Wednesday, 11 December 2019

'A recipe for better child participation'

Dr. Carine Le Borgne, Senior Policy Adviser, World Vision UK

Thirty years ago, the United Nations Convention on the Rights of the Child (UNCRC) was adopted. The UNCRC is the most ratified human rights convention. Only the USA has not yet ratified the UNCRC. Article 12 of the UNCRC recognises children’s right to participate in decisions that affect them. Since the UNCRC’s ratification, children and young people’s participation has been encouraged by many initiatives in schools, in communities or at the national level with decision-makers. However, the way children and young people participate in decision-making is often problematic in practice. Many participatory initiatives have been developed across different countries and contexts, but often without a clear definition of what children and young people’s participation is (Lansdown 2014).

In 2009, the Committee on the Rights of the Child (a group of independent experts who monitor the implementation of the UNCRC) clarified the term ‘participation’ as: “Ongoing processes, which include information sharing and dialogue between children and adults based on mutual respect, and in which children can learn how their views and those of adults are taken into account and shape the outcome of such processes.” (CRC/C/GC/12 para 3)

In practice, including children and young people in decision making can raise challenges that frustrate children, young people and adults. It is recognised that children and young people generally have positive experiences of participation but that their views have little impact to no impact on decision-making (Tisdall et al 2014). Indeed, children and young people’s participation processes “have sought to raise the voices of children and young people as an end in itself, rather than a means to achieve positive transformational change” (Johnson 2015: 159).

During my work for NGOs with World Vision and my research at the University of Edinburgh[1], I reflected on my practice in working for NGOs in the field of child participation and how we can implement better children’s participation.

Here it’s my recipe to change the mind-set of adults to implement better child participation!

In order not to be anxious about participation, we need to think about the benefits of changes for children and young people and for adults as well. New things make people uneasy, especially when they imply a change of mindset. Participation means a change of mind and behaviour in taking seriously into consideration the view of the child; but in some societies children ‘don’t exist’. Participation is to understand each other; to feel free to speak without fear; to take part in dialogue in the family, in school, in the community, with decision-makers and within the NGO.

When we want to make a change in our life, we need to consider the ‘time elements’. We can change, but to do so we need to know the meaning of ‘participation’. We need to be ‘motivated’ to do it (know the benefits) and to take action, to practise it (the knowledge that we have a safe space to reflect on it will help). We need to make an effort to initiate change and to achieve it.

We all need to incorporate some ‘ingredients’ to bring about change. We need self-confidence and determination. Changes consume time (even weeks or years), but the important thing is that when we have the knowledge, we should immediately start to internalise and utilise it. Indeed, participation needs to be practised in day-to-day life in order to understand its benefits rather than only talked about theoretically.

In the process of change we may come across many hurdles, but we need to sustain a positive attitude and commitment to continue. We need to find a person with whom to discuss our difficulties can be an asset. We can also recall our achievements since the beginning of the process and be proud of our accomplishments so far.

All this form a ‘recipe’ for accepting the true meaning of participation. Until we do this, participation will remain only a concept to preach, but it will not be practised.

-Lansdown, G. (2014) ‘25 years of UNCRC: Lessons Learned in Children’s Participation’. Canadian Journal of Children’s Rights.
-Tisdall, E. K. M., Gadda, A. & Butler, U. (2014) Introduction: Children and young people’s participation in collective decision-making.
-Johnson, V. (2015) ‘Valuing children’s knowledge: the politics of listening’. In: Eyben, R., Guijt, I., Roche, C., Shutt, C.




[1]Le Borgne, C. (2016) Implementing Children’s Participation at the Community Level: The Practices of Non-Governmental Organisations. Thesis, (PhD), The University of Edinburgh.

Tuesday, 8 October 2019

Kindness in court: who cares?

Today’s blog was written by Iain Smith, a criminal defence lawyer at Keegan Smith, Livingston, a core member of West Lothian ACEs Hub, and a trustee of Aid & Abet

This article was originally posted in February 2019 in Journal of the Law Society of Scotland (volume 64, no 2) and can be accessed here:

Kindness in court: who cares? 
Scotland has an enviable reputation for being a country with a compassionate heart. As a nation, we have been at the forefront of a recent upsurge in understanding of the biological science of the impact of childhood trauma on the developing brain, gaining an awareness of adverse childhood experiences (“ACEs”). Much of the campaigning has been at grassroots level, inspired by Dr Suzanne Zeedyk, leading trauma psychologist and Tina Hendry, former police officer and ACEs guru, but it is now bolstered by the backing of the Scottish Government. To date, the focus has been on health and education, but attention is now rightly turning to our justice system. Lawyers are slowly learning about ACEs, assisted by Dr Zeedyk’s article at Journal, June 2018, 16. As a criminal defence lawyer for more than 25 years, hearing about this science was a lightbulb moment and allowed me to view my clients, who are often wounded and broken individuals, in a different way. In my job, you regularly observe scars left by trauma – an inability to self-regulate and, for many, a reliance on substances to self-medicate emotional pain.

Relevance of background
Not every crime committed has a background of ACEs, and not everyone with significant childhood trauma commits crime. However, a significant proportion of people with convictions have had high doses of toxic stress from childhood that made it more likely, though not inevitable, that they would enter the criminal justice system. Here is a shocking statistic: while only approximately 5% of Scottish children are in care at some point, 70% of the inmates at Polmont Young Offenders Institution have care experience. That’s not just coincidence, and research suggests we are not doing enough for children in care. Hopefully the ongoing Independent Care Review can recommend ways to reduce that appalling figure and seek to redress this imbalance. Experts believe that a stable nurturing adult can rescue children from such stress and provide a buffer. Adults who have suffered trauma can also be salvaged by such care. Harvard Centre for the Development of the Child states: “Researchers provide three principles – reducing stress, building positive relationships, and strengthening life skills – [as] the best longterm preventative to combat ACEs”.

Hurt breeding hurt
What has any of this got to do with lawyers and the criminal justice system? If we look at the convicted person through an ACEs lens we may see things differently, prioritise help rather than punishment, and think creatively rather than of the futile revolving door of prison. Hurt people often hurt people, but they continue to hurt themselves more. Looking at criminal justice social work reports, you could be forgiven for missing the huge scientific discovery of ACEs. Information is tucked away quietly under “background” and reports often only whisper about childhood adversity, saying the person had a “poor upbringing” but giving no sense of the levels of misery and toxic stress created by grown-ups, either directly or indirectly, and the enormity of the impact on the adults these ACEs-riddled children become. The clients I deal with are often the hardest to like, but in the greatest need of love. Scratch the surface of their lives and you will witness terrible adversity and a tragic backstory. People who have high ACEs do bad things, but are rarely innately bad people. Armed with this knowledge, what effect has it had on how I practise as a lawyer?

