I have an ACES score of 9. That means I grew up with 9 of the 10 categories of Adverse Childhood Experiences that Drs. Vincent Felitti and Robert Anda found to be highly correlated with health risk behavior and chronic, even fatal disease in adults. For many health professionals this score would indicate that I am at high risk for heart disease, pulmonary disease, diabetes, sexually transmitted disease, autoimmune diseases and perhaps a shortened life span among many other things. For many behavioral health professionals, any score above 4 ACES would mean that I am 12 times more likely to attempt suicide, 7 times more likely to be an alcoholic, 8 times more likely to be violent or 7.5 times more likely to be a victim of violence.
Consequently, the chances that a health, behavioral health, educational, or criminal justice professional screening for ACES would refer me to parenting classes when I had my first child – and perhaps my second, even if I had already completed the first class – would be high, maybe even absolute in some settings. In a talk that Dr. Felitti repeatedly gives to various audiences (judges, health and allied health professionals, education professionals, etc.) about the likelihood of high-ACES turning the “gold” potential of childhood into “lead,” he states, “Every doctor in the country is going to be seeing two, maybe three ACE score 5 or higher patients every day. And who will they be? They will be the most difficult, confusing, intractable patients of the day.”
For all intents and purposes, it seems the jury is definitively in. People who grow up with traumatic childhood experiences are damaged, will have difficulty making good choices, and will continue to damage themselves and others, including their children, unless they get the attention, support, and help they so desperately need – and the earlier, the better.
I guess one could say that ACES research empowered an entire helping ecosystem to underscore a sense of urgency around taking action in service of people like me – who are, apparently, the “most difficult, confusing, intractable patients of the day” – to realize all the things I didn’t know I didn’t know. For example, when I was pregnant with my son (who was born in 2004), I did not know that I needed a parenting class, though I did know about ACES. I also did not know that leaving me to my own devices would equate to sentencing my children to a future of failure, potential abuse and maltreatment, and exposure to the same adversity and trauma that I had experienced as a child.
But I feared that was true!
During both my pregnancies and throughout both children’s lives (even now), I was afraid, unsure, and worried I would not be a good parent. Why? Quite simply because Dr. Felitti’s sentiment – that people who experienced childhood trauma were deeply wounded and without help would fare very poorly as individuals, partners, and parents – was the prevailing belief even before the ACES connection, and remains the prevailing belief today.
Yet despite that deep and pervasive fear, there are some things that I did know. I did know that I wanted badly and deeply for both my children to have the best childhoods possible. To be protected from what I had gone through but not shielded from life. I did know I did not want them to suffer, to be insecure or to feel undeserving. I knew I wanted them to have every opportunity. I also knew I would not have it easy, that I would have to work hard, sacrifice, and put their needs before my own because that is what I learned from my mother, my grandmother, my father, and my auntie and uncle despite enduring 9 of the 10 adverse childhood experiences under their care.
And like so many immigrant or refugee parents who came before or after me – that is exactly what I did. I worked 2, sometimes 3 jobs, and went to school full time so I could provide and care for my children. I stressed over childcare, health care, housing costs, and educational pathways. For many years, I even paradoxically sacrificed my time with them, leaving them in another’s care so that I could be an earner who could guarantee a pathway of access and opportunity for them.
I am super proud to say today I have two very healthy young people who are kind, compassionate, giving, curious, opinionated, funny, and resilient. AND I raised them without a parenting class! Not to say that parenting classes are unhelpful – I might have really benefitted from one had someone screened and referred me – but nobody did (more on this another time). At the end of the day, everything that I didn’t know I didn’t know, about how to be a good mother, I learned, through my relationships with others – my children and my community. Relatives, friends, neighbors, faith leaders, caregivers, mother’s helpers, coaches, music and school teachers who went above and beyond, and employers who not only allowed but enabled me to ask for help and support and then provided it.
As a parent I have spent much of my parenting existence doing what I suspect ANY parent does – worrying and trying. Worrying about every sniffle, fall, tear, or outburst, and trying every moment, every day, to make the next moment and day better, especially when the previous moment or day was not ideal or even an epic fail… because that is what parents do. But for me, that normal worry was compounded by the worry that, well, I have an ACES score of 9, and according to much research, the chances of me recapitulating the adversities I experienced on my kids is high.
For too many other parents – especially Black, Brown, and Indigenous parents – the worry that comes with wanting to make sure one’s children are healthy and safe and have a good life is not only unacknowledged by many professionals but also compounded by the worry that they will be hurt by others – on purpose and by design, just because of the color of their skin, the hardships of their parents, their family income, or their parents’ education level (all risk factors in child well-being or maltreatment studies). These individual and family attributes represent indicators (either explicit or implicit) of what it means to be either a fit and “good” parent who is wise, loving, doting, and capable, or an “at risk” parent who, without help and guidance, is unfit to parent without professional intervention and therefore requires education about child development and specifically about discipline. This is the standard for “preventive” care meant to address the risk of child abuse and neglect.
