Several years ago I had the unique opportunity of having dinner with Dr. John Anda and Dr. Sandra Bloom, both pioneers when it comes to trauma and trauma informed care. It was a special experience, of course, with enlightening conversation. With dinner companions such as these, it’s not surprising that we began questioning why the ACEs study doesn’t get more attention outside those in the mental health community chanting 'ACEs too high'. The Adverse Childhood Experiences Study (ACEs) assessment provides a measure that calculates how many adverse experiences one endured in childhood. The study showed that the higher someone scored on the ACEs scale, the more likely they were to experience negative health side effects. While this question is less significant today as there is wider acceptance and understanding of the ACEs, it is still valid as there is a long way to go.
Tickling the Appetite
My colleagues and I noted how it would change everything if decision makers would embrace the ACEs study. A lot would change if the study was embraced and more people understood it. We discussed the many areas of impact. Early intervention has long been on the public’s radar. But understanding the ACEs study would make early intervention paramount. People would need to accept that adverse experiences are more common than they thought, with 64% of the population reporting at least one ACE (Felitti et al. 1998). Additionally, a greater number of ACEs increases the risk of negative health outcomes such as smoking, substance abuse, obesity, diabetes, depression, and even heart disease and cancer (Felitti et al. 1998 ). If these major medical concerns could be reduced by acknowledging and preventing adverse childhood experiences, the medical care system would shift dramatically, saving billions of dollars.
This data would indicate that change in the medical care system was productive and possible. But this change would not be possible without a shift of the aforementioned billions of dollars. Funding would need to shift from focusing on solving problems once they occurred to focusing on children and reducing adverse childhood experiences. We acknowledged the time it would take to help this shift happen. We lamented a bit that it would be difficult to get complete a buy in of these monumental changes.
The Main Course of Action
Our discussion moved to how much harder it is to think about children than it is to think about adults as adults are so much more vocal when they notice injustices against them. So many systems must interface and come together to shape one’s childhood. And that’s not even considering the impact one’s parents and family have. Children are so affected by the education system. This system would need to continue to change to ensure that the educational system’s impact is positive. Teachers, administrators, curriculum advisors and counselors would all need to be trained and tuned into trauma informed care. The goal would be to change the culture in schools so that struggling children were assessed through a “trauma lens”.
The legal system needs to do the same. Too often, children and young adults who score high on the ACE measure find themselves embroiled in the legal system. The needed change would not be these individuals being excused from their crimes, but rather being viewed through the trauma lens. Police would need to understand the nuances of trauma to identify what happened to the children they deal with as opposed to seeing them as bad. They should look towards the “why” rather than towards the consequence, and treat them as if something wrong was done to them, not that something was wrong with them.
Despite the progress we’ve made since that discussion long ago, it still feels like there is a long way to go. And the changes in the world continue to remind us of this importance and that the potential for traumatic events to seriously impact on our children is heightened. Some states have taken the lead and started steps to encourage and support Trauma Informed Care to reduce children’s exposure to adverse childhood experiences. Alaska, California, Pennsylvania and Vermont have all taken a public health approach to addressing these experiences, investing in preventative care and moving towards Trauma Informed Communities. Yet, there is still much to be done.
As clinicians and service providers, we are reminded that beyond the commitments to our own practices and organizations, it’s important to focus on actions that focus on universal change. I found this list of possible actions from the National Center for Children in Poverty helpful: Develop Communication Tools that enhance public awareness
- Advocate for the development of public policies.
- Educate state and federal policy makers about cost savings and care delivery impact of a Trauma Informed Care model.
- Support investments in education and training for health care, social service, educational and law enforcement workers.
- Require clinics (schools, health care etc.) to monitor and evaluate progress in these areas.
Any provider will tell you that the trauma our children endure has been a concern for a very long time. The ACEs study has handed us the necessary tools to articulate with data and evidence this most significant concern. Now, more than ever, should we use its insights to help move our communities to a place that better serves our children, our families, and ultimately our entire community. It will be difficult and it is desperately needed, but if we take action and are hopeful, it is not impossible.
It’s amazing what can come out of a dinner conversation with good friends.
Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. Vincent J. Felitti, Robert F. Anda, Dale Nordenberg, David F. Williamson, Alison M. Spitz, Valerie Edwards, Mary P. Koss, James S. Marks. American Journal of Preventive Medicine. May 1998.