical factors are associated with an increased risk of PVT and VF in patients with SCM. Methods: All consecutive patients meeting the InterTAK (international takotsubo) diagnostic criteria for stress cardiomyopathy at the Hennepin County Medical Center between January 1 st , 2010, and December 31 st , 2022, were identified from electronic medical records. Logistic regression was used to estimate the odds ratios (OR). The receiver operating characteristic curve (ROC) was plotted to identify the best QTc cutoff at admission to predict ventricular arrhythmia. Results: A total of 296 patients were included in the study, of which 27 (9.1%) experienced PVT/VF. Baseline demographics, including gender, race, and age at diagnosis, were similar to patients without PVT/VF (median age 61 years, and 66.7% were females). Patients with PVT/VF were more likely to have a history of stimulant use (22.2% vs. 8.2%, OR =3.20 p =0.023), apical (Takotsubo) variant stress cardiomyopathy (78% vs.56%, OR=2.69 p=0.038), and an ejection fraction (EF) of less than 30% on admission (63% vs. 41.5%, OR=2.39 p=0.032) ( Table 1 ). Admission QTc interval cut-off value of 490 msec had the highest sensitivity and specificity in predicting the risk of ventricular arrhythmia (AUC=0.687). Notably, all PVT/VF events occurred within 17 hours of hospital admission. Conclusion: Nealy 1 in 10 patients with SCM had life-threatening ventricular arrhythmia. The presence of severe LV systolic dysfunction, recent stimulant use, apical variant SCM, or prolonged QTc &gt; 490 msec is associated with the occurrence of PVT/VF, with the first day of hospital admission being an especially high-risk period.

Development and validation of a risk model for hospital-acquired venous thrombosis: the Medical Inpatients Thrombosis and Hemostasis study

BackgroundRegulatory organizations recommend assessing hospital-acquired (HA) venous thromboembolism (VTE) risk for medical inpatients. ObjectivesTo develop and validate a risk assessment model (RAM) for HA-VTE in medical inpatients using objective and assessable risk factors knowable at admission. MethodsThe development cohort included people admitted to medical services at the University of Vermont Medical Center (Burlington, Vermont) between 2010 and 2019, and the validation cohorts included people admitted to Hennepin County Medical Center (Minneapolis, Minnesota), University of Michigan Medical Center (Ann Arbor, Michigan), and Harris Health Systems (Houston, Texas). Individuals with VTE at admission, aged <18 years, and admitted for <1 midnight were excluded. We used a Bayesian penalized regression technique to select candidate HA-VTE risk factors for final inclusion in the RAM. ResultsThe development cohort included 60 633 admissions and 227 HA-VTE, and the validation cohorts included 111 269 admissions and 651 HA-VTE. Seven HA-VTE risk factors with t statistics ≥1.5 were included in the RAM: history of VTE, low hemoglobin level, elevated creatinine level, active cancer, hyponatremia, increased red cell distribution width, and malnutrition. The areas under the receiver operating characteristic curve and calibration slope were 0.72 and 1.10, respectively. The areas under the receiver operating characteristic curve and calibration slope were 0.70 and 0.93 at Hennepin County Medical Center, 0.70 and 0.87 at the University of Michigan Medical Center, and 0.71 and 1.00 at Harris Health Systems, respectively. The RAM performed well stratified by age, sex, and race. ConclusionWe developed and validated a RAM for HA-VTE in medical inpatients. By quantifying risk, clinicians can determine the potential benefits of measures to reduce HA-VTE.

Genomic epidemiology reveals the dominance of Hennepin County in the transmission of SARS-CoV-2 in Minnesota from 2020 to 2022.

We analyzed over 22,000 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genomes of patient samples tested at Mayo Clinic Laboratories during a 2-year period in the COVID-19 pandemic, which included Alpha, Delta, and Omicron variants of concern to examine the roles and relationships of Minnesota virus transmission. We found that Hennepin County, the most populous county, drove the transmission of SARS-CoV-2 viruses in the state after including the formation of earlier clades including 20A, 20C, and 20G, as well as variants of concern Alpha and Delta. We also found that Hennepin County was the source for most of the county-to-county introductions after an initial predicted introduction with the virus in early 2020 from an international source, while other counties acted as transmission "sinks." In addition, major policies, such as the end of the lockdown period in 2020 or the end of all restrictions in 2021, did not appear to have an impact on virus diversity across individual counties.

