America’s Current Approach
Adverse Childhood Experiences (ACEs) consist of stressful or traumatic events, including: physical, sexual or emotional abuse, emotional neglect, parental separation and more. ACEs can lead to both immediate and long-term mental and physical illnesses, including but not limited to heart disease, various types of cancers and drug use.
Our society’s current approach to addressing ACEs is to wait for our children to develop mental and physical diseases, and only then addressing the serious health repercussions. We are improving our life boats rather than avoiding icebergs. We’re avoiding the issue by addressing trauma after it becomes a major issue, rather than taking preventive action.
Early detection means screening, means inquiring. Despite a great deal of education and attention given to the topic of child maltreatment among medical professionals, current measures for screening are indirect, not comprehensive, and inadequate. Pediatricians are required to learn how to identify the signs of child abuse by looking for signs such as bruises, sprains, burns, a child not wanting to go home and other apparent signs. Missing from this list is the most reliable method- asking the child.
Pediatricians are currently not required to ask the child if they are being hit, neglected or sexually molested by their parents, siblings or anyone else. Only if there is a sign of such abuse might they ask. But how often are these signs ambiguous? Often. How often are there no overt signs of abuse? Often.
The Public Health Approach
How do we develop early intervention? We need to address child maltreatment and adverse childhood experiences just as doctors addressed tuberculosis in the early 1900s. The treatment of tuberculosis is a prime example of how a public health intervention can lower the incidence of disease without having a cure for its cause (Yancey, 2007). In 1900, tuberculosis was a significant health problem, with 450,000 people infected with the disease and 200 of every 100,000 people dying of tuberculosis each year.
In order to decrease the prominence of TB, doctors developed the tuberculin test in 1910, followed by mandatory chest X-rays in 1935. As a result, the incidence of TB decreased to 45 deaths per 100,000 in 1940, and then only 5 deaths per 100,000 by 1950.
The elimination of tuberculosis serves as an example of taking the public health approach to an epidemic. By taking the public health approach to address adverse childhood experiences we’ll be able to make a positive impact on our children’s mental and physical health.
The Need For Action
Most child maltreatment consists of repetitive patterns of behavior that become established within a family or other close personal relationships. Such patterns are often not challenged or interfered with. We may not be able to stop the first act of abuse, but by asking children on a regular basis, in a number of settings and in an open manner, we’ll be able to break the cycle.
We need to take action regardless of if there are overt signs of abuse, by asking every child. Many children do not display physical signs of abuse, and because of this, we need to ask every child about their experiences whether we’re suspicious or not. We need to move from reporting after the fact to proactively asking before the act. By doing so, we’ll be able to intervene before our children develop serious diseases resulting from maltreatment.