Calling an Ace an ACE: Integrating Prevention Efforts
Perspectives is a regular Network column edited by Dr. Clara Gerhardt, CFLE, Professor in Human Development and Family Science at Samford University. In this article, Dr. Bridget Walsh, CFLE, shares her perspective about enlightening her students about ACEs.
Professionals in the family sciences are typically concerned about the factors contributing to Adverse Childhood Experiences (ACEs) as they have the potential to cause negative health outcomes. The flagship ACEs study was published in the late eighties (Felitti et al., 1998) and since then hundreds of additional related studies have been conducted.
Even so, many future professionals lack awareness of the ACE studies. A recent study asked faculty at a medical school if they had heard of the ACE study, and only 15% were aware of it (Nealon, 2017). My lifespan developmental science course, which serves 300 students from diverse majors, produced only one student who had heard of the ACE studies.
The ACE study is extremely important for medical and healthcare professionals as well as family life educators. As a class activity, we identified home visiting, supportive mentors for children and adolescents, family life education, nutrition, universal pre-kindergarten, efforts to support 2- and 3-year-old children and their families, and early screenings for toxic stress as important interventions for individuals facing multiple adversities. Dr. Nadine Burke Harris exclaimed in her TED Talk, “How childhood trauma affects health across a lifetime,” that the minute she started to make the connection between ACEs and intervention science, she wanted to scream it from a rooftop. A handful of students in my introductory lifespan course had a similar reaction.
Most students are able to make cogent links between early life experiences and later life outcomes. Our course text devotes a few pages to prevention and intervention. My students had to consider that prevention and intervention science can potentially alter ACEs and the trajectory to negative outcomes later in life. This was a good place to emphasize concepts from prevention and intervention science.
My students noted the important shift in dialogue. Instead of “What is wrong with you?” the more open-ended and empathic question, “What has happened to you?” was used.
The definitions of prevention and intervention overlap (Myers-Walls et al., 2011). In 2017, Gershoff stated that interventions include efforts to alter a process to affect a more positive or less negative outcome. Preventions on the other hand are efforts to intervene before the onset of a problem and may be construed as a type of intervention. Because I teach a variety of majors (e.g., nursing, HDFS, education), it was important to mention that home visiting is helpful to reduce negative health outcomes, although different fields apply their own terms to describe these efforts. For example, medical professionals like Mrazek and Haggerty may call it targeted/selective intervention, whereas family life educators like Myers-Walls et al. call it secondary prevention. We are talking about families with risk factors when we talk about targeted/selected intervention or secondary prevention. Whenever we are concerned with families with multiple risks, it is imperative to consider the impacts of policy.
In 2017, Gershoff explained at the "Society for Research in Child Development" (SRCD) and the Developmental Science Teaching Institute, that policies encompass government programs and laws that prevent or intervene social problems. I would like to think that policymakers are well versed on important intervention and prevention efforts such as home visiting, mentoring, family life education, early screenings for toxic stress, universal pre-kindergarten, and the need for more resources for children and families before pre-kindergarten. Although my students are enthusiastic about ACEs and intervention and prevention science, they were also concerned that their newly acquired knowledge did not reflect what was happening in practice.
We reached out on the NCFR CFLE listserv to learn from CFLEs with expertise on the topic. Dr. Mary Sciarrafa and Jennnifer Best, as well as many others in the field, offered to talk more about ACEs. We invited graduate students and advanced undergraduate students from HDFS to the talk. Dr. Mary Sciaraffa and Jennifer Best addressed a group of approximately eight students; five students from an introductory lifespan development course and three advanced undergraduate and graduate students, via a conference call to our campus.
Dr. Sciarrafa and Jennifer Best helped us further situate ACEs as part of a preventive health movement. They acknowledged that toxic stress contexts were present before ACEs but as recent attention to trauma-informed communities increased so too had attention to ACEs. My students noted the important shift in dialogue. Instead of “What is wrong with you?” the more open-ended and empathic question, “What has happened to you?” was used.
For this mix of students from an introductory lifespan course and advanced HDFS courses, ACEs represented something that their future clients, patients, or students would experience; they posited that ACEs affect all of us. The trauma-informed approach compelled them to share that there is a need for further prevention and intervention science to change outcomes in adulthood. In addition, because awareness of ACEs reframes interventions and preventions to focus not on what is wrong, but on what happened, the students opened up about ACEs and wanted to do something.
This experience was educational and therapeutic for them without being any formal version of therapy. As a FLE, I am acutely aware of the similarities and boundaries of FLE and Family Therapy. By calling an ACE an ACE, and internalizing the information, a handful of students are now cognizant of ACEs. There is so much to learn when considering the inextricably linked areas of human development and family studies. Additionally there are now a few more educated and aspiring professionals feeling the need for prevention and intervention in relation to ACEs. This is an important role of science in the preventive health movement and the potential benefits affect us all.
Bridget A. Walsh, PhD, CFLE is an Associate Professor of HDFS at the University of Nevada, Reno.
Resource: The ACE study can be accessed at the website of the Centers of Disease Control and Prevention: https://www.cdc.gov/violenceprevention/acestudy/index.html
Felitti, V.J., Anda, R.F., Nordenberg, D., Williamson, D., Spitz, A., Edwards, V., Koss, M. and Marks, J. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The adverse childhood experiences (ACE) study. American Journal of Preventive Medicine, 14(4), 245-258.
Harris, N. B. (2014, September). Nadine Burke Harris: How childhood trauma affects health across a lifetime [Video file]. Retrieved from https://www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime
Gershoff, E. (2017, April). Answering the “So, What?” question with applied examples from interventions and policy. Paper presented at the SRCD Developmental Science Teaching Institute, Austin, TX.
Reducing Risks For Mental Disorders: Frontiers For Preventive Intervention Research. Committee on Prevention of Mental Disorders, Division of Biobehavorial Sciences and Mental Disorders, Institute of Medicine; Patricia J. Mrazek and Robert J. Haggerty, editors. http://www.nap.edu/openbook.php?record_id=2139&page=R2
Myers-Walls, J. A., Ballard, S. M., Darling, C. A., & Myers-Bowman, K. S. (2011). Reconceptualizing the domain and boundaries of family life education. Family Relations, 60, 357-372. doi: 10.1111/j.1741-3792.2011.00659.x
Nealon, K. (2017, March 20). Haunted by life’s ghosts. The Times-Tribune, pp. B9.