Reprint of: Homelessness and child protection involvement: Temporal links and risks to student attendance and school mobility

BackgroundThe experience of homelessness and child protection involvement pose risks to children's school success. Elucidating processes by which these interrelated systems affect child well-being is important for guiding policy and practice. ObjectiveThis study examines the temporal relation between emergency shelter or transitional housing use and child protection involvement among school-aged children. We evaluated effects of both risk indicators on school attendance and school mobility. Participant and settingUsing integrated administrative data, we identified 3278 children (ages 4 to 15) whose families used emergency or transitional housing in Hennepin and Ramsey County of Minnesota during the 2014 and 2015 academic years. A propensity-score-matched comparison group of 2613 children who did not use emergency or transitional housing. MethodThrough a series of logistic regressions and generalized estimating equations, we tested the temporal associations of emergency/transitional housing and child protection involvement as well as how both experiences affected school attendance and mobility. ResultsExperiences of emergency or transitional housing often proceeded or occurred concurrently with child protection involvement and increased the likelihood of child protection services. Emergency or transitional housing and child protection involvement posed risks for lower school attendance and greater school mobility. ConclusionsA multisystem approach to assist families across social services may be important for stabilizing children's housing and bolstering their success at school. A two-generation approach focused on residential and school stability and enhancing family resources could boost adaptive success of family members across contexts.

In Memoriam: Richard H. Grimm, Jr, MD, MPH, PhD (August 22, 1946-September 8, 2022).

In Memoriam: Richard H. Grimm, Jr, MD, MPH, PhD (August 22, 1946-September 8, 2022).

Assessing the impact of community-based interventions on hypertension and diabetes management in three Minnesota communities: Findings from the prospective evaluation of US HealthRise programs.

Community-based health interventions are increasingly viewed as models of care that can bridge healthcare gaps experienced by underserved communities in the United States (US). With this study, we sought to assess the impact of such interventions, as implemented through the US HealthRise program, on hypertension and diabetes among underserved communities in Hennepin, Ramsey, and Rice Counties, Minnesota. HealthRise patient data from June 2016 to October 2018 were assessed relative to comparison patients in a difference-in-difference analysis, quantifying program impact on reducing systolic blood pressure (SBP) and hemoglobin A1c, as well as meeting clinical targets (< 140 mmHg for hypertension, < 8% Al1c for diabetes), beyond routine care. For hypertension, HealthRise participation was associated with SBP reductions in Rice (6.9 mmHg [95% confidence interval: 0.9-12.9]) and higher clinical target achievement in Hennepin (27.3 percentage-points [9.8-44.9]) and Rice (17.1 percentage-points [0.9 to 33.3]). For diabetes, HealthRise was associated with A1c decreases in Ramsey (1.3 [0.4-2.2]). Qualitative data showed the value of home visits alongside clinic-based services; however, challenges remained, including community health worker retention and program sustainability. HealthRise participation had positive effects on improving hypertension and diabetes outcomes at some sites. While community-based health programs can help bridge healthcare gaps, they alone cannot fully address structural inequalities experienced by many underserved communities.

Implementation of Extracorporeal Membrane Oxygenation Without On-Site Cardiac Surgery or Perfusion Support: A Tale of Two County Hospitals.

Patients with refractory respiratory and cardiac failure may present to noncardiac surgery centers. Prior studies have demonstrated that acute care surgeons, intensivists, and emergency medicine physicians can safely cannulate and manage patients receiving extracorporeal membrane oxygenation (ECMO). Harborview Medical Center (Harborview) and Hennepin County Medical Center (Hennepin) are both urban, county-owned, level 1 trauma centers that implemented ECMO without direct, on-site cardiac surgery or perfusion support. Both centers 1) use an ECMO specialist model staffed by specially trained nurses and respiratory therapists and 2) developed comparable training curricula for ECMO specialists, intensivists, surgeons, and trainees. Each program began with venovenous ECMO to provide support for refractory hypoxemic respiratory failure and subsequently expanded to venoarterial ECMO support. The coronavirus disease 2019 (COVID-19) pandemic created an impetus for restructuring, with each program creating a consulting service to facilitate ECMO delivery across multiple intensive care units (ICUs) and to promote fellow and resident training and experience. Both Harborview and Hennepin, urban county hospitals 1,700 miles apart in the United States, independently implemented and operate adult ECMO programs without involvement from cardiovascular surgery or perfusion services. This experience further supports the role of ECMO specialists in the delivery of extracorporeal life support.