Professional response
I now ask clients the question “What has happened to you?”, rather than “What is wrong with you?” I am more patient, more compassionate and I listen. In court, I discuss childhood trauma if it is relevant and suggest long term solutions to improve the individual’s life away from crime. I try to give them hope and encourage perseverance. After court I signpost clients to seek help from agencies, for example Aid & Abet, a charity which has volunteers with experience of the criminal justice system and who have turned their lives around. They can engage with offenders, young and old, to show recovery is possible. Regrettably, when everything fails, I attend clients’ funerals, sometimes with few other people there. It is exhausting, and as a business model it would not meet with approval from Dragons’ Den. So why bother with this ACEs stuff? If we all look back to why we became criminal lawyers, and it certainly wasn’t for the money, we may surprise ourselves by remembering we wanted to help the most socially deprived and overlooked citizens and to give them a voice. The other professionals in the justice system need to play their part by becoming trauma informed. Stop using derogatory words like “neds” or “junkies”. The use of this type of language sustains stigmas and myths that somehow people “choose” this way of life. Prosecutors should look at young persons’ backgrounds and consider their individual circumstances as well as the offence itself, in order to consider diverting them away from the court rather than stamping a label on them which will stop them making progress in life.

Recognising trauma
What effect could awareness of childhood trauma have on judges? I seek to encourage judges to consider presiding with kindness when it comes to dealing with these vulnerable and wounded offenders. As a society, we rightly recognise that there can be fallout from war for soldiers and this can create casualties in civilian life because of PTSD. We empathise with veterans because we feel a duty of care to them and we try to help them. Yet why should children who have experienced high levels of toxic stress be treated so differently? Their wounds may not be state inflicted but may be passively created by societal failure. In care until 15 years of age, children who are looked after by local authorities are seen as a “wee shame”; thereafter the same kids are deemed “wee shites” and treated as a problem in the community. And as for the next generation? James Docherty from the Violence Reduction Unit says: “When it comes to parenting with ACEs, what you don’t transform, you transmit.” Surely it’s time to try something different. ACEs research gives a bio-psycho-social platform and evidence based awareness to develop a new approach.

Two American ideas
The innovative Community Justice Scotland team has invited two prominent United States judges to come over to Scotland to share their ideas at events in March 2019. Both judges employ a judicial concept created by academic lawyer and psychologist Tom R Tyler, called procedural justice. The basic pillars of this are “voice, respect, neutrality and understanding”. The jurisprudence behind procedural justice is that persons who perceive they are being dealt with fairly and with dignity before a court will respect the decision of the court, the judge and the law. Judge Ginger Lerner-Wren created America’s first mental health court in 1997 in Florida. There are now over 400 specialist mental health courts in the USA and worldwide. Her problem-solving court is an example of how to dispense what she calls “the law reform science of therapeutic justice”. She has recently published a book called A Court of Refuge: Stories From the Bench of America’s First Mental Health Court. It sets out the remarkable efforts she and her team have made to divert people with mental illness and co-occurring substance use disorders from an anti-therapeutic setting in jail to more humane treatments in the community. In the mental health court, treatment is offered over punishment, with monitoring through a collaborative and inter-disciplinary process. It mirrors how the Violence Reduction Unit reduced knife crime in Glasgow by treating violence as a public health concern, a disease that needed to be cured at source. Interviewed recently on her “humanising” approach, she said: “We developed a collaborative process that was a swift diversionary means of having individuals transported out of an inappropriate system of care (i.e., a jail). The court instead acted like a funnel to move people from one inappropriate system to a humane system of health care.” Judge Victoria Pratt sat as a judge in Newark, New Jersey, in a notorious court nicknamed the “Green Monster”. She was appointed by the then mayor, now Senator, Cory Booker. She says: “I just get on the bench and treat people the way I would want my family members to be treated.” She ensured people left her court with hope, as without it they were sure to return.

Smart justice
Presiding with kindness will garner respect not only for the judge, but the court and the law. It will improve responses, and the judge may be that person who disrupts the cycle of offending by showing compassion. The degradation ceremony seen in our sheriff courts, often characterised by frustrated judges shouting at and humiliating broken people, doesn’t work. Why not set a positive example for offenders to look up to, rather than fear? Court participants may, however, pay attention to someone who is kind. Being informed of ACEs may allow judges to make informed and transformative disposals. A judge’s job is not an easy one and is undoubtedly emotionally taxing, but kindness literally costs nothing and can happen without training or delay. Some of you may think this approach is soft on crime and pandering to the “snowflake generation”. It is, however, “smart justice”, a term coined by Karyn McCluskey, the co-founder of the successful Violence Reduction Unit and now CEO of Community Justice Scotland. Smart justice means long term reduction of crime, and genuine and real benefits financially by reducing crime (it costs £44,000 to keep someone in jail for a year) – a no-brainer for the humanitarians among us. It will require a leap of faith, a change of lens and perseverance. At the end of an illustrious career spanning two decades, one judge displayed compassion on their last day on the bench by hugging an offender who was always in and out of the court. A very bold thing to happen in a Scottish court. Imagine, however, what might have happened to the girl if the judge had hugged her (metaphorically) the first time she appeared in court rather than the last time?

Researching LGBT+ Families and Relationships in Africa

On the blog today we hear from one of CRFR's Associate Directors, Dr Matthew Waites. Matthew is a Reader in Sociology, in the Sociology subject group within the School of Social and Political Sciences at the University of Glasgow. 

He is co-editor, with Corinne Lennox, of Human Rights, Sexual Orientation and Gender Identity in the Commonwealth: Struggles for Decriminalisation and Change, published open access online as well as in print (School of Advanced Study, 2013).  Recent journal articles during 2019 have been published in International Review of Sociology and International Sociology, addressing both the historical sociology of colonialisms in Africa in relation to queer analysis, and critical interpretation of contemporary transnational LGBTI activism including human rights claiming.

In this blog, Matthew reflects on his work on a project seeking to change attitudes towards LGBT+ people in Africa. 



Strong in Diversity Bold on Inclusion team.  
Taken in Maputo, Mozambique, 7 September 2019

About Strong in Diversity Bold in Inclusion
I have been working during 2019 as part of a new consortium project, focused on supporting LGBT+ people in five African cities within Kenya, Nigeria, Senegal, Zambia and Mozambique ('LGBT+' meaning lesbian, gay, bisexual, trans, and others with experiences outside heterosexual norms of gender and sexuality).  The project - Strong in Diversity, Bold on Inclusion is led by the development organisation HIVOS, with partner organisations including Coalition of African Leslbians (CAL) and African Men for Sexual Health and Rights (AMSHER), leading African transnational activist networks for LGBT+ people.

Our aim is to increase social inclusion and promote sustainable development goals (SDGs). As a project addressing the situation of LGBT+ people, it is clearly concerned in general terms with relationships and families alongside other issues; the theory of change being used is focused on changing the attitudes and practices of societal leaders towards LGBT+ people. These concerns speak to the concerns of CRFR, and our  international conference in 2020, ‘Intersectionality, Families and Relationships’.

