Power of Words and ACEs
“Words are singularly the most powerful force available to humanity. We can choose to use this force constructively with words of encouragement, or destructively using words of despair. Words have energy and power with the ability to help, to heal, to hinder, to hurt, to harm, to humiliate and to humble.” -Yehuda Berg
A concept that I have been pondering since entering the field of social work is how the language we use to describe people, explain circumstances, or tell a story has an impact on the way we work in the field and live in society. The power in language and words cannot only impact people at a community level, but the power of words shifts the way we address problems and even create policy at the macro level. One of the first examples where I learned about the power of words was the use of the words, “at-risk youth”. When we use this terminology to describe youth, we place the focus on the youth and place the issue within the youth. We see research articles, organizations, and large governmental institutions using this terminology to describe kids, which creates the narrative that we need to fix the youth to fix the problem. However, on the flip side, what would change if we started to say, “youth that are at-risk”. The question starts to arise, what is making youth at risk? The story shifts to look for the problem outside of the youth and transitions to look at what is impacting the youth. This concept, continuously runs in my mind because the more I look at evidence-based practices, programs, and policies I am consistently wondering, are we using the appropriate language.
One of the areas that I have been questioning the use of language is within Adverse Childhood Experiences (ACEs) questionnaires and research. “Adverse childhood experiences (ACEs) are potentially traumatic events that can have negative, lasting effects on health and well-being” [1]. The discussion around ACEs came from a study conducted by Kaiser Permanente in 1990s with over 17,000 Health Maintenance Organization members from Southern California completing confidential surveys regarding their childhood experiences and current health status and behaviors[2]. This study found that experiencing ACEs is common across populations and the higher your ACE score from the ten-question screening, the higher the risk level you will have for negative health outcomes. “Negative outcomes associated with ACEs include some of society’s most intractable (and, in many cases, growing) health issues: alcoholism, drug abuse, depression, suicide, poor physical health, and obesity”[3].
Working within social work, many professionals use ACEs questionnaires to help identify areas they can help assist youth or gain better insight on how trauma has played a role in their life. However, the issue that I have identified with ACEs is the lack of historical context in the research and the lack of acknowledgment that racism, oppression, and discrimination are huge drivers in ACEs scores. The original Kaiser study was conducted on predominantly upper middle class and college educated white individuals, which does not represent the United States population[4]. However, many research studies conducted since 1998 have dedicated their focus to represent more demographics. As of 2018, the largest study conducted was with 214,157 respondents. The study found that individuals that identified as black, Hispanic, multiracial, less than a high school education, income less than $15,000, unemployed, and gay, lesbian, or bi-sexual reported higher exposure to ACEs than comparison groups[5]. I believe it is safe to say that despite knowing that ACEs are common among people, there are demographics that are more prone to having higher scores. It is important to note that the intersectionality of identities is another area that most likely would impact ACEs score.
To continue my concern, when exploring ACEs and the current work that is coming from ACEs I have developed the idea that without using explicit language such as, racism, oppression, discrimination are reasons why youth are being exposed to ACEs which is leading to negative adult health outcomes, we will never address the larger issues at play. Keeping this in mind, lets looks at how we are currently using ACEs research. Since the original study was published in 1998, the term ACEs has proliferated the research literature and professional place and even communities are starting to use this term to discuss traumatic and stressful events[6]. An example, of how ACEs is used in a community is the Center for Youth Wellness that was created by Dr. Nadine Burke Harris. The Center for Youth Wellness mission is “to improve the health of children and adolescents exposed to Adverse Childhood Experiences (ACEs)”[7]. The centered focuses on improving services to address ACEs and to create a national movement to advance the clinical practice with children and adolescents. One of their leading practices is to make sure that every patient served goes through the screening process for ACEs.[7] The concept is, if we know a child is at risk for ACEs or we are aware they have high number of ACEs we can assist earlier. Furthermore, “The ACEs framework has served as a useful tool for raising awareness of the prevalence and impact of childhood trauma, and has thus helped to create opportunities for advancing both science and practice”6. This shift in practice is spreading to Legislature as bills are pushing towards disseminating the science on ACEs and creating more trauma-informed practices.[6]
The use of ACEs research and The Center for Youth Wellness excites me but at the same time concerns me that we are forgetting some of the larger issues at play. When we discuss racial disparities, we cannot forget that we have them because of racism. Racism is often left out of the discussion and it appears it has been left out of many of the discussion for ACEs. I note that the Center for Youth Wellness is not the only place that is discussing and implementing ACEs, but it is one of the leading organizations with ACEs embedded within their mission. That is why I am concern that if they do not use the word racism, oppression, discrimination I believe there will lack of discussion, programming, and policies to address them. In today’s society I argue that racism is one of the most feared words today, but it is the reality that many youths endure.
So, I question, if they added a question regarding experiencing racism on the ACE questionnaire would scores go up? I think so. If we added a question regarding racism, would we have to sit down and discuss what we are going to do about this. I think so. This discussion is only the tip of the iceberg but within ACEs research, I believe there needs to be a push to discuss ways to include these larger systematic issues so as we move forward, we address them verse put a Band-Aid on the outcomes of these systematic issues. The concept around the use of words and language can be applied to so many realms of work but I think it needs to be continuously explored. When we read articles, research, mission statements our analytical brains should take the moment to ask ourselves, why did they use these words, what words were left out, or how did they frame these words in a sentence? I want to continue to explore ACEs research and programming because I believe if they never include the larger issues, we will never work towards no youth having Adverse Childhood Experiences.
[1] Sacks, Vanessa, David Murphey, and Kristin Moore. “ADVERSE CHILDHOOD EXPERIENCES: NATIONAL AND STATE LEVEL PREVALENCE.” Child Trends, 2014, 1–11.
[2] “Risk and Protective Factors|Child Abuse and Neglect|Violence Prevention|Injury Center|CDC.” Centers for Disease Control and Prevention. 2019. Accessed June 03, 2019. https://www.cdc.gov/violenceprevention/childabuseandneglect/riskprotectivefactors.html.
[3] Sacks, Vanessa, and David Murphey. “The Prevalence of Adverse Childhood Experiences, Nationally, by State, and by Race or Ethnicity.” Child Trends. February 20, 2018. Accessed June 04, 2019. https://www.childtrends.org/publications/prevalence-adverse-childhood-experiences-nationally-state-race-ethnicity.
[4] “Adverse Childhood Experiences (ACE) Study: The Evidence behind What We Know.” Texas Institute for Child & Family Wellbeing. March 06, 2017. Accessed June 05, 2019. https://txicfw.socialwork.utexas.edu/adverse-childhood-experiences-aces-study/.
[5] Merrick, Melissa T., Derek C. Ford, Katie A. Ports, and Angie S. Guinn. “Prevalence of Adverse Childhood Experiences From the 2011–2014 Behavioral Risk Factor Surveillance System in 23 States.” JAMA Pediatrics172, no. 11 (2018): 1038. doi:10.1001/jamapediatrics.2018.2537.
[6] Portwood, Sharon. “Adverse Childhood Experiences: Current Research and Practice Applications.” American Psychological Association, November 2018.
[7] “Mission.” Center for Youth Wellness. Accessed June 03, 2019. https://centerforyouthwellness.org/mission/.