An Erie Taking: Tyler v. Hennepin County and the General Common Law Revival

An Erie Taking: Tyler v. Hennepin County and the General Common Law Revival

Homelessness and child protection involvement: Temporal links and risks to student attendance and school mobility

BackgroundThe experience of homelessness and child protection involvement pose risks to children's school success. Elucidating processes by which these interrelated systems affect child well-being is important for guiding policy and practice. ObjectiveThis study examines the temporal relation between emergency shelter or transitional housing use and child protection involvement among school-aged children. We evaluated effects of both risk indicators on school attendance and school mobility. Participant and settingUsing integrated administrative data, we identified 3278 children (ages 4 to 15) whose families used emergency or transitional housing in Hennepin and Ramsey County of Minnesota during the 2014 and 2015 academic years. A propensity-score-matched comparison group of 2613 children who did not use emergency or transitional housing. MethodThrough a series of logistic regressions and generalized estimating equations, we tested the temporal associations of emergency/transitional housing and child protection involvement as well as how both experiences affected school attendance and mobility. ResultsExperiences of emergency or transitional housing often proceeded or occurred concurrently with child protection involvement and increased the likelihood of child protection services. Emergency or transitional housing and child protection involvement posed risks for lower school attendance and greater school mobility. ConclusionsA multisystem approach to assist families across social services may be important for stabilizing children's housing and bolstering their success at school. A two-generation approach focused on residential and school stability and enhancing family resources could boost adaptive success of family members across contexts.

LBSUN151 The Impact Of The COVID-19 Pandemic On Diabetes &amp; Weight Management

Abstract COVID-19 was declared a pandemic on 03/11/2020 by the WHO and the State of Minnesota issued a stay-at-home mandate on 03/27/2020. While individuals with diabetes mellitus (DM) and severe obesity were identified as more likely to be infected and at higher risk of complications from COVID-19, access to outpatient clinics was limited during this time, with a shift towards telemedicine. In June 2020, the WHO reported that in 49% of 155 surveyed countries, diabetes treatment was disrupted. However, the impact on diabetes care in the US was poorly characterized, particularly among underserved groups. Aim To study the impact of the pandemic and telemedicine on medical treatment of patients with DM at Hennepin County Medical Center (HCMC), a teaching hospital in Minneapolis, Minnesota serving a diverse inner-city population. Methods Retrospective cohort study design with 710 participants. We compared A1C and weight changes before and after the pandemic. The study group (n=344) included patients, 18 years of age or older, with DM Type 1 or Type 2 who presented for an HCMC diabetes clinic visit between 12/2019-02/2020 and a follow up visit between 6/2020 -10/2020. The control group (n=366) included patients with DM who presented for an HCMC diabetes clinic visit between 12/2018 - 02/2019 and a follow up visit between 6/2019 - 10/2019. Results There was a significantly lower A1C reduction in the cases as compared to the control group (-0.34 [CI -0.59, -0. 09] p value 0. 007), adjusted for inpatient admission, continuous glucose monitor use, diabetes type 1, insurance status, insulin use, GLP-1 agonist use, smoking status and hypertension. Weight reduction during the pandemic was lower as compared to the control but did not achieve statistical significance (-0.96 [CI -3. 02, 1. 09] p value 0.36). Telemedicine use among the study group resulted in an insignificant A1c reduction of -0.24 (p value 0.23). There was statistically significant weight gain of 0.42 among the group who used telemedicine, while nonusers had weight loss of -3.24 (p value 0. 04). Telemedicine users had higher insulin utilization (92.6% vs 83.3%, p value 0. 017) and lower self-pay and Medicaid enrollment (1.7% vs 5.9% and 33.8% vs 40.6% respectively, p value 0. 011) as compared to nonusers. Conclusion The COVID-19 pandemic led to a significant deterioration of glycemic control but had no effect on weight. Telemedicine use led to A1c reduction but did not reach statistical significance potentially due to the small sample size and short duration of follow up. Significant weight gain was observed in telemedicine users influenced by greater insulin use and insurance coverage as compared to weight loss amongst nonusers which may be attributed to socioeconomic barriers such as food scarcity among those without the means to access telemedicine. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Beyond “pains” and “gains”: untangling the health consequences of probation