Strong in Diversity, Bold on Inclusion is funded by the UK government’s Department for International Development (DFID), as part of the wider UK Aid Connect programme – which implies a structural position in North/South power relations that has to be carefully negotiated. Further NGO partners are Kaleidoscope TrustSynergĂ­aArticle 19 and Workplace Pride, with varying levels of experience of working in the Global South. The research is based at School of Advanced Study in the University of London (led by Dr Corinne Lennox), in collaboration with the University of Glasgow and University of Pretoria’s Centre for Human Rights in South Africa (led by Professor Frans Viljoen). A positive feature of UK Aid Connect is that it has allowed an initial ‘co-creation’ phase for international consortia to work together designing planned activities. Phase 1 is nearly complete and we are awaiting news on the funding for Phase 2.

My main contribution to the work so far has been leading a literature review, co-authored with Dr Felicity Daly at School of Advanced Study. Within the review I led the reading and writing concerning the five national contexts (as distinct from international contexts): Kenya, Nigeria, Senegal, Zambia and Mozambique, and their respective cities: Nairobi, Lagos, Dakar. Lusaka and Maputo. As well as using keywords to search for material in the International Bibliography of the Social Sciences, we also looked at relevant books, NGO publications and suggestions from our partner organisations for work happening outside academia.

Our work has led to some important insights on relationships and family life for people living outside heterosexual norms.

Lack of baseline data
The first main theme is the lack of baseline data from research in relation to LGBT+ people.  In particular, very little relevant baseline data on such people has emerged from the African universities. In this context NGOs of various kinds, especially LGBT+ NGOs, have been crucial in conducting research to establish data in specific national contexts. For example, in Nigeria The Initiative for Equal Rights (TIERS) commissioned a Social Perception Survey on Lesbian, Gay, Bi-sexual and Transgender Persons Rights in Nigeria in order to establish attitudinal data.  This has shown that while following the passage of the Same Sex Marriage Prohibition Act in 2014, in 2017 83% of Nigerians said they would not accept an LGBT person as a family member. By 2019 attitudes improved significantly, with the same figure reduced to 60%.  A central task for our planned project is to collect and analyse new data on various dimensions of inclusion such as health, education, and employment, for which we plan to use both quantitative and qualitative methods.

HIV/AIDS research dominating the field 
A second main theme is the way that HIV/AIDS research has profoundly dominated the field of academic knowledge-production in relation to LGBT+ people in Africa.  Particularly within major cities there are substantial studies concerning HIV/AIDS in relation to both sexual practices (risks of infection) and treatment of gay and bisexual men and other men who have sex with men (‘MSM’).  For example, in Senegal a significant body of research was taking place early in the emergence of the disease. However, this often focuses on contextually distinctive patterns, such as the high proportion of MSM who also are married and have sex with women (eg. Lamarange et al, 2009).). A major problem is the way that the focus on MSM leaves other groups out of the research picture, especially lesbian, bisexual and queer (LBQ) women, and transgender men and women in certain ways.  Only in the past decade do we find the first studies emerging that are focused specifically on LBQ women’s experiences, especially in major city contexts (eg. Zaidi et al 2016).

The challenge to gender binary thinking 
Also emerging from our literature review was the challenge to gender binary thinking. This was posed by Oyeronke Oyewumi in their 1997 book The Invention of Women: Making an African Sense of Western Gender Discourses, and subsequently taken up and popularised globally by Maria Lugones in the influential decolonial feminist essay ‘The Coloniality of Gender’. Oyewumi’s argument focuses specifically on the Yoruba people who live in areas including western Nigeria; yet the issues raised pose wider questions about the effects of what Lugones calls the ‘gender dimorphism’ of European colonialisms, and its contemporary legacies.  One possible way to address this might be to methodologically deploy the concept ‘double consciousness’ from sociological theorist W.E.B. Du Bois, to investigate and express experiences of duality and two-sided reality that are a legacy of colonialism, including where  people speak both African and European languages in different contexts. This poses difficult questions in terms of how to operationalise an approach in research methods, including for the planned team of city-based African researchers.

The relationship between contemporary Christianity and other forms of religion
A fourth theme is the relationship between contemporary forms of Christian religion finding popularity - especially neo-Pentecostalism as a key source of homophobia - and the preceding and intertwined forms of African religion such as of the Yoruba.  Literatures on religion suggest that earlier notions of spirits invading the body have found refractions in Pentecostal Christian discourses concerning movements of the Holy Spirit, and the devil (see Pearce 2012). Hence some of the vehemence of Pentecostal homophobia in Africa, as seen in Nigeria for example, cannot be explained by the newness and distinctiveness of this form of Christianity, but rather can be better explained with reference to ways in which it amplifies prior discursive formations of subjectivity, cultural structures of feeling and perhaps affects.  

Moving forward
The themes are offered here to provide, at this stage, only an initial sense of some emergent issues, that are not intended to provide a representative overview. What is clear is that consideration of the limitations of existing research literature on LGBT+ experiences in Africa can highlight the need for further research. Crucially such research needs to be undertaken in ways that seek to change existing transnational power relations shaped by colonialisms.

The review implies questions about whether and how researchers in CRFR’s network could and should become involved in research in Africa.  In my case, the invitation to become involved reflected recognition of my work with LGBT+ African researchers and activists such as Monica Tabengwa and Sexual Minorities Uganda, over the past decade (such as in co-authored chapters with Tabengwa and collaborative events with Sexual Minorities Uganda). In general research partnerships best emerge from ongoing collaborative engagement. But I also found that the review of literature starkly showed major gaps in research on LGBT+ people’s lives in Africa.  Transnational collaborations suitably structured to counter power imbalances could make more of a supportive contribution, in a context where African LGBT+ people are often finding it difficult to achieve secure academic posts within African universities to research these issues - despite the efforts of exceptional centres like the Centre for Human Rights at University of Pretoria, to promote such changes. The socio-political situation for LGBT+ people in many parts of Africa is too serious for academics in the United Kingdom, and in Europe more widely, not to engage with willing African partners in transnational research collaborations - and in light of this seriousness, such collaborations need to take a variety of forms.

References:
  • Lamarange et al, 2009 ‘Homosexuality and Bisexuality in Senegal: A Multiform Reality’, Population-E, 64 (4) pp.635-666
  • Pearce, T.O. 2012 ‘Reconstructing sexuality in the Shadow of Neoliberal Globalization: Investigating the Approaches of Charismatic Churches in Southwestern Nigeria’, Journal of Religion in Africa 42, pp. 345-36
  • Zaidi et al 2016 ‘Women who have sex with women in Kenya and their reproductive and sexual health’, LGBT Health 3 (2) pp.139-145

Monday, 7 October 2019

Understanding children's 'accommodation' of parental separation and divorce

Dr Sue Kay-Flowers is a Senior Lecturer in the School of Education at Liverpool John Moores University. Building on her earlier professional career in probation and the family courts, and longstanding interest in researching children and young people’s relationships, Sue’s recent book, 'Childhood Experiences of Separation and Divorce; Reflections from Young Adults' (Policy Press) gives ‘voice’ to children’s experiences of parental separation.

You can hear Sue talk about her book and new tool to support professionals at her forthcoming seminar, 'Understanding children's 'accommodation' of parental separation and divorce' on 5th November at 12 noon. Details, including sign up, is on eventbrite.  



