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California has Begun Screening for Early Childhood Trauma, But Critics Urge Caution []


By Emily Underwood, Science, January 29, 2020

On 1 January, California became the first U.S. state to screen for adverse childhood experiences (ACEs)—early life hardships such as abuse, neglect, and poverty, which can have devastating health consequences in later life. The project is not just a public health initiative, but a vast experiment. State officials aim to cut the health impacts of early life adversity by as much as half within a generation. But critics say the health benefits of screening are unproven, and it could create demand for services the state cannot provide.

The $160 million initiative applies to 7 million children on Medi-Cal, California’s insurance for low-income people. Health care providers who complete 2 hours of online training are encouraged to screen children up to age 18 for ACEs. The questionnaire, filled out by children’s caregivers or teenagers themselves, includes 10 categories of ACEs, such as domestic violence, neglect, and substance abuse, with questions such as “Has your child ever seen or heard a parent/caregiver being screamed at, sworn at, insulted or humiliated by another adult?” and “Have you ever felt unsupported, unloved and/or unprotected?”

If a child has a worrying score, the provider is instructed to give information about helpful resources such as food stamps or housing assistance, discuss how trauma and stress affect the developing body and brain, and, if necessary, make referrals to specialists, such as psychologists.

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In the early 1990's my late colleague Karen Polonko and I started teaching a university course called "Violence in the World of Children". Though the focus of the course was on a child-centered approach to the environments in which children live, the goal of the course was to make adults (adult college students) aware of the worlds we create for children to live in.

A couple of years after this course started to develop, I became aware of the UN Convention on the Rights of the Child (CRC). Though the CRC's focus was on children, its real message and impact were directed adults who denied children's rights and behaved in ways that indicated little concern for children. You know, the usual: the various forms of abuse (physical, emotional, sexual) directed at individual children and the broader, structural forms of harm from sexual exploitation and trafficking, child labor, making children victims and participants of war, not providing health care, education, safety and security, brought to the world of children. Though the CRC did call for positive responses to those already injured, the CRC’s main focus was a preventive one: getting those of us in the adult world (in governments, communities, families, child-care institutions, schools, etc.) to become aware of what we were doing and to stop doing these things to children.  

In the late 1990’s along comes the first Adverse Childhood Experiences research report. When I read it in 1999, I took it to my colleague and said, “Here is a game changer!!” Now adults can no longer say that childhood does not matter, that children are naturally resilient and get over experiences easily, that even though we adults experienced many negative things as children, we are all OK now! Childhood experiences are clearly related to adult health and behavioral outcomes. Again, as with the CRC, the message we heard was that “CHILDHOOD MATTERS!!” We heard the important preventive message of ACES: getting those of us in the adult world (in governments, communities, families, child-care institutions, schools, etc.) to become aware of what we were doing and to stop doing these things to children. What ACES told us (adults) about how our childhood experiences affected us was important. The intergenerational importance of ACES was a key transformational piece of the puzzle of understanding and removing violence from the world of children.

I think that in a rush to build bureaucracies and bureaucratic responses to ACES of current children we lose site of the preventive message: remove the ACES, understand how our adult behaviors and practices affect children and STOP THOSE PRACTICES! Not just those that happen to be part of the ACES questionnaire, but all of those practices and structures that interfere with positive child development. When we continue to tell adults that CHILDHOOD MATTERS (and in the process support children)  and we ask children and adults about the ACES in their lives – the healing effects of CARING ENOUGH TO ASK and respect the experiences described in responses will bring dignity to children and adults and help adults stop doing what they are doing that harms children.


Last edited by Lucien Lombardo
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