A guest post by Eileen Joy, PhD candidate, University of Auckland
In the United Kingdom, ACEs (Adverse Childhood Experiences) have been getting a lot of government attention recently – largely due to a government committee announcing, in October 2017, that it was going to “examine the strength of the evidence linking adverse childhood experiences with long-term negative outcomes, he evidence base for related interventions, whether evidence is being used effectively in policy-making, and the support and oversight for research into this area”. Here in New Zealand the conversation about ACEs has been less official, but has still permeated government departments and local social media, with exhortations to watch Nadine Burke Harris’ ‘Ted Talk’ about them.
Whilst the use of an ACEs (Adverse Childhood Experiences) type checklist might be limited in New Zealand, for now, it is important that social workers are aware of what is happening in the wider social work world. Checklists, like that proposed via the ACEs framework, have the ability to reduce extremely complex issues into a score that purports to assess risk and even trauma. For social workers, and more importantly policy and decision makers, who are working in an environment where the public demand ‘results’, a checklist can be appealing. Social work is often accused of being too ‘touchy feely’, too qualitative, and a checklist like this seems more scientific, more quantitative. However, in adopting any such checklist, let alone ACEs, it is important to understand what the list is ‘checking’ and what the list is leaving out.
The idea of the ACEs checklist is that one can tally adverse experiences one has a child, and come up with a number, out of ten, that then links to risk for all kinds of outcomes in life. These outcomes include suicide, heart disease, alcoholism, domestic violence, a veritable grab bag of nasties. The idea is compelling, and does have a commonsense ring to it. Yes, people exposed to nasty experiences in their childhood may have a harder time through life, and may end up using maladaptive coping mechanisms (such as alcohol) that may put them at further risk. Indeed, the research demonstrates that the correlational (but not causal) links are there. Social work history, and our practice tells us that these things are indeed associated with negative outcomes, so it is not this fact that is problematic in the use of ACEs.
The trouble is that the ACEs tally only measures ten different life events, all of which must have happened prior to your 18th birthday, which are listed here . Taking only one of these, and examining it, enables us to see some of the problems. The first question asks “Did a parent or other adult in the household often, swear at you, insult you, put you down, or humiliate you? Or, act in a way that made you afraid that you might be physically hurt?” Note, this relies on a retrospective view of how your parents behaved toward you, which is methodologically shaky unless safeguards are employed. Safeguards such as gaining verification of such events from other sources, and through careful interviewing techniques (Brewin, Andrews, & Gotlib, 1993); both of which are not necessarily employed in every study, and certainly would not be applied at a population level if this were to be employed as a diagnostic tool.
Aside from these flaws, it also relies on you doing a quick calculation on what the word ‘often’ means – is that daily, once a week, once a month? Further on, question 6 asks if your parents ever separated or divorced. In terms of the statistics here in New Zealand, we know that the most recent data shows that our divorce rates are declining , thus one could conclude that fewer children are being exposed to divorce. However, given that marriage rates are also falling it would be fair to say that divorce rates do not reflect the total number of children being exposed to parents break up, regardless of their marital status and whether they got back together again, and did not file for divorce. This is aside from the fact that we as social workers know that children exposed to a ‘stormy’ relationship with patterns of breakup/make up, without permanent dissolution have the capacity to be more damaging than those that split once, amicably, for good. Thus, this question, potentially has the capacity to gather many, many children into any ACEs net, and despite their diversity, somehow score them all the same.
Almost all the other questions in the test are equally problematic when you do not consider the wider context, and this is without asking what the test does not ask. It does not ask about the social conditions in which you grew up. It does ask about whether you had food to eat, were taken to the doctor, or had dirty clothes, but none of those specifically delve into deprivation in a meaningful sense. It does not consider if you grew up with classism, sexism, racism, ableism, an uncertain migration status, antagonism directed at you or your family because you or a member of your family was LGBTQIA, and/or, pertinent to New Zealand, lived through a natural disaster. It does not consider any structural factors which may mean you had a harder time growing up, through no fault of your own, or that of your family. One could check off all the ‘extra’ factors I have listed, and still score zero. Alternatively, you could score over 4 (a score of 4 or more is considered to be the threshold for risk of later negative outcomes), yet the incidents mentioned are differently impactful in comparison to someone else. For example: a parent died when you were very young, yet you were brought up in a large supportive extended family; you had an older sibling who had a drug problem for a while, but with that extended family support, it abated; your surviving parent had a diagnosis of depression but was well managed; and finally, your surviving parent had a relationship that lasted a couple of years with someone whom you considered a step parent, but they separated amicably and you still see them to this day.
ACEs are merely one new iteration of a way to turn a ‘wicked’ problem into a mathematical formula, and it is easy to see why they are so beguiling because the research behind each individual item being linked to future potential harm, is sound. KPIs, risk scores, putting cases on a continuum, these are all part of the same issue. Human beings want quick fixes to problems, social workers are not immune to this. In a climate whereby the results of the ‘Office of the Chief Social Worker’ report (2014) into workload and casework have not been properly responded to nor acted upon, it is understandable that such ‘solutions’ might gain traction. Indeed, since the 2014 report, and the restructuring of ‘Child Youth and Family’ into ‘Oranga Tamariki’ the shortages of staff (and one assumes the accompanying workload) do not seem to have abated. Social workers, and more importantly, their managers, and policy makers, need to guard against the over deployment of quick mathematical formulas. They are tools, only to be used alongside other tools which may, and can widen our lens to encompass structural concerns. We must remember that the tools that enable us to see the micro can often obscure the macro, looking only at the family, at the child and ignoring the impact of societal factors.
References
Brewin, C. R., Andrews, B., & Gotlib, I. H. (1993). Psychopathology and early experience: A reappraisal of retrospective reports. Psychological Bulletin, 113(1), 82-98
Office of the Chief Social Worker (2014). Workload and Casework Review: Qualitative Review of Social Worker Caseload, Casework and Workload Management. Wellington, New Zealand: Ministry of Social Development.