In their work “Adverse Childhood Experiences and Life Opportunities: Shifting the Narrative,” researchers Metzler, Merrick, Klevens, Ports, and Ford (2016) analyzed data from ten states and the District of Columbia which utilized the adverse childhood experiences (ACEs) module from the 2010 Behavior Risk Factor Surveillance System. Metzler et al. (2016) used the analysis of that data to explore associations between ACEs and later outcomes related to adult education, employment, and income. The authors acknowledge that there established associations between ACEs and subsequent adverse outcomes, noting significant dose-response relationships between childhood abuse, neglect, and other ACEs and causes of adult morbidity and mortality. However, what is not clear is the connection between ACEs and outcomes related to later education, employment, and income. Using the Behavior Risk Factor Surveillance System data, the authors determined several things which may be regarded as take-away points.
It should be noted that the data is considered through the lens of the Conceptual Framework on Social Determinants of Health developed by Solar and Irwin known and used by the World Health Organization. The use of this framework to understand the surveillance data itself is a take-away insomuch as it provides a visual representation of the interrelationships of the factors commonly involved and potential outcomes. With regards to the data, one of the initial take-aways is that the prevention of ACEs may affect both health and life opportunities in ways which are cross-generational. Another take-away derived from the authors’ findings is that the prevention of ACEs could be more effective if both public and professional understanding (what the authors refer to as the narrative) of the connections between ACEs and poverty were enhanced. The third take-away is an extension of the previous take-away. While it would be easy to attribute the ACEs and their outcomes to the parents of individuals affected by those ACEs, Metzler et al. (2016) point to structural elements within the conceptual framework which exceed the abilities of the family to address. In other words, there are problems which contribute to and exacerbate the effects of ACEs which exceed the experiences of the individuals involved and their parents – the sins of the father, as it were, being visited on later generations. It is these issues which must also be addressed by health and social services and cannot be adequately or meaningfully addressed by the family alone.
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In terms of the overall quality of this research, one has to admire the authors’ ingenuity and resourcefulness in making use of existing data and statistical analysis. The text is well-written and easily accessible, though there is a sense that some of their assertions might be described as obvious or common sense. The tables used to present and analyze the data in a visual way assist in quickly reviewing the authors’ analysis of the data and quickly seeing key elements (such as the odds of completing high school in the context of x number of ACEs). The integrity of the authors’ logic seems, for the most part, above reproach. They present a coherent train of thought for pursuing their argument; their methods for exploring the object of their argument likewise make sense given how they chose to obtain data.
If there is a complaint to be made about this work, it is that the authors offer few strategies for broadening the understanding of both the public and professionals and changing the narrative surrounding these issues. It is meaningful and helpful for the point to be made that the parents of children who experience ACEs are often victims of ACEs themselves, firmly establishing the intergenerational nature of these issues. However, strategies for addressing these issues, given how firmly the research seems to be in asserting the reality of these issues, seem few and far between. Of course, given the complexity of the issues at hand – as visualized by the Social Determinants framework – perhaps the paucity of strategies may be attributed to a failure to translate the knowledge into meaningful application as yet.
Instead, the data serves as a call-to-arms for both the public and relevant professionals to reconsider these issues; perhaps this means the authors are leaving it up to the public and professionals to develop strategies which would be tailored for and more meaningful to the families and communities in which they live and serve. Nevertheless, it seems as though the sheer amount of data and the clarity of the findings would prompt the authors into identifying some “best practices” strategies with broad and/or flexible applicability.
What emerges from the assessment of these findings is that intergenerational issues mean that (a) both the public and professionals must understanding the importance of involving the whole family unit to address child welfare-related policies and (b) that likely the parents of these children also require support and assistance to mitigate the adverse outcomes experienced by the parents. This suggests that child welfare services may need to develop collaborative relationships with services for adults as a means of helping the parents understand how their experiences influenced them and will continue to influence them and their children adversely.
Professional development which equips practitioners with the skill to reach out to parents of children and recommend the parents seek assistance would be highly beneficial, especially in terms of promoting positive practices at home (ending a cycle of adverse events and poor later adult life outcomes). One might say that a holistic approach of sorts, as proposed at the outset of the article by Metzler et al. (2016) is in order: what social needs require addressing in order to positively stimulate and bolster the effects of other elements in the social determinants framework? While it is necessarily practical, given the complexity of the framework, to use it as a means of broadening the horizons of related stakeholders, it does emphasize the importance of visual approaches and the importance of understanding the cyclical nature of ACEs and their impact.
- Metzler, M., Merrick, M. T., Klevens, J., Ports, K. A., & Ford, D. C. (2016). Adverse childhood experiences and life opportunities: Shifting the narrative. Children and Youth Services Review, 72, 141-149.
