ACEs as catch-all – Professor Rosalind Edwards
Rosalind Edwards is Professor of Sociology and a co-director of the National Centre for Research Methods at the University of Southampton. Along with colleagues she co-authored a written submission and gave oral evidence to the House of Commons Science and Technology Committee Inquiry on ACEs and early intervention, accessible at:
Rosalind is also a co-editor and contributor to a themed section assessing ACEs for the journal Social Policy and Society, currently available on First View here: https://www.cambridge.org/core/journals/social-policy-and-society/firstview
ACES AS CATCH-ALL
Bad things happening to children, young people and adults is bad. ACEs is a persuasive idea for how to address this, but there are reasons why I’m sceptical of the concept and methodology of ACEs, and wonder why practitioners would want to apply them.
It’s not a good diagnostic tool
It can’t be stressed enough that extrapolations cannot be made from population level epidemiological studies of adversities and outcomes to individual level diagnosis for particular children or young people in service provision. The statistical notion of risk just doesn’t allow that simplistic slippage. Also, while there are rigorous analyses now taking place about severity, timing and duration of ACEs, the measures used are inconsistent between studies. Advocates are adding their particular concerns into the ACEs mix (recently I read of a plan to include ‘institutional’ abuse as an ACE) so that it becomes a meaningless catch-all in terms of diagnostic rigour to guide practice.
It doesn’t indicate how to intervene
ACEs is a chaotic concept. As well as a shifting range of possible adversities, the inputs (ACEs) are not linked to effects (physical and mental health, social behaviours) on any straightforward causal track. The different combinations of adverse experiences are bundled together as if any negative effects are underpinned by a common mechanism. Other processes that shape outcomes, such as social marginalisation and deprivation, are obscured. Consequently, the concept doesn’t offer much in the way of awareness for practitioners about how best to offer support or intervene, of what type, when and for how long, according to which ACEs are evident. Rather, we have a generalised catch-all approach.
It can reproduce inequalities
The focus of standard ACEs measures is firmly on intra-familial relations, drawing on and reproducing sexism, as well as racism and classism. Parents, in particular mothers, are embedded in ACEs as a both a cause of and solution to childhood adversities while their own adversities garner little consideration or awareness. For example, domestic violence and mothers’ mental health is an issue because of the consequences for children rather than mother’s own sufferings. Some social divisions are disappeared in ACEs. For instance, the assumption of a nuclear or lone mother household means that the supports available or difficulties faced by children raised in extended families don’t register, and these family situations may be more prevalent amongst certain ethnic or social class populations. And other social divisions register more strongly skewing who is judged to have ACEs, such as ethnic differences in receipt of custodial sentences. An ACEs focus in practice reproduces gendered, classed and raced inequalities.
Why do we even need awareness of ACEs?
Advocates of an ACEs approach to practice often explain that awareness stops victim-blaming.
- It stops people who’ve experienced abuse thinking that it’s their fault.
This is a sad comment. ACEs can stop us from stepping back and asking why do people think that? We live in an age of hyper-responsibilisation of individuals where we feel and have reinforced for us that what happens to us in life somehow is all down to our actions and deficiencies.
- It stops practitioners thinking it’s people’s fault and makes them understand and care.
Really? Where is the evidence that before they were told about ACEs social workers, teachers, health visitors and so on were uncaring professionals? And might ACEs stop us from stepping back and asking whether climates of austerity and auditing allow practitioners the time and remit to act in a humane caring and understanding manner?
Finally, what does it say about our attitudes and our society that it’s an outcomes-based idea that has traction? As my colleague Sue White has remarked, if the evidence was that abuse didn’t cause damage in the longer term would we be content to let children suffer it?
(Photo by Johnny Miller / Unequal Scenes)