Good point, Martha. Thanks for your comment. We do indeed have a long way to go, and with the progress we've made in the last few years, it doesn't seem as if it's impossible for people across sectors to embrace and use this new knowledge....in every community!!
Not impossible at all!! A little educational infrastructure can go a long way. And your progress is immense!!! This information is now everywhere. And where it isn't it's still well received. It's validating so many people. I think it is healthy here to embrace criticisms so that this work can continue to grow.
Martha Chiavetta posted:I think Finklehor's points are valid when taken into the context of generalization. I believe he is speaking to a larger model. If you wanted to screen everyone in the United States medical system tomorrow for ACE's you would not have the resources, educated staff (that have addressed their own ACE's), and standardized questionnaire to do it. You would also have pandemonium. I think his article is taken harshly here because you are taking for granted that you already have groups of educated practitioners in community doing this work. But those here are maybe forgetting what it took to get where you are. And what Finlehor is bringing some awareness to is that it's going to take a lot of work to get this to EVERYONE. Which is the goal.
I think you're absolutely correct, Martha.
And despite what some people think, I wasn't being a smart alec with that article. Unfortunately, very little research -- academic, and hardly any practice-based, research -- is done looking at cost-effectiveness. Look for reviews of the Scandinavian experiment into widespread nationalized support for CBT -- the approach with "the best evidence base" -- not in national outcome studies there.
So for people to take this "ACEs Science" approach seriously we need more practice-based research including cost-effectiveness outcome data to answer "By doing what, with whom, using what resources, can we produce these outcomes for people with histories of childhood adversity?"
and we must be prepared to give up, when the data shows it's necessary, some of our preconceptions. Who would have dreamt the outcomes of studies such as that of Nathaniel Lewis? Incarceration --- effect of race or class, Lewis 2018 Somewhere in all that data there'll be a link to ACEs (or there should be!) just as, getting back to Colette's original question, poverty and substance abuse are linked to domestic violence, and ACEs, documentary "Nigel Latta: Killing Our Kids" but for a lot of "traditionally trained" (thus less-informed) people in the medical system, we'll need the evidence to show what needs to, and can be, done.
I completely agree Paul, and you may have been misunderstood. Unfortunately, conventional medicine will only accept ACE's under certain conditions, the ones you speak of. I do believe a lot is being achieved by continuing the grassroots efforts. Because a lot of patients/clients are becoming aware of the impact of their trauma and neglect and are seeking out ACE's and trauma informed care. And they don't want to wait for conventional medicine to catch up. In order for them to catch up we have to give them the data they need to alleviate their cognitive dissonance. So Paul, in order for the whole community to move forward we need someone to give us the data collection template and methods that will satisfy the system. That's out of my wheelhouse :-)
whoever that person will be, whatever their "qualifications", will need to be both "acceptable" and still a "contrarian"; someone sympathetic to, yet not a "sympathetiser within" so-called "ACEs Science" -- a term not accepted by many who have contributed, for decades, to improving the well-being of those who have weathered the storms of "childhood adversity" -- another valid point of Finkelhor's. Plus a whole host of other personal and skills-based qualities. "Not impossible at all!!" Let's hope not, but still a lot to ask for. Outlining the right "selection criteria" for the person to ask "the right questions" is yet to begin. Finkelhor has made an invaluable start, imho, by asking some essential, however uncomfortable, questions.
Thank you Jane, for providing access to Finkelhor's article and thank you Martha for your very adept reply! I really understood Finkelhor's points about generalizing the screening of patients in a medical setting for ACEs. He is looking at it through a clinical lens, wanting it to be connected with outcomes that are going to help patients, and filters that are going to screen out those who would not benefit from the information. I look at ACEs screening totally differently, because I am a mental health care provider. When someone comes in who has been traumatized or shows symptoms that may be connected with trauma, I want to figure that out. I don't want to symptomize (I know...new word) trauma by diagnosing someone who is acting out of a traumatic experience with very normal and natural reactions, with a DSM label! There's too many kids who have experienced trauma who are now labeled with ADHD or worse. In using genograms, which are family-based diagrams showing family dysfunction, cutoffs, triangulation, divorce, abuse, neglect, and other trauma, we are actually mapping out ACEs for the children of those who experienced or are currently struggling with trauma. For those who don't have kids yet, we can build up the adult's understanding of how trauma affects the brain, affects chiildren, and impacts a life's trajectory (without resilience building). We can educate about how to build resilience, empower someone who is newly traumatized, and we can help someone who comes from a dysfunctional abusive family understand the "normalization" that occurs -- so that doesn't get passed down. I don't have an issue with Finkelhor's paper. I know that medical professionals have an entirely different set of guidelines, rules, and ethics to work with. I'll just be glad when we, as a country, move to unite the medical with the mental health professionals and treat the whole person (which is what ACEs research and education is all about!).
Martha Chiavetta posted:Not impossible at all!! A little educational infrastructure can go a long way. And your progress is immense!!! This information is now everywhere. And where it isn't it's still well received. It's validating so many people. I think it is healthy here to embrace criticisms so that this work can continue to grow.
