What do the West Virginia foster care, child welfare, public education and court systems have in common? They are systems in crisis, because the children they serve — casualties of the drug epidemic — are in crisis.
Child neglect, death of a parent or sibling, having a parent in jail, witnessing domestic violence, physical and/or sexual abuse, parent or household substance use — these are adverse childhood experiences (ACEs), and they are the most important unaddressed public health crisis we have in our state.
The most important step the West Virginia Legislature could take to address the needs of its children and the systems that serve them is to create a statewide agenda to address ACEs.
Haven’t heard of ACEs? You’re not alone. As a pediatrician and legislator, we hadn’t heard of them until a few years ago, and still we’re surprised by how many in our professions have never heard of them, either.
Around 20 years ago, the impact of toxic stress on our health was “discovered” in a landmark study by Kaiser Permanente and the Centers for Disease Control and Prevention. Researchers found that adults who had been repeatedly exposed to abuse and other trauma as children were more likely to develop severe obesity, drug addiction, depression and other health issues. The more ACEs the individuals had, the higher their risk for poor medical and psychiatric outcomes.
Since then, many studies linking ACEs to poor health and behavior have emerged. Exposure to high doses of adversity has real potential to change the way kids develop into adults. Childhood adversity can change how we function and lead to myriad poor health outcomes. People with an ACE score of six or higher are at risk of their lifespan being shortened by 20 years. It’s a very real health indicator that has been exacerbated by the drug crisis. Some of our children are coming home from the hospital, after their birth, with a few ACEs. The odds are already stacked against them.
When we hear our teachers discuss the increase of challenging behaviors in their classrooms, or of children running away from state custody, there’s a good chance that these are children acting out because of ACEs. When the U.S. Department of Justice considered West Virginia noncompliant with the American with Disabilities Act and threatened to sue the state, it was because we had a lack of mental health services for children in our communities. This is directly connected to ACEs.
When the state removes children from their homes and places them in residential facilities or foster care settings, whether or not this is done in the best interest of the child, it perpetuates the cycle of trauma.
All roads of crises in our state systems serving kids can be traced back to ACEs. It’s an upstream problem that, if left untreated, can devastate the lives of affected children and cost the state dearly in the long run— in medical costs, lost productivity, crime and incarceration.
But there is hope. The important thing to remember is that ACEs can be identified and treated. Psychiatry pioneer Carl Jung said, “I am not what happened to me, I am what I choose to become.” Resilience is a powerful skill to help children address the effect of ACEs and lead them on healthier paths to better futures.
So how, as a state, do we address ACEs? We can begin by training all primary care providers in ACEs. Being able to understand the impact of ACEs makes a world of difference. Some practices around the state screen for ACEs. Others have trained their staff in trauma-informed care. We’d like to see all primary care providers trained in ACEs.
But we can’t stop there. To improve the lives of children and families, and reduce the societal costs of ACEs, health care providers and policymakers must work together to explore a range of strategies to prevent and mitigate childhood trauma. Effective strategies could include universal screenings, building resilience by strengthening community supports, supporting parents to develop stress management and positive parenting skills, and increasing access to and use of comprehensive health services.
And we need to dig in for a long haul. We are encouraged that the West Virginia Legislature has been working diligently, with bipartisan support, to address the foster care crisis in our state. Our hope is that ACEs education and assessment will also be included in their work this session.
For the next few years, we need to build on the previous year’s legislation until we have a statewide agenda to identify and mitigate ACEs. We need to take steps beyond awareness. We need to change the way our systems respond to the needs of our children with ACEs. Their futures depend on us.