BackgroundResearch on the health consequences of criminal legal system contact has increasingly looked beyond imprisonment to understand how more routine forms of surveillance and punishment shape wellbeing. One of these sites is probation, the largest form of supervision in the U.S. Drawing on an interview study with 162 adults on probation in Hennepin County, MN, in 2019, we map how adults on probation understand the consequences of supervision for their health and how these self-reported health changes correlate with individual, social, and structural circumstances.ResultsRoughly half of participants described their health as having improved since starting probation, while the remainder were split between no change and worsened health. Examining both closed-ended survey questions and open-ended interview prompts, we find that the “gains” of supervision were correlated with substance use treatment (often mandated), reduced drug and alcohol use, increased housing and food security, and perceptions of support from their probation officer. However, these potentially health-promoting mechanisms were attenuated for many participants by the significant “pains” of supervision, including the threat of revocation, which sometimes impacted mental health. In addition, participants in the most precarious circumstances were often unable to meet the demands of supervision, resulting in further punishment.ConclusionsMoving beyond the “pains” and “gains” framework, we argue that this analysis provides empirical evidence for the importance of moving social services outside of punishing criminal legal system interventions. People with criminal legal contact often come from deeply marginalized socio-economic contexts and are then expected to meet the rigorous demands of supervision with little state aid for redressing structural barriers. Access to essential services, including healthcare, food, and housing, without the threat of further criminal legal sanctions, can better prevent and respond to many of the behaviors that are currently criminalized in the U.S. legal system, including substance use.

Strong-arm Sobriety: Addressing Precarity through Probation

Over the past half-century, the US welfare and penal systems have become increasingly fused modes of poverty governance. At the center of the welfare-penal continuum sits probation, a form of community supervision that operates as a central hub, directing people to both services and incarceration. Drawing on interviews with 166 adults on probation in Hennepin County, Minnesota, in 2019, we argue that the coercive care of probation is structured by the broader project of controlling alcohol and drug use among the poor. Developing the concept of strong-arm sobriety, we show how the “criminal addict” trope undergirds the central processes of probation: treatment, testing, and revocation. We argue that strong-arm sobriety misreads structural precarity as the result, rather than the cause, of individuals’ choices. In doing so, strong-arm sobriety fails to address the circumstances that engender substance use and produces future subjects for coercive care.

An analysis of child suicide from three centers (2008–2017)

Although the overall suicide rate worldwide has changed minimally over the past 100 years, different trends have been observed over time in the USA, Australia, and New Zealand (NZ). However, few studies have focused on suicides in children (< 18 years), making evaluation of possible trends difficult. The last 20 years has also seen an increase in childhood obesity, eating disorders, and body image issues for children in many developed nations; however, few studies have shown whether a significant proportion of child suicides have an abnormal BMI. The current study evaluates child suicides (from 2008 to 2017) in South Australia (Australia), compared with the jurisdictions of Auckland (NZ) and Hennepin County (USA). Demographic data (age, sex, ethnicity), body mass index (BMI), the number of cases of youth suicide, and the method of suicide from these three regions were collected and analyzed. Across the 10-year period, the jurisdiction of Auckland had a downward trend, while Hennepin County and South Australia had increasing numbers of cases. The most common method of child suicide in all centers was hanging, occurring in > 80% of cases in South Australia and Auckland and 56% in Hennepin County. Hennepin County had a greater proportion of suicides using firearms (28%), compared to 1.9% in Auckland and 5.1% in South Australia. Unusual means of suicide were used less frequently by youth than previously.