Martha:
I totally agree. I think doubts and debates are healthy. I think we can share access to this public health info. In varied ways in and outside of the context of screening and need not wait for evidence-based whatever before doing so. As parents, survivors, families and communities - we can to decide for ourselves if and we can and are deciding how to use / share ACEs-related aha moments or social movements. Debates will continue.
I would love evidence based research on the impact of not sharing or screening as well... The fear and avoidance many have, in and outside of medical settings isn't benign.
But at least more of us know, discuss and debate this stuff and I find that encouraging. Cissy
Christine Cissy White posted:Martha Chiavetta posted:Not impossible at all!! A little educational infrastructure can go a long way. And your progress is immense!!! This information is now everywhere. And where it isn't it's still well received. It's validating so many people. I think it is healthy here to embrace criticisms so that this work can continue to grow.
Martha:
I totally agree. I think doubts and debates are healthy. I think we can share access to this public health info. In varied ways in and outside of the context of screening and need not wait for evidence-based whatever before doing so. As parents, survivors, families and communities - we can to decide for ourselves if and we can and are deciding how to use / share ACEs-related aha moments or social movements. Debates will continue.
I would love evidence based research on the impact of not sharing or screening as well... The fear and avoidance many have, in and outside of medical settings isn't benign.
But at least more of us know, discuss and debate this stuff and I find that encouraging. Cissy
Indeed, irrespective of Finkelhor's article, thankfully little is now going to "stop" the ACEs-awareness social movement -- it's never been, nor, realistically, can it ever be an "ACEs Science" -- "ACEs" per se are not scientific facts, they are subjective reports of difficulties people are experiencing with a presumed basis -- the same as any self-reported psychological / social difficulties -- the term is though highly useful as a rallying cry for a social movement. And that social movement will continue, at least for a while, irrespective of, and in the longer term despite, whatever may be the outcomes of research. But let's hope people engaged in the activities of that social movement have the integrity, and the courage, not to mention the skills, to objectively evaluate the cost-benefits of any changes they bring about. That will help address at least one of Finkelhor's longer term concerns.
Paul, when we refer to ACEs science, this is what we mean:
- The CDC-Kaiser Permanente ACE Study and subsequent surveys that show that most people in the U.S. have at least one ACE, and that people with four ACEsâ including living with an alcoholic parent, racism, bullying, witnessing violence outside the home, physical abuse, and losing a parent to divorce â have a huge risk of adult onset of chronic health problems such as heart disease, cancer, diabetes, suicide, and alcoholism.
- Brain science (neurobiology of toxic stress) â how toxic stress caused by ACEs damages the function and structure of kidsâ developing brains.
- Health consequences â how toxic stress caused by ACEs affects short- and long-term health, and can impact every part of the body, leading to autoimmune diseases, such as arthritis, as well as heart disease, breast cancer, lung cancer, etc.
- Historical and generational trauma (epigenetic consequences of toxic stress) â how toxic stress caused by ACEs can alter how our DNA functions, and how that can be passed on from generation to generation.
- Resilience research and practice â Building on the knowledge that the brain is plastic and the body wants to heal, this part of ACEs science includes evidence-based practice, as well as practice-based evidence by people, organizations and communities that are integrating trauma-informed and resilience-building practices. This ranges from looking at how the brain of a teen with a high ACE score can be healed with cognitive behavior therapy, to how schools can integrate trauma-informed and resilience-building practices that result in an increase in studentsâ scores, test grades and graduation rates.
So, there is, indeed quite a bit of science here. More info at ACEs Science 101.
Jane,
I never said there weren't scientific contributions which had contributed to the debate around ACEs issues, but was explaining that this website's proposal that there was such "a thing" as "ACEs Science" is a lot of hooey -- in my view (with postgraduate qualifications in a few different "real sciences"), and implicitly in the view of "serious scientific researchers", like Finkelhor, but also in the views of many others who have been researching the phenomena you mention for decades before "the" ACEs research, there is no such thing.
But, by all means use the term, on this website, no one not accessing this website will mind YOUR use of it here, but its use, or the suggestion of its use, elsewhere does raise concerns. People on this list have been quite dismissive when others have attempted to explain, in layman's terms, more complex scientific results, saying it's only important what people have to say about the implications of those results -- what they suggest should be the practical implications of those results.
If people want an ACEs Science to exist then the least they can do is submit articles debating the scientific principles behind other scientific contributions for peer review -- but clearly no one wants to do that. I would go so far as to suggest there's a lot more they could do but if people don't feel like it ....
Thanks for your response, Paul. I disagree, and can point out huge flaws in Finkelor's data, but will save that for another time.
Thanks, Jane, you've just proven my point, as you always will, I like it when it's that easy :-D
And fyi Finkelhor offers arguments, not data, so you can't find any holes in it, but you can disagree with his arguments, and provide your own, but, as usual ...