“It is easier to build strong children than to repair broken men” (Frederick Douglass, 1817-1895)

Frederick Douglass was an African-American statesman who, having escaped from slavery, became a leader of the abolitionist movement and campaigned throughout his life for equality of all people regardless of background, saying, “I would unite with anybody to do right and with nobody to do wrong”.

In 1855 Frederick Douglass had a series of dialogues with white slave-owners who could not, or would not, comprehend that slavery was morally wrong and it was during these communications that he wrote, “it is easier to build strong children than to repair broken men“.

This statement still holds true today and it is inextricably linked to issues surrounding early childhood experiences, child abuse and the development of individuals’ roles, and functioning, within society.

The Adverse Childhood Experiences (ACE) study is a collaborative research project, involving 17421 adults, between the Center for Disease Control and Prevention and Kaiser Permanente Preventative Medicine, San Diego, California (http://www.azpbs.org/strongkids/).

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An ACE is growing up with one or more of the following in the household prior to age 18:

  • Recurrent physical abuse
  • Recurrent emotional abuse
  • Contact sexual abuse
  • An alcohol and/or drug abuser in the household
  • An incarcerated household member
  • Someone who is chronically depressed, mentally ill, institutionalised, or suicidal
  • Domestic violence
  • One or no parents
  • Emotional or physical neglect

You can calculate your own ACE score here (http://acestudy.org/ace_score)

Child abuse and trauma in the household leave a child incredibly vulnerable which has the potential, in early years, to disrupt the normal development of the brain. Adverse Childhood Experiences appear to be associated with a predictable path towards disease and disability. Recognising this path and tackling it at the earliest possible opportunity is crucial to give children the chance to develop as they ought to so that they can play as full a role in society in the future, in the healthiest possible state, that they deserve to.

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An emerging multidisciplinary science of development supports an ecobiodevelopmental framework for understanding the evolution of human health and disease across the lifespan of an individual. Epidemiological studies, developmental psychologists and longitudinal studies of early childhood interventions have demonstrated significant associations between the ecology of childhood and a wide range of developmental outcomes and life course trajectories.

What happens in early childhood can matter for a lifetime and sadly the children of Arizona lead the nation in experiencing one or more adverse childhood experiences in the ACE study conducted in this State:

  • Living with someone who is mentally ill or who has suicidal ideation
  • Experiencing divorce or parental separation
  • Living sight someone who has an alcohol or drug problem
  • Being a victim or witness of neighbourhood violence
  • Experiencing socioeconomic hardship
  • Witnessing domestic violence
  • Having a parent in prison
  • Being treated or judged unfairly due to race or ethnicity
  • Experiencing the death of a parent

Here in Arizona, Phoenix Children’s Hospital have been spearheading a statewide ACE Consortium aimed at drawing attention to the crucial importance of ACEs and putting in place community projects to try to encourage parents to build Positive Childhood Experiences (PCEs) – protective factors that will enable children to succeed. Based on the findings of Arizona’s ACE study the following have been recommended strategies to reduce ACEs in this area and to build stronger Arizona communities:

  • Increasing public understanding of ACEs and their impact on health and well-being
  • Enhancing the capacity of families and healthcare providers to prevent and respond to ACEs
  • Improving the effectiveness of public-health campaigns by refining their messages regarding ACEs
  • Promoting identification and early intervention of ACEs through universal screening or assessment within child and family health systems

Early childhood intervention is arguably one of the best ways to improve the chances of children growing up to succeed as best they can and to have the best possible chances in life.

Vermont has already grasped the importance of combatting ACEs to build a healthy and successful society (http://acestoohigh.com) and I wonder which other States will follow suit in due course?

An individual with an ACE score of 4 has a three times higher risk of depression, is 5 times more likely to become dependent on alcohol, is 8 times more likely to experience sexual assault and is up to 10 times more likely to attempt suicide. An individual with an ACE score of 6 or higher is 46 times more likely to abuse intravenous drugs. An individual with an ACE score of 7 or higher is 31 times more likely to attempt suicide.

These are not just statistics – these are figures obtained from the longitudinal follow up of over 17000 adults and clearly show an association between adverse experiences in childhood and significant adverse outcomes during adult life.

Early experiences influence the developing brain, chronic stress can be toxic to this development, significant early adversity can lead to lifelong problems, early intervention can prevent the consequences of early adversity and stable, caring relationships are essential for health childhood development.

Tomorrow is my last working day in Arizona before I move on to Pennsylvania on Sunday. I’m spending the day with the Crews’n Healthmobile Team (http://www.phoenixchildrens.org/community/healthcare-outreach/crewsnhealthmobile) out in the community seeing the work that they are doing with the thousands of children who live on the streets of Phoenix as well as visiting a shelter for women and children, many of whom have fled from domestic violence and abusive relationships.

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Thousands of young people live on the streets of Phoenix, many of whom are in desperate need of medical treatment being at risk of illness, injury, adverse mental health and all forms of abuse. Since 2007 the Crews’n Healthmobile 38-foot long Mobile Medical Unit, equipped with three examination rooms, has been able to bring free, comprehensive medical help to this vulnerable group of young people to try and provide them with the healthcare that they need as well as the support that they deserve to re-integrate them into society. Hopefully a society that cares for them more than the situation which led these vulnerable young people to end up on the streets in the first place.

This is not just something that affects children living in Phoenix. It is not restricted to children living in Arizona. It is not only about children living in the United States of America. There is a lesson and a message for all of our societies buried in this. Adverse Childhood Experiences have a terribly deleterious effect on children’s lives. Living in households where domestic abuse and violence are the norm has a significant and adverse effect on the development and mental health of children. Suffering from abuse, be it physical, emotional, sexual, exploitative, trafficking or neglect, can have a profound effect on the emotional well-being of children and their ability to grow up and realise their true potential as the future of our society.

It takes a community to protect a child and it is clear to me that society has a role that is more important than ever before to protect those children within it who are at risk of, or who have suffered from, significant harm. The challenge for this people and organisations responsible for resourcing societies is what weight they will place on the importance of positive childhood experiences and what resources will be provided to allow children to maximise their potential. The challenge for communities and the societies in which they function is whether or not they are prepared to accept the responsibility that society clearly has in protecting children for if they do not, and protecting children is seen as someone else’s business, how can we expect things to improve for the children who live within those communities?

Adverse Childhood Experiences certainly can last a lifetime. But they don’t have to.

 

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