The opportunity for young people to speak for themselves about their experiences of parental separation is often missing from the research literature. Their participation tends to be based on their parent(s) participation in previous studies, requires parental consent, or their accounts are seen through a professional lens.  

What I wanted to do through my research was to understand young people’s childhood experience of parental separation; what they thought, and felt, about the separation at the time, what they considered important then, and how they view their experiences as they looked back now. Analysis of their accounts led to:
  • understanding of how they felt about the changes that took place as a result of the separation
  • the opportunity to assess ‘accommodation’ of the separation over time.
  • the opportunity to identify aspects of their experience that helped to support, or created challenges, in accommodating the separation.
  • the knowledge being used to create a framework to support those working and living with children experiencing separation, in helping them to adjust to the changes it brings.
Working with young people, a 'bricolage' of innovative research methods were created to access the ‘voices’ of young people about their childhood experiences of parental separation. The challenge was to create a space where they felt able to talk openly and honestly about their personal experiences. The young people involved in the research felt that participants would most likely engage online, however, it was also agreed that an online survey would not be enough to engage their interest. The young people decided that a short video clip at the start would help as the ‘hook’ needed. 

Adopting this approach, I used my professional experience of working in the Family Courts to write a case study. This was then acted out by young people, filmed by a young film maker and uploaded onto YouTube. The result was 'Prompt Simulation Video' and it was viewed by all participants who completed the questionnaire. 

The accounts of young people were analysed to assess the extent to which they ‘accommodated’ their parents’ separation over time. First, we analysed accounts according to the level of satisfaction shown - did they feel their expectations or needs had been met? Second, we analysed accounts according to acceptance - did they see post-separation arrangements as adequate or suitable?

Our analysis allowed us to identify the things that helped support a child in accommodating parental separation and those that created challenges. This led to the creation of the 'Framework for understanding children's accommodation of parental separation', a tool designed to deepen understanding of how children experience parental separation over time. This can be used by practitioners and parents to support children and young people in adjusting to the changes parental separation brings. Subsequently it has been used to inform a short article on 'what young people say helped them get through their parents' divorce' in The Conversation.

The framework is now being tested by practitioners in different roles in schools (Deputy Headteachers, SENCos, Social Workers), in the Children and Family Court Advisory and Support Service (CAFCASS) and psychologists working in a Centre for Mental Health and Counselling in Nepal. Assessing its usefulness in practice is the next stage of the research process. It is also being used to inform a pack designed to promote children and young people’s resilience for use in schools.

Monday, 19 August 2019

Childhood sexual abuse: At the heart of problems with ACES policy, Part 2, Dr Sarah Nelson

Dr Sarah Nelson is a Research Associate at the Centre for Research on Families and Relationships (CRFR) and a research specialist on childhood sexual abuse and its effects across the lifecourse. Sarah’s book, ‘Tackling Child Sexual Abuse: Radical Approaches’, offers hope of more effective, imaginative means of protecting children and young people from sexual abuse.

This blog was first published on 19 August 2019 at: https://blogs.ed.ac.uk/CRFRresilience/2019/08/14/childhood-sexual-abuse-part2/

This is the second of a two part blog in which she discusses childhood sexual abuse in the context of ACE policy.

In part 1 of this blog (5/7/19) I outlined reasons why reducing childhood sexual abuse (CSA) in society, and addressing its damaging effects in adulthood, need to form and remain a key component of ACES policy. The considerable risks to mental health, and now increasingly to physical health also, have been widely researched and evidenced for decades: more so than any other of the original ten Adverse Childhood Experiences (ACES) compiled by Prof Vincent Felitti and his team, which have been widely adopted in studies and in policy ever since.

The relevance of a CSA history to persisting substance misuse, to blot out distressing effects of the trauma; to cognitive problems damaging education and career prospects, due to neurobiological effects of chronic early stress; and to higher rates of offending, due mainly to anger, alienation and involvement in drug and exploitative commercial sex cultures, are also well researched, and connect with findings of later ACE studies (Nelson 2016).

Yet although the recent, belated emphasis on understanding the role of traumas in general in the lives of children and adults which ACES have helped to promote is valuable and very welcome, attention within that to sexual abuse issues remains marginal, and at times non-existent.

Part 1 of this blog considered unmet prevention and therapy needs for abused children and teenagers. This second part will look at the implications for the diagnosis and treatment of adults who experienced CSA.

The importance of ACES work with adults

A key message from the original ACE studies was the need for changes in the way adults with ill health are listened to and treated. These original studies, we can recall, were actually sparked by the health behaviours of adults sexually abused as children (KQED, 2018). Yet traumatised adults have been rather surprisingly neglected in most ACES policy – except in negative ways, as mothers who risk increasing their children’s stress. Thus, in thinking about action against CSA as part of a wider ACES policy, we need to include both children and adults. The Scottish Government has indeed stated its clear intention both to prevent ACES, and to ameliorate their effects through the lifecourse (The Scottish Government 2018).

Mental health issues

On mental health, it is undoubtedly welcome that they are investing more than £250 million into mental health services over the next five years. It is very welcome too that training on working with trauma in general (not just CSA trauma) is being rolled out within the Scottish workforce, based on NHS Education for Scotland’s key documents setting out its training framework and training plan (NHS Education for Scotland, 2017, 2018).

However, given consistently high rates of CSA histories among psychiatric patients it will be vital for bodies such as the new National Quality & Safety Board for Mental Health to monitor and audit how far such welcome initiatives actually improve sexual abuse survivors’ experiences. This Board was set up after the Carseview mental health unit scandal in Dundee (BBC News 18/4/19).

My own research studies (Nelson et al 2013, Nelson 2018) confirmed the practice experience of support agencies that there has been considerable dissatisfaction among adult survivors of CSA, with both mental health and general health services. That is the starting point which national policy needs to address. These complaints have centred around adherence to purely medical-model diagnoses and stigmatising personality disorder diagnoses; around polypharmacy, with damaging side effects; failure to inquire into an abuse history or to follow it up; dismissal of disclosures, and unsafe or triggering behaviours and healthcare environments.

If they genuinely want to improve the lives of adults who suffered CSA and wider sexual trauma, they will need to monitor closely what is actually happening in mental health services, in hospital settings and in the community. How far is the rollout of trauma training undermining these longstanding complaints of CSA survivors, and are examples of best practice being identified and adopted across Scotland? That will include health services in prisons, homeless services and in drug/alcohol services, where many adult survivors of CSA are to be found.

In particular, the Scottish Government and health authorities now need to monitor the following:

  • How far does psychiatric diagnosis now reflect recognition of post-traumatic effects, how far does it remain dominated by biomedical and personality disorder diagnoses? Dr Joanna Moncrieff and colleagues have meticulously traced considerable increases, for instance, in diagnoses of (and medication for) bipolar disorder (Moncrieff et al 2005, Ilyas & Moncrieff 2012,). Yet researchers like Prof John Read have painstakingly revealed the frequency of a CSA history even in patients diagnosed with serious mental illnesses such as schizophrenia and bipolar disorder (Read et al 2003, .Moskowicz 2011, Varese et al 2012).
  • How far does the dominance of medication as the primary or sole treatment in mental ill health persist, even when a trauma history is recognised?
  • How available are talking therapies, even if the modest and unsatisfactory goal of 90% of patients being seen within 18 weeks is reached by Scottish health boards?