Land manager decision-making practices when establishing public fruit-bearing plants in Hennepin county municipalities, Minnesota

Increasingly, public land managers face decisions about using fruit-bearing perennial plants (including fruiting trees, shrubs, and vines) on public lands. While public trees provide many positive ecological, economic, and community health benefits, fruit-bearing perennials provide similar benefits and more. Expanded benefits include enhanced pollinator habitat, increased food access, unique educational opportunities, and ways for residents to interact more deeply with public vegetation. Despite the benefits of fruit-bearing perennials, their use and incorporation into public spaces vary among cities, resulting in an uneven and often inequitable distribution of public services. This study aims to better understand public land managers’ decision-making processes by exploring what factors are considered when deciding to plant, or not plant, fruit-bearing perennial vegetation. Specifically, interviewees (n = 12) described what they perceive as the most significant benefits and barriers to establishing fruit-bearing perennials in public spaces. Respondents reported using fruit-bearing perennials to augment species diversity, community engagement, wildlife habitat, and public education. Barriers cited included limited time and financial resources for management, lack of specialized training, fears associated with liability, limited public awareness, and competing urban forestry goals. This study contributes to the literature on public land manager decision-making which has not previously focused specifically on fruit-bearing perennials. The findings inform vegetation decision-making and urban natural resource planning by outlining key risks and rewards of adopting fruit-bearing perennials.

Performance Evaluation of Modified Cyclic Max-Pressure Controlled Intersections in Realistic Corridors

Max-pressure (MP) signal timing is an actuated decentralized signal control policy. Rigorous mathematical studies have proven the stability properties and established the benefits of different MP policies. However, theoretical studies make assumptions about traffic properties that may not represent reality and whose effects are not explored much in the literature under realistic traffic conditions. This study focuses on examining how different variations of MP perform in realistic scenarios and on finding the most practical policy among those for implementation in real roads. Microsimulation models of seven intersections from two corridors, County Road (CR) 30 and CR 109 from Hennepin County, Minnesota were created. Real-life demand and current signal timing data provided by Hennepin County were used to make the simulations as close to reality as possible. In this paper, we compare the performance of current actuated-coordinated signal control with an acyclic MP and two variations of cyclic MP policies. We present the performance of different control policies as delay, throughput, worst lane delay, and number of phase changes. We also present how different parameters affect the performance of the MP policies. We found that better performance can be achieved with a cyclic MP policy by allowing phase skipping when no vehicles are waiting. Our findings also suggest that most of the claimed performance benefits can still be achieved in real-life traffic conditions even with the simplified assumptions made in the theoretical models. In most cases, MP control policies outperformed current signal control.

Adverse Childhood Experiences and Current Psychosocial Stressors: Exploring Effects on Mental Health and Parenting Outcomes from a Mother-Baby Partial Hospital Program.

Adverse childhood experiences (ACEs) can detrimentally impact perinatal mental health, birth outcomes, and parenting behaviors. Proximal psychosocial stressors also increase risks to perinatal health and wellbeing. Additional research on effective perinatal mental health programs is needed, especially for individuals and families with historical and concurrent adversity, and those with moderate to severe symptoms. The Mother-BabyDay Hospital at Hennepin County Medical Centerprovides trauma-informed, multi-generation treatment for perinatal women. Data were collected from patients between January 2016 and September 2019. Self-reported depression, anxiety, and maternal functioning assessments were administered pre- and post-treatment. Patients completed the ACE questionnaire and indicators of current psychosocial stressors (i.e., food insecurity, housing insecurity, and social support) at intake. A series of bivariate tests and hierarchical regression models examined relationships among variables, including whether distal and proximal adversity predicted post-treatment symptoms. 159 Perinatal patients consented to research and completed the ACEs questionnaire at first admission. High proportions of patients reported 4+ ACEs and current psychosocial stressors. Effect sizes for associations between ACEs, psychosocial stressors, and self-report symptoms were small to moderate. Individuals with food or housing insecurity entered treatment with higher anxiety. In regression models, the most robust predictors of post-treatment symptoms were pre-treatment symptoms. Effects of ACEs on post-treatment depression and food insecurity on post-treatment maternal functioning approached the adjusted significance cut-off (p < .01). CONCLUSIONSFOR PRACTICE: Current psychosocial stressors and ACEs did not substantially limit post-treatment depression, anxiety, and maternal functioning outcomes. High prevalence of ACEs and psychosocial stressors highlight the need for trauma-informed, multi-generation treatments to improve maternal mental health and parenting capacity.