Raising Awareness: The Impact of ACEs on Child Abuse and Neglect
My younger daughter, Laura, works as a mental health technician at Helping Hand Home, a not-for-profit residential childcare agency in Austin for children healing from physical, emotional and sexual abuse, and/or neglect. The center provides therapeutic residential treatment, education at an on-site charter school, and foster care and adoption programs.
I previously wrote about the stories my husband and I related to Laura describing our personal stories of encountering severe child abuse as pediatric residents. Laura sometimes tells us about the backgrounds of the children she cares for. Some sound horrific, almost unbelievable. Many have parents who abuse drugs.
Just this week the American Academy of Pediatrics (AAP) published some updated figures describing the prevalence of child abuse. I want to highlight these findings for you.
“More than 7.5 million children were reported to child protective services (CPS) and more than 3 million received an investigation in 2022, according to the U.S. Department of Health and Human Services (HHS).
Furthermore, investigations substantiated abuse or neglect in more than 550,000 children, and foster care services were provided to more than 145,000 children in 2022.” Most notable is that “an estimated 1,990 children died from maltreatment.”
My older daughter, Anne, is a Pediatric ICU nurse, and she has witnessed, in her eight-year career, more than forty children die as the result of child abuse! Pause…. and think about that for a moment.
The Family First Prevention Services Act (FFPSA) was signed into law in 2018 and provides the legislative foundation for states to enlist CPS agencies to prioritize prevention, instead of investigation. The AAP lobbied vigorously for this bill.
Recently, progress has been made in policy and program efforts to prevent child abuse and neglect and CPS involvement. Policies that improve health care access and affordability (expansion of Medicaid offers the greatest benefits), child tax credits, earned income tax credits, childcare credits, and the Supplemental Nutrition Assistance Program (SNAP) can help reduce CPS investigations, and/or foster care placements.
These policies help to prevent child maltreatment in several ways. They can reduce the harmful effects of poverty and material hardship for families, and Medicaid can connect parents to physical, mental and substance abuse care.
Our individual states play a large role in providing support that can prevent maltreatment. Over the last five years, the states that offer refundable child tax credits have increased from 2 to 11. Recently, Idaho, Missouri, Nebraska, North Carolina, Oklahoma, South Dakota, and Utah expanded Medicaid. Unfortunately, my home state of Texas has not!
As parents, we can advocate for expansions of Medicaid coverage and services in our states to promote affordable health care for children and their caregivers.
Turning Pain into Purpose: the ACE Score, Child Abuse, and Advocacy
All parents need to 1) be aware of this high prevalence of child abuse and maltreatment in our country and 2) be familiar with the term Adverse Childhood Experience, or ACE.
We can measure our own ACE score and/or the score for our children. Doing so offers invaluable insights into the long-term effects of childhood trauma. By quantifying adverse experiences such as abuse, neglect, and household dysfunction, the ACE score provides insight into an individual's early life challenges. This tool aids in identifying those of us at higher risk for physical and mental health issues.
An ACE is an adverse childhood experience such as:
· child abuse (emotional, physical, sexual),
· child neglect (emotional, physical),
· parent or household member with mental illness,
· parent or household member with substance abuse or alcoholism,
· children witnessing domestic violence,
· having a parent or family member in jail,
· children experiencing parent separation or divorce,
· death of a parent or sibling.
Exposure to childhood ACEs can increase later risks for:
· teen pregnancy,
· alcoholism,
· smoking,
· misuse of prescription drugs and illicit drug use,
· depression,
· heart disease,
· liver disease,
· domestic violence,
· sexually transmitted infections (STIs),
· suicide attempts and death by suicide.
The ACE Study was originally conducted by the CDC and Kaiser-Permanente, and it found that diseases like diabetes, high blood pressure, obesity, and substance abuse are much more common in adults who experienced serious adversity when they were children. The study showed a graded dose-response relationship between the ACE score and negative health and well-being outcomes. That means that as the number of ACEs increases so does the risk for negative outcomes. Here is the original article.
You can measure your own ACE score here at the Stop Abuse Campaign.org and get information about your own risk for poorer health outcomes. Almost two-thirds of adults surveyed on this site reported at least one ACE, and most respondents had more than one.
My personal ACE score is 3, and according to ACE study statistics, it predicts that I have a 36% risk of depression, compared to a 14% risk among adults with ACE scores of 0.
I wrote about my personal encounters with an authoritarian, rage-filled father in my memoir, “So Many Babies.” Throughout my childhood, he often whipped me and my siblings with a belt, screamed at us, made us stand at attention, and slapped our faces. Once he even pulled my hair. These awful things I have never forgotten.
Not surprisingly, I have dealt with persistent depressive disorder (dysthymia) since my early forties. Undoubtedly my childhood experiences contributed to this condition. I share my struggles with this ailment so that others will feel inclined to examine their adverse childhood experiences, and so that we - as parents - will have a greater understanding of the damage that adverse childhood experiences can foretell not only for ourselves, but also for our children.
Our children are precious. We cannot abuse or neglect them without consequences!
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For more information, please see https://www.cdc.gov/violenceprevention/childabuseandneglect/fastfact.html