Omission of longstanding therapies

How far are other therapies than a narrow range of psychological therapies, as prescribed in the NES Transforming Psychological Trauma documents, available as options for people with sexual trauma to choose? For example various counselling approaches, skilled groupwork, psychodynamic psychotherapy or EMDR (Eye Movement Desensitization and Reprocessing)?

It is remarkable for instance, and frankly rather insulting, that counselling and the skills of trained counsellors are barely mentioned throughout the NES documents, given counsellors’ consistent role over many decades in working with abuse trauma. It would not be patient- and client-centred if we were to substitute the traditional colonisation of mental health treatments by psychiatry with the same behaviour by psychology.

Connected with this point, how far are adult survivors of sexual trauma and their third sector support agencies invited to contribute collaboratively to the evidence base of “what works” among therapies; to the evidence base of the desirable personal skills and qualities of therapists; or to the outcome indicators selected for current therapies? In my long experience, the answer is very little indeed.
How far are alternatives to physical restraint, where many patients frighteningly re-live traumatic experience, now being pursued and implemented in psychiatric and penal settings, especially in the wake of public scandals involving violent restraint, such as Carseview?

How far is routine inquiry into a sexual abuse history actually taking place in mental health services and others such as substance misuse and maternity-linked services? Is staff training in a topic which has traditionally caused anxiety and avoidance supportive and confidence-building rather than instructional and information-led, so that relevant, client-centred follow-questions about clients’ needs are always asked?

For instance, it is nearly ten years since Health Improvement Scotland set out practical and patient-centred guidelines for work with survivors of sexual abuse during pregnancy, birth and postnatal care.(HIS 2011). Is this currently being followed by midwives and other staff who work in this field?

Physical health issues

On services addressing physical health and abuse trauma, the original and follow-up ACE studies highlighted higher rates of a number of physical conditions in people with traumatic experiences –from greater risks of heart disease and some cancers to gynaecological, respiratory and gastro intestinal problems, and chronic pain (see Nelson, 2016 ch 7 and its references). Voluntary sector support agencies in Scotland report up to 85% of their clients experience significant physical health problems (Nelson 2018).

The biggest single complaint from abuse survivors about responses from health professionals is that once their abuse history or indeed their mental ill health status is known, medical staff readily dismiss their conditions as hypochondriacal or “all in their heads” while some GPs see them as “heartsink patients”. “Somatisation” has too often become a perjorative term, a diagnosis given to ten times as many women as men (McWhinney et al 1997). This shows that having CSA on your health records is not sufficient in itself to ensure an impartial approach to patients’ health problems.

To what extent is investigation into the causes of abuse survivors’ physical conditions and disabilities as open-minded, thorough and knowledgeable as it is with everyone else? How far are medical staff aware of the range of possible factors contributing to their conditions, including neurobiological responses to trauma and direct physical violence?

How far have wider health services, including GP practices, taken on board survivor-informed guidance about how to create safe and welcoming healthcare settings (including dentistry) for people whose trauma has made many fearful of such settings, and fearful of agreeing to intimate examinations? That question is of course also relevant to survivors of domestic abuse, and of violence experienced by refugees and asylum seekers. Pockets of excellent practice need to be copied throughout Scotland (Teram et al 2006, Schachter et al 2009, Nelson 2018).

As with my first blog blog on children and teenagers, the points above are not made as long and impossible ‘wish lists’. Nor of course can they all be implemented and resourced at once. Rather, if you promote an ACES strategy as Scotland does, you have to start showing – through action from Government ministers downwards – that you have actually thought how to begin addressing individual components of ACES.

A component, in this case, which decades of research and practice have shown to risk particularly serious and damaging effects on those who suffer it. In the case of adult services, the Scottish Government and health authorities need to consider how wide-ranging those actions may actually need to be. They then have to make a long- term plan, and begin step by step to implement it.

That will require working together with doctors and mental health professionals who see the need for change; and being prepared to take on and challenge those members of such powerful and dominant professions who decline to do so.

References

BBC News, 18 April 2019: : “Carseview Centre mental health unit restraint ‘shocking’”, https://www.bbc.co.uk/news/uk-scotland-47948515

Healthcare Improvement Scotland, 2011: http://www.healthcareimprovementscotland.org/our_work/reproductive,_maternal_child/programme_resources/victims_of__sexual_abuse.aspx

Ilyas, S. and Moncrieff, J. (2012). ‘Trends in prescriptions and costs of drugs for mental disorders in England, 1998–2010’, British Journal of Psychiatry, 200(5): 393–98.

KQED (2018) https://www.kqed.org/mindshift/49894/how-trauma-abuse-and-neglect-in-childhood-connects-to-serious-diseases-in-adults

McWhinney, I. Epstein, R. and Freeman, T. (1997) ‘Rethinking somatisation’, Annals of Internal Medicine, 126(9): 747–50.

Moncrieff, J., Hopker, S. and Thomas, P. (2005) ‘Psychiatry and the pharmaceutical industry: who pays the piper?’ BJ PsychBulletin , 29:84–5.

Moskowitz, A. (2011) ‘Schizophrenia, trauma, dissociation, and scientific revolutions’, Journal of Trauma & Dissociation,12(4): 347–57

Nelson S. Lewis R. Gulyatlu S. (2013) ‘Male Survivors of Childhood Sexual Abuse: Experience of Mental Health Services’, In Pritchard J. Good Practice in Promoting Recovery and Healing for Abused Adults, London: Jessica Kingsley.

Nelson, S. (2016) Tackling Child Sexual Abuse: Radical approaches to prevention, protection and support, Bristol: Policy Press. Chs 4-9. References for mental health impacts of CSA are very numerous. Sample listing available from Sarah.Nelson@ed.ac.uk

Nelson, S. (2018) Surviving Well-useful information for health professionals working with people who have been sexually abused, 2nd edn, Alloa: Wellbeing Scotland.

NHS Education for Scotland (2017) https://www.nes.scot.nhs.uk/media/3971582/nationaltraumatrainingframework.pdf; https://www.nes.scot.nhs.uk/education-and-training/by-discipline/psychology/multiprofessional-psychology/national-trauma-training-framework.aspx;

NHS Education for Scotland and Scottish Government (2018), https://www.nes.scot.nhs.uk/media/4321706/Scottish%20Psychological%20Trauma%20Training%20Plan%202019.pdf.

Read, J., Agar, K., Argyle, N. and Aderhold, V. (2003) ‘Sexual and physical abuse during childhood and adulthood as predictors of hallucinations, delusions and thought disorder’, Psychology and Psychotherapy: Theory, Research and Practice,76(1): 1–22.

Schachter C., Stalker C. and Teram e. (2009) Handbook on sensitive practice for healthcare practitioners: lessons from adult survivors of childhood sexual abuse, Public Health Agency of Canada, National Clearinghouse on Family Violence.

