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

Resilience is a process and opportunity, not something children have or don’t have

Professor Ramona Alaggia, University of Toronto

Professor Ramona Alaggia is a trauma and resilience researcher in social work at the University of Toronto. Her focus of study is in child sexual abuse disclosures, children exposed to intimate partner violence and trauma informed practice. She teaches child and family assessment and treatment and multi-level interventions in the area of violence against women and children.

Studying resilience with children and adults exposed to intimate partner violence (IPV) has taken me on a journey that has resulted in a fundamental shift in how I do research, teach and counsel clients. This has been significant in my understanding of adversity, trauma and the profound role of resilience.

When I initially encountered the term resilience I approached it with skepticism and questions. Was it a “feel good” term to minimize the fall-out from very big problems in people’s lives? Or a tool used by governments to scale back on service funding using platitudes like kids are resilient; they’ll be fine; they’ll bounce back - which has not been my experience with highly vulnerable children.

Fostering resilience is a concerted effort that needs to be intentionally built into programming.

Is resilience something people simply have or don’t have with very little in between?  Up until recently, the research literature focused largely on individual characteristics for explaining why some people are more resilient than others. These identified characteristics are often related to personality traits - including intelligence, easy temperament, and extroversion for example - traits that appear from birth.

Is resilience a state or a trait? 

This then led me to take a deeper dive into writings on this topic, bringing me to the many debates as to whether resilience is a trait or state. These conceptual debates dominated the literature for a long time and large international conferences have been held to discuss, define and sort out this elusive concept. It became clear to me, though, that these debates were more about inter-disciplinary orientations divided into camps of individual or environmental stances.   

Resilience is a process. Not a singular event or state of being, but an active process of fostering resilience over the life course. 

As a social worker I have landed on an interactive explanation of resilience. The conditions for fostering resilience, from this perspective, requires personal factors and environmental influences to come together, in the right combination.

In my research I interviewed adult survivors exposed to intimate partner violence in their childhoods, and collected data using resilience measures from mothers and children exposed to intimate partner violence. This was conducted alongside longitudinal data on protective factors from a large scale Canadian study: the National Longitudinal Survey of Children and Youth (NLSCY). From this work, I have come to the conclusion that a person-in-environment/ecological  framework best helps to elucidate factors and processes contributing to resilient outcomes.

A person-in-environment/ecological lens is needed for resilience informed practice.

 In Canada we subscribe to an ecological approach for many social issues and troubles. My research with IPV exposed children and youth underscores the need for a person-in-environment/ecological approach. Individual characteristics alone are not enough to carry children through adversity. Inter-personal factors such as secure attachments, safe relationships and cohesive family support, and contextual influences such as safe neighbourhoods, supportive resources and school connectedness are all required to foster resilience - both as preventive measures and also for those children who show vulnerabilities and end up in social services for intervention. As well, socio-political forces promoting child and family friendly policies, pre-and postnatal care, affordable child care, access to high quality education and after school supports and activities, and funding for sports and arts programs are all important parts of the equation.

Kids cannot be resilient on their own. The important people in their lives - their families, cultural supports, their networks of positive peers, and well-resourced neighbourhoods - are all part of the picture of fostering resilience.

Programming needs to be resilience informed. 

Because resilience has only recently come across our radars, as helping professionals providing services children who display vulnerabilities in the face of adversity, we need to take stock and inventory of how resilience informed these services actually are. Are protective factors, strengths and potential sources of resilience identified at intake or through the assessment process?  Are resilience based goals well-articulated in treatment planning? Are these clearly spelled out and measurable? 

For ideas on how to make your program resilience informed please visit www.makeresiliencematter.ca for further research findings and reports, tools, case studies and podcasts to support your practice and programming.

Making Scotland an ACE informed nation: continuing the conversation - an event summary

CRFR co-director Dr Emma Davidson summarises the key themes emerging from our recent seminar reflecting on the emergent ACE (Adverse Childhood Experiences) and resilience agenda in Scotland.

We began a conversation on ACEs and resilience in December 2017 at the seminar, ‘The Troubling Concept of Resilience’, where Dr Eric Carlin and myself voiced our concerns that the dominant narrative on resilience could obscure inequalities; penalising individuals by making them responsible for their own wellbeing. Since then, we have witnessed the mounting influence of ACE and resilience-focused policy in Scotland. It is now even more important to provide a space in which popular rhetoric on ACEs and resilience can be constructively and respectfully critiqued.

Our event on 6^th November 2018 aimed to reignite that process. We welcomed three speakers: Dr Amy Chandler, Dr Cara Blaisdell and Laura Wright, each of whom talked from their perspective of their own field of research.

Amy’s presentation (which you can watch here) examined the potentially counter-productive ways ACEs are used in research on suicide and self-harm. Early experiences, Amy noted, are undeniably important in shaping later risks of, or experiences with, suicide and self-harm. However, there is a tendency to rely on a mechanical or ‘addictive’ analysis, with a correlation drawn between early adversity and later problems. The work of explaining what these correlations actually mean, or understanding the mechanisms behind them, are less well developed. Drawing on her own research, Amy highlighted that this focus can mean that interpretation and meaning is omitted – what do adverse experiences mean and feel like to different people, at different times? And how are social and political conditions implicated in this? Also absent, Amy suggested, is the role of agency. The popular narrative of resilience plays into the long standing stigmatisation of mental health problems as being associated with weakness. This way of thinking about resilience implies that those experiencing self-harm and suicide are not resilient.  The reverse can in fact be true, with the practice of self-harm being evidence of extreme resilience in extreme circumstances.

