There are so many wonderful responses to this question. Several people pointed out that we have to keep in mind the parents' own trauma experiences. I think this is absolutely critical. And - we need to look at current cultural practices (including medical practices) that add to parents' trauma and create new trauma rather than alleviating it. We are missing so many opportunities to help parents and children.
To create a healthier world for children, we have to create a healthier world for parents. And we have to look not only at family dysfunction but at our culture's dysfunction (income inequality, racism, harmful maternity practices, societal hostility toward parents and children).
I think this is a critical piece of the puzzle: adopting the “parental experience of child rearing” perspective, as explained by Alice van der Pas. It takes a while to get used to this idea -- it's not about the actions the parents do that impact the child, it's about how the parents' world (including their own childhood experiences and current cultural experiences) impact their experience of raising a child. And that parental experience is expressed in the way the parent cares for the child, in emotional connection (or lack of connection), in tone of voice, physical care (tender or rough contact), in the parents' ability (or lack) to reflect on the child's experience (researchers call it mind-mindedness). I wrote about van der Pas' ideas in Thinking about Parenting:
Van der Pas offers a thorough rethinking of many myths about child rearing. Rather than categorizing children as either "at risk" or not, she asks us to recognize that children are put at risk when there are not adequate buffering processes [she uses the term moderating factors]. The first moderating factor is "a community which acknowledges the importance of parenting" and by "acknowledge" she means not only respect and encouragement but also concrete support, including economic support and also the nurturing of parents. As van der Pas emphasizes and strong research demonstrates, appropriate moderating factors such as interventions, support and services can improve a parent's well-being and nurturing behaviors.
And this:
Van der Pas notes about contextual factors including parents' relationship difficulties and poverty: "the 'risks' are risky only in so far as we do not 'buffer' them [with moderating factors]".
As Alice van der Pas says, in order for parents to nurture their children, they must themselves be nurtured; and she quotes anthropologist Sarah Hrdy: “Nurturing has to be teased out, reinforced, maintained. Nurturing itself needs to be nurtured.”7 In the Western world and among behavioral scientists, however, van der Pas observes widespread belief that parents themselves do not need to be nurtured. Also, many people think that a not-so-nurturing parent is a fixed contextual factor (or risk factor)--when in reality, and as shown by evidence-based research studies, appropriate and sufficient moderating factors (support, services, interventions) are likely to improve this parent's nurturing behaviors.
I think the van der Pas "parental experience" perspective would help change the conversation (including the words we use) about child abuse/neglect.
I recently read Dr. Felitti's 2003 article "The Origins of Addiction" (thanks to Kathy Brous, who wrote about this her on ACESConnection and on her blog). On page 10, Dr. Felitti writes about the importance of primary prevention and some of the barriers as well as potential avenues such as mass media.
A great example of a community public health prevention focused on parents:
In Madison, Wisconsin, the community achieved a drastic drop in the rate of preterm births among African Americans. Quoted in this New York Times article, the County health director, Dr. Schlenker, said "Pregnant women need to feel safe, cared for, and valued..."
For more on mother-friendly maternity care, see the Coalition for Improving Maternity Services
For a long time, I've been collecting resources related to parent support, and listening to parents talk about their struggles and what kinds of things help. Here are some thoughts and examples:
Years ago there was a pilot study that placed social-emotional support staff in pediatrician's offices. These staffers saw parents at the time they came for well-baby checkups, and their role was to talk with the parents about many ACES issues (though this was before the ACES study). Funding ran out. I think I could find that study again if anyone is interested.
If we could emphasize a “growth mindset” for parents (as researcher Carol Dweck terms it as applied to children’s learning) I think it would have a powerful effect. As parents learn, they will share that knowledge with others.
A few examples: Most parents didn’t even consider homeschooling a few decades ago, they thought they were not qualified to “teach” their children. But as some people homeschooled, and learned more about how children learn, they gained confidence, they shared their experiences with others. Another example is breastfeeding, promoted by a grassroots nonprofit started by mothers – La Leche League…. And another example is home birth.
Via Facebook, parents are sharing their struggles to change their behavior and reduce stress for their children, and they are attracting tens of thousands of followers. Two examples:
The Orange Rhino (a mother who vowed to stop yelling)
The Hands-Free Revolution (a mother who vowed to stop being so perfectionist/busy when she realized how much stress she was causing for her young daughters). Here’s my review of her new book, Hands Free Mama.
And this mother writes about her philosophy of gentle parenting - Nurshable - with plenty of day-to-day experiences as illustrations of the challenges, struggles and successes. Others find inspiration here, a sense of community and shared struggle to be patient, loving, kind.
My organization, Family and Home Network, published a monthly journal for parents for 22 years. Now some of the articles are on our website. One of the most popular is “Learning from a Difficult Child” by Jeanne Faulconer. The comments illustrate how hungry parents are for understanding, for support and insight. Our capacity to follow through with the parents who comment is so limited. There is so much need.
A parent support organization that does a great job in helping parents who want to do better with their relationship with their children is Hand-in-Hand Parenting. They offer webinars, telephone support, a blog, and informational articles – this one touches on parents’ ACES (without using ACES)… language here might be useful: “I swore I’d never say that! On being a parent”
On taking a public health approach to prevention, I highly recommend a book I just finished reading - “Join the Club” by Tina Rosenberg. This great review of the book explains the main points. The book includes a lot of information about the use of language, and the use of marketing techniques.
In our culture currently, we minimize the importance of parenting - parents don't feel respected or valued, many are isolated and struggle to find and maintain supportive relationships. In most communities, there is no place parents can gather. There is virtually no support for parent-child time together.
I think there are some hopeful things happening, but change is hard! Thank you to everyone working on prevention and supporting parents and children.