Teram, E., Stalker, C., Hovey, A., Schachter, C. and Lasiuk, G.( 2006) ‘Towards malecentric communication: sensitizing health professionals to the realities of male childhood sexual abuse survivors’, Issues in Mental Health Nursing, 27(5): 499–517.

The Scottish Government, Adverse Childhood Experiences (ACES), 2018. https://www.gov.scot/publications/adverse-childhood-experiences/

Varese, F., Smeets, F., Drukker, M., Lieverse, R., Lataster, T., Viechtbauer, W., Read, J., van Os, J. and Bentall, R. (2012) ‘Childhood adversities increase the risk of psychosis: A metaanalysis of patient-control, prospective and cross-sectional cohort studies’, Schizophrenia Bulletin, 38(4): 661–71.

Childhood Sexual abuse: At the heart of problems with ACES policy, Dr Sarah Nelson

Dr Sarah Nelson is a Research Associate of Centre for Research on Families and Relationships (CRFR) and a research specialist on childhood sexual abuse and its effects across the lifecourse. Sarah's book, ‘Tackling Child Sexual Abuse: Radical Approaches’, offers hope of more effective, imaginative means of protecting children and young people from sexual abuse. In this post - the first of two - she discusses children sexual abuse in the context of ACE policy. 

This blog was first published on 05 July 2019 at: https://blogs.ed.ac.uk/CRFRresilience/2019/07/05/childhood-sexual-abuse/

It was the impact of childhood sexual abuse trauma which gave Professor Vincent Felitti and colleagues the first, vital clues to persistent poor health and unhealthy behaviours in adults. It was the trigger to the range of ACE studies they then conducted, and to numerous others held internationally ever since.

People kept dropping out of Felitti’s obesity clinic despite successfully losing weight, because weight gain, he discovered, provided several protective ways of coping with their child sexual abuse (CSA) trauma. The team’s unexpected findings of high rates of CSA, even among the largely white, middle class, educated, employed, economically-comfortable members of the Kaiser Permanente health maintenance organisation, also suggested that this traumatic experience might be widespread among people of all backgrounds.

The uncritical adoption of ACES in public policy has been criticised, particularly when that policy adopts the original ten ACES without including structural impacts on health, through poverty, homelessness, unemployment, racial discrimination and other social determinants of health. ACES are often viewed as a recent, startling discovery: yet such structural impacts have been widely known and evidenced through research for many decades, involving the World Health Organisation and other global action to reduce social and racial inequalities in health (WHO). They did not appear among the original ACES precisely because of the nature of Kaiser Permanente’s client group:  Felitti and colleagues drew up the ten most common adversities among their large cohort of middle class clients.

Just as with structural inequalities, the considerable risks to health of childhood sexual abuse trauma have also been widely researched and evidenced for decades, more so than any other of the original ten ACES. A large volume of published research exists, particularly on a wide range of mental health risks, and increasingly in recent years on physical health ones. (Nelson 2016a). The relevance also of a CSA history to persisting substance misuse, to blot out distressing effects of the trauma; to cognitive problems damaging education and career prospects, due to neurobiological effects of chronic early stress; and to higher rates of offending, due mainly to anger, alienation and involvement in drug and exploitative commercial sex cultures, are also well researched, and connect with findings of later ACE studies. Hence those of us working with CSA trauma and its effects throughout life have long argued the importance of primary prevention of this abuse, and for changes in the ways adult survivors are regarded, diagnosed and treated in mental health and in wider health services.

This is not to downplay the impact of other forms of trauma on many people, far less to downplay the still greater, demonstrated impact of cumulative ones, especially given  growing understanding of developmental trauma in young people. But it is to argue that attempts to reduce childhood sexual abuse in society, and to address its damaging effects in adulthood, need to form and remain one of the key components of ACES policy. And although the recent, belated emphasis on understanding the role of traumas in general in the lives of children and adults which ACES have helped to promote is valuable and welcome, attention within that to sexual abuse remains marginal, and at times nonexistent.

The key implication of the original ACE studies, and subsequent studies and surveys which did attempt to include some structural inequalities, has been primary prevention. But structural inequalities are notoriously difficult to reduce, far less to remove, requiring strong political will and wider, sustained political strategies. Childhood sexual abuse has also been seen as difficult to reduce, with the added problem of being very hard for authorities even to identify in children. Along with this has been a longstanding distaste, nervousness or even reluctance to believe the evidence among many policymakers and professionals, as Felitti himself discovered (KQED, 2018).

Thus it has been tempting for much public policy across the UK and internationally to concentrate on easier, broad goals, amelioration of the effects of a range of ACES. Easier too to make hopeful  efforts to increase  general resilience in children, in schools and other settings, yet these can give little protection from serious crimes against them, due to the power dynamics involved in perpetration.

It has also seemed more interesting for many researchers - and regrettably easier for some policymakers to fit into theories which hold the poor, most especially mothers, largely responsible for their children’s wellbeing -  to concentrate on deterministic interpretations of modern neuroscience, about children’s development in the womb and in the first three years of life. Most sexually abused children, incidentally, are assaulted after that time. Nor are most assaulted by their mothers.

Aside from the need for primary prevention, the other key implication from the original ACE studies was the need for changes in the way adults with ill health are listened to and treated. The original studies gave important insights into why some unhealthy adults behave as they do, and how this knowledge might shape strategies to improve their health. Yet traumatised adults have been rather surprisingly neglected in most ACES policy (except in negative ways, as mothers who risk increasing their children’s stress).  Thus, in thinking about action against CSA as part of a wider ACES policy, we need to include young people and adults alike.

This first blog will look at the implications for children and young people.

It is very welcome that where ACES policy is concerned, the Scottish Government has not shrunk from prevention issues purely in favour of amelioration. “We are committed to preventing ACEs and helping to reduce the negative impacts of ACEs where they occur, and supporting the resilience of children, families and adults in overcoming adversity”. (Scottish Government 2018). So what are the main current challenges to action where CSA, as a component of ACES, is concerned?

A basic and considerable problem is the identification of child victims. That seriously undermines the accuracy and usefulness of ACES checklists completed about children, or with them. Most children and young people do not disclose of their own accord; or not in ways that adults can understand; or only anonymously; or only in very sympathetic and protective circumstances. (Crisma et al 2004; McElvaney 2013). Most adults, including teachers, do not know, or are nervous of asking, or believe they should not ask. Perpetrators do not tell.

Social work and children’s hearing statistics show identification of CSA has been consistently falling- the figures are tiny- even though at the same time reports to police of sexual crimes against children, including online crimes, keep rising (Nelson 2016b). A recent Scottish study (Marryat & Frank 2019), using Growing up in Scotland study statistics to draw conclusions about Scottish children affected by ACES, did not even consider CSA, since there were ‘too few cases to include’ (sic). Yet the questions used, the environment of the GUS surveys and the respondents chosen would have meant that GUS surveys have been very unlikely to reveal sexual abuse.

