Understanding and Applying ACEs Data Responsibly

Posted: 9/3/2019 1:08:54 PM by Dr. Elizabeth Meeker

As understanding of Adverse Childhood Events (ACEs) has moved from the world of research into the mainstream, close attention must be paid to what is meant by “ACEs” and how they are considered within a larger social construct.  In examining the recently released New York Fact Sheet 2019 produced by the Child and Adolescent Health Measurement Initiative (CAHMI), it would appear that not only are fewer ACEs experienced by youth in NYS but that fewer young people are experiencing the social, emotional and behavioral consequences of trauma. The fact sheet presents the following data:

  • 15.7% of NYS children experience two or more ACEs compared to the national average of 20.5%
  • Of children with two or more ACEs, only 7.7% have an ongoing emotional, developmental or behavioral problem compared with 18/6% nationally. 

As a clinical psychologist working with children and families for over twenty years, I sincerely wish these statistics were true and were an indication of improving emotional health and well-being of children across NYS.  However, in partnering with many children and families on their journey towards healing as well as working with communities throughout the state who are addressing trauma systemically, I know that it is simply not an accurate representation.  This leads us to question what has contributed to this misleading picture.

To understand this discrepancy, it is necessary to go beyond the data presented and examine what data was collected, how it was collected, and the demographics of the participants of the study.  The deeper dive of the 2016-17 National Survey of Children’s Health (NSCH), upon which the fact sheet is based, reveals the following:

  • Parents were asked about household challenges (i.e. incarcerated household member, parental divorce, etc.) but were not asked about physical, sexual, or emotional abuse nor about physical or emotional neglect. This means five of the ten ACEs were not included in the findings presented. 
  • As noted, NSCH data is collected through parental report and while generally a reliable method of data collection for information on children, it has limitations when collecting information on ACEs. Parents may be biased on reporting their child’s history, particularly if any of adverse events were caused by the parent (i.e. physical abuse, neglect). Additionally, the parent may be unaware of adverse events that their child may have experienced. For example, a parent may not realize their child witnessed domestic violence or a child may not report sexually abuse.  Lastly, a parent may underreport due to uncertainty as to how the information will be used even if anonymous.
  • Finally, the majority of those who participated in the study were White, middle to upper class parents, who had at least a college degree or higher. Both parents were also reported to still be married and living within the household (which would also automatically negate another ACE question on parental separation or divorce) and were born in the United States.  Based on these demographics, this data cannot be generalized and considered representative of all children in NYS.  It also suggests that the population sampled may have less exposure to toxic stress associated with racism, poverty, and discrimination which has implications for the findings shared on child outcomes by ACEs. 

Based on the reduction of ACEs included in the survey, reliance on parent report, and the non-representative sample, it is also likely that there is also an underreporting of the physical (chronic conditions, obesity), emotional (developmental or behavioral problems), and social (bullying, engages in school) challenges faced by children across New York State.

As a point of comparison to the profile shared in the fact sheet, a sample of 1700 high school students in an upstate New York community completed the Youth Risk Behavior Survey (YRBS) that included all ten ACEs plus a question on community violence.  In this survey, 25% reported two or more ACEs as opposed to 15.7% reported by CHMHI.   Those with two or more ACEs had statistically significant risk for mental health challenges, suicide ideation and attempts, and substance use.

As our interpretation of information will drive our intervention, it is important to be informed consumers of data.  The New York Fact Sheet could lead to erroneous conclusions that we have made more progress addressing ACEs and toxic stress in our state than has actually been made.  With growing awareness of ACEs and trauma and the impact on individuals, families and communities, now is the time for New York to continue to invest resources in order to strengthen the network that has been building across the state.  Communities and organizations across the state have been working to become trauma responsive and providing trauma specific treatment.  Our concentrated efforts to formalize a network of support both locally and state-wide dramatically increases the opportunity to engage with children and families. With this approach, we will achieve a true reduction in rates of exposure to trauma and subsequent outcomes.

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