Dr Cara Blaisdell’s work picked up on this critique within an early years setting (read Cara’s new blog here). She highlighted the potential for the ACE agenda in Scotland to reinforce what Tuck (2009) refers to as a ‘damage narrative’. Rather than holding those in power to account, these narratives can reinforce particular ideas about children and society: where the ‘poor’ child is a site of damage to self and society; where professional labels children and seek to ‘fix’ them; and where structures of oppression remain unchallenged and unchanged. Cara’s made the acute observation ‘what you focus on is what grows’. This is not a denial that bad things happen, but rather an acknowledgement that deficit based models can label, provoke normative ideas (of family, of parenting, of childhood). Ultimately deficit models stigmatise, and they leave little room for the complex meaning making emphasised by Amy as being so crucial.

Our final speaker was Laura Wright who raised what is an under-acknowledged issue within ACEs – and that is the role and status of children’s rights. Scotland is, noted Laura, a country recognised as a global leader in children’s meaningful participation. This work is supported by multiple organisations, initiatives (we are now coming to the end of the Year of Youth People) and legislation (i.e. Children and Young People (Scotland_ Act 2014). A tension, nonetheless, remains between participation and protectionism – with the latter superseding the former. The implications of this, argues Laura, requires exploration. At present, children and young people have not been given the opportunity to meaningfully participate in discussions about what is included or excluded from the list of ‘adverse childhood experiences’. Indeed, at an individual level, adults are completing checklists for children and young people, and using this to make decisions about possible interventions. What, asked Laura, does such an approach look like, and how it is given meaning by children and young people? Critically, how can a plan designed to be child-centred, like Getting it Right for Every Child, better engage children and young people in active conversations about their own well-being?

There is – as Laura concluded – no magic bullet. However, the speakers agreed that the way forward is not simply to shift from asking ‘what’s wrong with you’, to ‘what happened to you’. Rather, what is required is a move towards a strengths approach which asks what is right with you, your family, your community and your society. On a practical and pragmatic note, more reflection and time needs to be spent on how complex ideas – such as meaning, context and interpretation – be meaningfully incorporated in institutional structures and practices already under incredible pressure.

We intend to continue these conversations and look forward to seeing you at our forthcoming events. There are four more seminars planned for 2019. Each will consider ACEs and resilience through a different conceptual lens. These are: 

·        ACEs and foetal & infant development

·        ACEs, resilience and gender

·        Resilience in the Majority World

·        ACEs and resilience in Scottish schools

We will be announcing dates for these seminars in the New Year. Please subscribe to the CRFR website for updates on this, and CRFR’s other events and research activities.

Further links

Drs Emma Davidson and Eric Carlin reflect on their CRFR Informal Seminar ‘The Troubling Concept of Resilience’.
Resilience – continuing the conversation

CRFR Associate PhD student Ariane Critchley provides her thoughts on resilience in response to the recent CRFR Seminar ‘The Troubling Concept of Resilience’ given by Eric Carlin and Emma Davidson.
How resilient do we want our children and young people to be?

Dr Caralyn Blaisdell from the University of Strathclyde continues our discussion on the theme of resilience and how this term is being used, with specific reference to early years.  
Resilience in early years – continuing the conversation

ACE Awareness,damage narratives and social justice in early years practice: personal andprofessional reflections

Laura Wright, University of Edinburgh talks about engaging children in the ACE agenda.

ACE Aware Nation: Engaging Children in the Conversation

ACE Awareness, damage narratives and social justice in early years practice: personal and professional reflections

Dr Caralyn Blaisdell from the University of Strathclyde continues our discussion on the theme of resilience and how this term is being used, with specific reference to early years. 

As an experienced practitioner, researcher and lecturer specializing in early childhood education, I have had a mixed reaction to the recent push for being ACE Aware. Discussions about love, kindness and empathy are very welcome and needed. At Strathclyde, our students discuss how their settings are moving away from punitive practices, toward a deeper culture of listening to children and young people and reflecting on relationships of power. There seems to be a real interest in recognising and remedying injustice and changing practices within systems. There has been increasing discussion of children’s rights within ACE Awareness, which is also very welcome and needed in early years.

At the same time, there is a danger that ACE Awareness is reinforcing damage narratives (Tuck 2009) and deficit thinking about young children and families:

•        The (poor) child and family as a site of damage to self and society

•        Labelling—professionals telling people what they are

•        Hero worship--the valiant professional who swoops in to fix the individual

•        Oppressive structures and behaviours remain unchanged 

(Quarrell and Davis 2018)

This vision of the heroic professional is not new or revolutionary in early years—it is just more of the same. Early years education is plagued by deterministic and simplistic views of human development—for example, the belief that the pattern for our lives is set by three years old. This belief easily leads to aggressive diagnosing of difference and labelling of young children. Alternative visions for early childhood education include celebration of difference as a source of strength, anti-bias work, political action, and walking alongside children and families to dream equitable worlds into reality (RECE, 2014).

In the CRFR seminar, we heard from audience members who felt curiosity, hesitance, inspiration and anger about ACE Awareness. Calls to dismiss or even condemn those who aren’t sure about ACE Awareness, or to accuse people of not caring about children or even doing more harm to children by questioning ACEs, are profoundly unhelpful and disheartening. In early years, ACE Awareness could potentially help challenge oppressive practices, recognise children and families’ own voices about their lives, disrupt power dynamics in institutional settings, and inform political education and action. However, ACE Awareness also has the potential to reinforce damage-based thinking, paternalistic practices and professional ego. If we choose to accept ACE Awareness, we must see it as only one facet of the intellectual and moral challenges of early childhood work. We must insist on continuing to ask uncomfortable questions about who benefits from this awareness.

To view her presentation from seminar on 6 November 2018, click the link below
http://www.crfr.ac.uk/assets/Ace-Aware_Cara-Blaisdell-1.pdf