Any serious attempt to improve the identification of children suffering, or having suffered, CSA would require several assertive changes in our child protection practice, including more perpetrator-focused investigation, freedom from official fear of asking, close co- operation with confidential voluntary sector services for young people, and much closer liaison between action against child sexual exploitation (CSE) and trafficking, and protective work with younger children.  Sexual exploitation is a form of sexual abuse, not a distinct and separate entity.

On prevention, greater support for the identification and conviction of offenders would require higher police resourcing and staffing, particularly for investigation of the burgeoning industry in child abuse images. Prevention also requires investment in creating informed, aware and involved local communities, not the sidelining of such communities in our now highly-professionalised, excluding, child protection system. Resilience, as part of a prevention strategy, needs to include specific work geared to ways in which young people might be kept safer from sexual crime.

Even amelioration of the effects of CSA and CSE, among the small minority of children and young people who are identified, would require much wider resourcing of skilled therapeutic services, and a far greater preparedness to work with trauma within Child & Adolescent Mental Health services (CAMHS). Studies such as NSPCC Scotland’s The Right to Recover (Galloway et al 2017) revealed how serious are inadequacies in existing therapeutic services for abused children, and the extent to which CAMHS services have failed to address CSA trauma. The Scottish Government is investing an additional £4 million in child and adolescent mental health services across Scotland, but they need first to ensure that these services actually accept and conduct routine, skilled work with abuse trauma.

Meanwhile in the education system, the difficult task of finding lasting alternatives throughout the country to school exclusions needs to be prioritised. Exclusion is where so many sexually abused,  angry, distressed and vulnerable young people have found themselves, who are then at even greater risk on the streets, and among exploitative sex, drug and offending cultures.

Some of the points above involve willingness to carry out major changes to how protecting children has ‘always been done’. All the points above are not made as long and impossible ‘wish lists’. Nor of course can they be implemented and resourced at once. The point about what is itself a far from comprehensive summary of requirements across several key services is that if you promote an ACES strategy as Scotland does,  if you even attempt to judge and record how many ACES young people have experienced, let alone ameliorate their trauma, you have to start showing through action from Government ministers downwards, that you have actually thought how to begin addressing  individual components of ACES.

A component, in this case, which decades of research and practice have shown to risk particularly serious and damaging effects on those who suffer it. You have to consider how wide-ranging those actions towards prevention and amelioration may actually need to be. You then have to make a long- term plan, and begin step by step to implement it.

References

References for mental health impacts of CSA are very numerous. Sample listing available from Sarah.Nelson@ed.ac.uk

Crisma, M., Bascelli, E., Paci, D. and Romito, P. (2004) ‘Adolescents who experienced sexual abuse: fears, needs and impediments to disclosure’, Child Abuse & Neglect, 28 (10):1035-48.

Galloway, S. Love, R. and Wales, A. (2017) The Right to Recover:  Provision of therapeutic services in the West of Scotland for children and young people following sexual abuse, NSPCC.

KQED (2018) https://www.kqed.org/mindshift/49894/how-trauma-abuse-and-neglect-in-childhood-connects-to-serious-diseases-in-adults
Prof. Felitti has also described in numerous public lectures the disbelief and ridicule he faced initially from fellow professionals.

McElvaney, R. (2013)  ‘Disclosure of sexual abuse:delays, nondisclosure and partial disclosure’, Child Abuse Review, DOI:0.1002/car.2280.

Marryat, L. and Frank, J. (2019) ‘Factors associated with adverse childhood experiences in Scottish children: a prospective cohort study’, BMJ Paediatrics Open, 3 e000340.

Nelson, S. (2016a) Tackling Child Sexual Abuse: Radical approaches to prevention, protection and support, Bristol: Policy Press. Chapter 7: Physical ill health.

Nelson, S. (2016b) Tackling Child Sexual Abuse: Radical approaches to prevention, protection and support, Bristol: Policy Press. Chapter 1: From rediscovery to suppression?

The Scottish Government, Adverse Childhood Experiences (ACES), 31 July 2018. https://www.gov.scot/publications/adverse-childhood-experiences/

World Health Organisation, Social determinants of health: Tackling health inequalities through action on key sectors, https://www.who.int/social_determinants/Guidance_on_pro_equity_linkages/en/ is an example of a useful summary.

Adverse Childhood Experiences: a social justice perspective: Gary Walsh


Gary Walsh is a PhD Researcher at the School of Education, University of Glasgow. His research focus is on social justice, citizenship and philosophy of education. His practice background is in education and the charity sector, including NSPCC (ChildLine Schools Service). 

Gary has previously written about ACEs in an article for TESS magazine. His other academic work includes a critique of character education. He tweets as @PeopleValues and he runs the Curriculum for Equity website.

This blog was first posted on 15th May 2019 at: https://blogs.ed.ac.uk/CRFRresilience/2019/05/15/aces-a-social-justice-perspective/

In this blog I am going to look at ACEs from a social justice perspective. So, what does social justice mean to me?

"Research in the field of childhood studies defines social justice in terms of children and young people’s entitlement (e.g. to the law, services and democratic processes), redistribution (e.g. of rights, duties and resources), recognition (e.g. of culture, difference, capacity) and respect (e.g. of strengths, attributes, abilities)." (Davis et al., 2014)

Nancy Fraser understands justice as "...social arrangements that permit all to participate as peers in social life." (Fraser in Lovell 2007, p.20)

In short, social justice is about making sure everyone in society is taken care of and included. This means paying close attention to sites of injustice such as power, poverty, gender, race, sexual orientation, disabilities. Using this understanding, a social justice critique of ACEs involves asking whether the ACEs agenda contributes to socio-economic redistribution, recognition, respect and participation. In this blog I explore some thoughts on this, before concluding that the ACEs agenda contributes little to social justice and could potentially be an unhelpful distraction. I finish by suggesting some alternative ways forward.

Does ACEs research recognise social explanations?
One of the main criticisms of the ACEs model is that its biomedical focus “might lead to the importance of socioeconomic conditions being overlooked” (Taylor-Robinson et al 2018, see also Edwards et al 2017, Kelly-Irving and Delpierre 2019, Anderson 2019). A recent systematic review of ACEs research conducted by the Glasgow Centre for Population Health (David Walsh et al, forthcoming) found that out of almost 3,000 papers, only 6 attempted to explain ACEs with reference to childhood socio-economic conditions. Arguably, this amounts to a major blind spot in ACEs research.

This is especially concerning given the strongly evidenced impact of social inequalities in child maltreatment studies and ACEs literature. Economic factors have been shown to predict all forms of child maltreatment, with poverty and unemployment being the strongest determinants (Doidge et al. 2017), and ACEs have been shown to be highly correlated with socioeconomic disadvantage (Marryat & Frank 2019). This would suggest that social justice, economic redistribution especially, is essentially ignored in the ACEs model. This is like critiquing global warming without mentioning fossil fuels or deforestation: these issues should be deeply embedded.

An image known as the ‘Pair of ACEs Tree’ has been created in an attempt to address this. While the recognition of this serious shortcoming is welcome, the ‘Pair of ACEs Tree’ is an afterthought and does not resolve the issues outlined above. It risks creating a rather simplistic binary relationship between family and communities, without reference to politics, and it would be difficult to claim that it represents a serious attempt to engage in a critical analysis of power and social justice.