But here’s the thing. I have to ask (parents and non-parents alike), how many of us knew before becoming a parent what it would really take to raise a child through adulthood? If we are going to be honest – NONE of us. Not one of us knew before we became a parent what it would take or what it would be like.
Yet there remains the prevailing and preconceived notion or norm that there are people in the world who will be or are better suited to be parents than others. More often than not it is the educated, older, cis and straight, married, financially well-off person. And for the rest of us who do not fall into those profiles – a coupled or uncoupled teen, a Black and single mother, undocumented parents, any parent who is queer, transgender or low income or did not graduate from high school, well they might as well be as bad off as I was supposed to be – a person with an ACES of 9.
As Child Abuse Prevention Month comes to an end, I feel compelled to ask – is that what child abuse prevention is? To profile certain parents over others, and refer them to services they don’t know they need, entirely because dominant discourse about the causes of child abuse is focused singularly on individual risk factors over other causal contributors like poverty, racism, gender discrimination, and social norms condoning the use of violence that affect our families and our communities?
As of 2020, 11.6 million U.S. children were living in poverty while 4.3 million children were without health coverage for the entire year. In 2019, 10.7 million children, or 1 in 7 American children were food insecure, living in households where members did not have enough to eat. On a single night in January 2018, 111, 592 children experienced homelessness. Is it not neglectful for us to know these babies, toddlers, children and young people are out there and do so little to ensure their well-being because we don’t want to use public funds to address their real needs and promote their health, safety, and stability?
In 2020, the Centers for Disease Control and Prevention identified suicide as the second leading cause of death among young people. The Trevor Project estimates that at least one LGBTQ youth attempts suicide every 45 seconds in the U.S. alone. Yet, in March of this year, a children’s hospital in Texas stopped providing gender affirming care to children and youth when the Governor ordered the state’s child welfare system to investigate reports of gender affirming care as abuse. In a special issue of the International Journal of Stem Education, experts around the country highlight the important role school and classroom environments play in identity development. Yet, lawmakers in Florida recently approved legislation regulating and limiting school lessons around gender identity. Clearly, neglect of and threats to children’s emotional and physical well-being do not come solely at the hands of their caregivers.
Our children deserve our best, most sophisticated thinking and courageous action. As we turn our attention to what it takes to prevent harm to our youngest community members beyond this one month of the year, let us draw from what we have learned from impacted people, community leaders, seasoned child and family serving practitioners, and 21st Century science.
There is a lot of individual variation in how children and their families respond to crisis, adversity, and trauma. There can be an approach to care and prevention that can work for most, but no one size fits all. Allocating resources and enabling leadership to foster innovation, experimentation, and iterative learning in service of continuous improvement to impacted people’s quality of life must be a sustained part of how we operate and deliver education, services, and care.
Contexts matter. Experiences and conditions shape who we are, inform how we feel, think, and act, build and promote our resilience, and enable our healing, learning, wellbeing, and lifelong health.
Timing is important. There are critical and sensitive periods of development shaped by four precious life moments – expecting a baby, welcoming a baby, becoming a family, raising a family. Intentionally designing services and policies to support and enable these precious life moments ensures meaningful and positive returns later in life for everyone.
Prolonged activation of our stress response is bad. Chronic exposure to negative environments and conditions are primary sources of trauma and toxic stress (e.g., violence, racism and discrimination, poverty, family separation, housing and food insecurity). Without buffering, these experiences can get under our skin and affect our physical and emotional health and wellbeing. For infants, the negative impacts of toxic stress can change the structure of their developing brain and negatively affect their health over their entire life course.
Healing is possible, and it involves acknowledgement and intentional repair of past, current, and ongoing systemic harm. Ensuring equity driven and trauma informed care, practices, and policies is essential to prevention and to children’s health and well-being.
Children and their caregivers deserve our commitment to fostering and sustaining the five research-backed protective factors that strengthen families, promote health, healing, and wellbeing, and prevent family violence.
I know I am not the only parent out there with a high ACES score who deserves more than what is being offered. My story of sacrifice, survivorship, resilience and positive child-parent relations is one of millions. How about starting there – with the good stuff? The hopes and goals. The things dreams are made of. Let us take child abuse and maltreatment seriously by abandoning practices that focus solely on singling out or blaming individuals and tackle its root causes. We can do it. And we have to do it – because it’s what our children deserve.