Angry, Confused, Evangelism: ACEs public discourse
Examining the ACEs discourse beyond academia may reveal whether social justice is part of its underpinning, particularly in relation to rights, recognition and respect. Discourse is a key part of Fraser’s understanding of justice and ‘parity of participation’. The ability to effectively challenge and advocate for social justice depends on the available understandings of complex social issues and ‘interpretative schemas’ that can be used in the expression of justice-related concerns (Fraser in Lovell 2077, Fraser 2012).

The ACEs discourse concentrates largely on relationships, kindness and compassion. This focus could be welcomed if it did not obscure socio-political factors that are anything but kind, compassionate or conducive to healthy relationships, such as poverty, discrimination and other injustices. Many of the causes of trauma and health inequalities in childhood and society are social and political. Kindness, compassion and relationships are all important, of course, but focussing on these issues at the expense of broader factors is a form of obfuscation. While the ‘individualisation of complex social problems’ is a valid critique of the ACEs approach (Edwards et al 2017), there are elements of the ACEs public discourse that I find much more troubling.

The keynote presentations from the ACE-Aware Nation 2018 conference included some disturbing claims about how the ACEs ‘grassroots movement’ should proceed and particularly how it should respond to criticism. One speaker claimed that the ACEs movement is like a stampede and that critics should ‘join the herd or we will trample over you’. Another speaker, again talking about ACEs critics (such as myself, presumably), suggested that the movement should ‘condemn them. Let’s dance on their graves.’ Yet another speaker compared the ACEs movement to the IRA: ‘The IRA would say ‘you might see only one of us, but behind us there are thousands.’ That is what the ACEs movement should be about.’

There are many ways to convey the power of social movements. Talking about Ghandi or the Suffragettes, for example, would surely have been more suitable than comparing followers of this ‘movement’ to mindless beasts or terrorists, using metaphors of violence and aggression. Since that event I have observed many examples of worrying commentary about ACEs on social media and in personal discussions: conflating adversity, trauma and abuse; promoting a distrust of critics and academics; ACEs criticism being dismissed as selfish, egotistical, or even a form of denial; ACEs science being compared to the discovery of gravity, and ACEs being described as the ‘next stage in human evolution’ that will ‘create better people’.

I am in touch with many people who have felt alienated by ACEs discussions or who have even been shunned when telling their personal story if it does not ‘fit’ with the established ACE narrative. Even while writing this blog I have come across other examples in the public domain such a powerful ACEs protagonist discussing the murder of Alesha MacPhail and the death of Jonah Lomu to make ACEs-based claims, seemingly without giving any consideration to the problematic ethics of publicly speculating about the murder of a child, making public diagnoses without the knowledge or expertise to do so, or the racial, post-colonial implications of distant white people criticising the upbringing of a Polynesian man with Maori, Samoan and Tongan links.

While the intentions may be positive, it is difficult to see how rhetoric such as this can competently promote the need for justice-oriented conditions such as respect, participation and recognition of difference. While social justice can involve cultivating anger and indignation, in this instance the anger is directed at the wrong targets. This results in mixed messages coming from a movement that purports to be about childhood, kindness and compassion, while pursuing an evangelical and occasionally aggressive discourse. It appears that the main purpose of these comments is about controlling the narrative while warding off the possibility of further critique. This sets a worrying and unhelpful precedent for dialogue concerning trauma and childhood. Extremely difficult and emotive subject matter such as this needs sensitive discussion. A social justice perspective may help in this regard as it suggests that every voice is deserving of respect, recognition and participation.

Some potential ways forward
Below are some suggestions that could help to bring about some useful, respectful dialogue on the difficult subject of childhood trauma, drawing on social justice:
  • Address the politics of trauma, adversity and wellbeing. ACEs, evidence and associated claims are not politically neutral. Trauma is closely linked to the failures of governments to realise the rights of citizens. ​
  • Harness the energy of frustrations. Let’s encourage broader thinking and action that address inequalities and social determinants of health (poverty, housing, discrimination, racism, homelessness, working conditions, pollutants, violence etc.).​ These should be the targets of frustrations and actions.
  • Avoid stigmatisation, labelling and individualisation. Let’s not allow a situation to develop where children, families and communities are constructed as both the ‘cause of’ and the ‘solution to’ complex social problems. ​
  • Flip the narrative. Instead of starting with a deficit model of adversity and trauma, we could start from a hopeful position that recognises children’s strengths, rights, agency and participation.
  • Get back to basics: social justice, rights, participation, values, trust. Let’s encourage small-scale, proximal, humane structures and solutions instead of a sweeping ‘revolution’. ​
  • Focus on what is important to children: safety, fairness, respect, recognition, inclusion, environment (e.g. green spaces), play, relationships, bullying, money, transport, involvement in decisions (Davis et al 2014).
  • Stop calling it ‘ACEs’. We already have adequate language to describe the challenges we face and the required solutions. ACEs may capture people’s interest in the short term, but in the longer term it looks unlikely to provide much insight. At worst it may even cause further pain that we will need to heal in the future. There is a positive way forward in all of this, but it may well involve learning some tough lessons while moving on from an ACEs narrative altogether.
References
Anderson, S. (2019) ‘Rethinking adverse childhood experiences. Howard League for Penal Reform, Issue 41, April 2019.
Davis, P. J. et al. (2014) ‘Social Justice, the Common Weal and Children and Young People in Scotland’. The Jimmy Reid Foundation.
Doidge, J. C. et al. (2017) ‘Economic predictors of child maltreatment in an Australian population-based birth cohort’. Children and Youth Services Review.
Edwards, R. et al. (2017) ‘The Problem with ACEs’. submission to the House of Commons Science and Technology Select Committee Inquiry into the evidence-base for early years intervention (EY10039)’. 12 December 2017.
Fraser, N. (2012) ‘On justice’. New Left Review, no. 74, pp. 41-51.
Kelly-Irving, M., & Delpierre, C. (2019) ‘A Critique of the Adverse Childhood Experiences Framework in Epidemiology and Public Health: Uses and Misuses’. Social Policy and Society, 1-12.
Lovell, T. (2007) ‘(Mis)recognition, Social Inequality and Social Justice, Nancy Fraser and Pierre Bourdieu’. Routledge, Abingdon, Oxon.
Marryat, L. & Frank, J. (2019) ‘Factors associated with adverse childhood experiences in Scottish children: a prospective cohort study’. BMJ Paediatrics Open, vol. 3, no. 1, pp. e000340.
Taylor-Robinson, D. C., Straatmann, V. S. and Whitehead, M. (2018) ‘Adverse childhood experiences or adverse childhood socioeconomic conditions?’. The Lancet Public Health, 3(6), pp. e262–e263.
Walsh, D. et al (forthcoming) ‘The relationship between childhood socio-economic position and Adverse Childhood Experiences (ACEs): a systematic review’. Glasgow Centre for Population Health and partner organisations