Monday, January 2, 2023

In California, “child welfare’s” ACEs evangelists are saying the quiet part out loud


Does that health care worker who wants you to fill out a questionnaire about “adverse childhood experiences” think you’re really just a “mentally ill, violent, criminal deadbeat”? 

Check out these website comments, both from the same commenter, during a discussion of issues that touched on “adverse childhood experiences” (ACEs), the confusion of poverty with neglect and racial bias in “child welfare”: 

You can give some poor families a million dollar house and 20,000 dollars a month and it won’t make a dent in child abuse because as the ACE Study shows, we are dealing with character disordered Parents - Addicts, Alcoholics, Mentally Ill, Violent, Criminal, Deadbeats who abandon their own kids. 

It isn’t a racial issue either. There are plenty of Rural kids coming from Middle Class families that drop into poverty because they grew up w/ Character Disordered Parenting and because of it, they grew up character disordered. 

I’ve seen so many white Parents who sell their own kids’ bodies for Drugs - Methamphetamine, Oxycontin and now Heroine.  Or the mothers, so desperate to be loved by anyone take in Character Disordered Men who are only interested in sexually abusing her child.   No Amount of Money is going to end this dysfunctional, circular pattern.  [Bizarre use of capitalization in original.]

First, just for the record: Out of every 100 children reported as possible victims of abuse, 91 simply weren't - the report was screened out or found false after investigation. Six were "substantiated" victims of neglect, which often means simply that the family was poor. Three were said to be victims of sexual abuse or of physical abuse, from the most minor to the most severe.  I guess the commenter must have seen all of them.

Nevertheless, comments like those quoted above are common in certain vile corners of the internet and elsewhere.  But these comments weren’t made on Fox News or under a story in the New York Post.  They appear on a site supposedly devoted to science and, apparently, filled with doctors and other health industry professionals.  

Not just anyone can post.  You have to explain why you want the privilege, what you do for a living and the reason for your interest first.  (My own application is still pending.) 

Yet not one of these distinguished professionals challenged the comments.  No moderator took them down. 

You may be able to guess which site by the reference to “the ACE study.”  As noted above ACE stands for Adverse Childhood Experiences.  The study in question, from 1998, says that if a child experiences enough of them, it can cause serious health problems.  The study makes no reference to high scores meaning the subject’s parents are “Addicts, Alcoholics, Mentally Ill, Violent, Criminal, Deadbeats.” 

ACEs have become quite the fad. It began with that single study in which a ten-question survey was administered.  People were asked things like whether, as a child, they had witnessed domestic violence, whether they felt no one in their family made them feel important or special or whether they “didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you.” 

From that has evolved an entire industry, in which doctors, mostly, extrapolate far beyond anything in that original study.  It’s another way for doctors to assert hegemony over what is actually a social justice problem and persuade people it’s a “public health” problem.  (Have you noticed now many doctors like to characterize pretty much everything as a public health problem?) 

Among those most alarmed by the misuse of the ACEs questionnaire: one of the doctors who invented it. 

The comments with which I began this post appear on a website called PACEs Connection. (It used to be ACEs Connection, but they decided it sounded better to add the P for Positive and Adverse Childhood Experiences.)  PACEs Connection describes itself as 

the human and digital catalyst that unites the people, organizations, systems and communities in the worldwide PACEs movement. We are its main information exchange and resource. And we are a support for hundreds of local, state and national ACEs initiatives. 

PACEs Connection which, remember, hosts the comments referenced above, to which no one objected, also describes itself as “an anti-racist organization committed to the pursuit of social justice.” 

My introduction to PACEs Connection began after I wrote a column for the online news site CalMatters concerning what is potentially the most dangerous use yet of ACEs – taking the original questionnaire, adding a few more questions that skew it even further toward confusing poverty with neglect and paying doctors who see poor people $29 a pop to administer the questionnaire to their impoverished patients.  Note that the payments are made only when doctors administer the questionnaire to patients on Medi-Cal, the state’s health insurance program for the poor. It’s all part of a giant $300 million “ACEs Aware” initiatve in California. 

My column for CalMatters began this way:

Two years ago, Dr. Robert Anda, one of the authors of the original study of Adverse Childhood Experiences, cautioned that the scores from questionnaires to screen children for ACEs could be “misappropriated” as a diagnostic tool. California does not appear to have listened.

“Inferences about an individual’s risk for health or social problems should not be made based upon an ACE score, and no arbitrary ACE score, or range of scores, should be designated as a cut point for decision making or used to infer knowledge about individual risk for health outcomes,” Anda wrote in 2020.

Other experts on childhood trauma, such as renowned researcher Dr. Bruce Perry and University of New Hampshire professor David Finkelhor, agreed.

Yet more than two years into a massive science-be-damned, ethically-questionable and albeit well-meaning experiment on overwhelmingly poor, nonwhite Californians, the only concern officials seem to have is that doctors haven’t done enough to surveil their parents and report on them to a state agency.

I also noted that Dr. Anda specifically singled out the California program for criticism. 

As I discussed in a previous commentary about the ACEs project, the questionnaire is problematic in itself, but far more problematic is who administers it and how it is administered.  The questionnaires are administered by people who also are mandated reporters of “child abuse” or “neglect.” Notwithstanding Dr. Anda’s specific warning against a “cut point,” the California guidelines include exactly that: four or more ACEs  are considered reason to refer the family for “services.”  

And who might doctors call to do that?  There are all sorts of complicated, time-consuming but genuinely useful things they might do.  Or they might just call the child abuse hotline.  Even if they know that can do enormous harm, they may feel obligated to do it because they are mandated reporters.  There is nothing in the questionnaire process that requires doctors to warn their patients about this before administering the questionnaire – in other words, no requirement for truly informed consent.  That is unethical. 

One of those who sees no problem with making that call to the hotline is Dr. Jeoffry Gordon, a frequent contributor to PACEs Connection. 

Gordon is almost certainly not a Fox News fan.  On the contrary, he spent decades working with Physicians for a National Health Program, a group calling for “a publicly financed, non-profit single-payer national health program” – in other words, a version of what Bernie Sanders wants: Medicare for all. Another of his columns in the PACEs site condemns opposition to the expanded child tax credit. 

But he also called for reauthorization of the Child Abuse Prevention and Treatment Act, an odious law passed with the deliberate intent of obscuring the confusion of poverty with neglect, and which created the federal framework for the current child welfare surveillance state – in which one-third of all children, and more than half of Black children, will be forced to endure a child abuse investigation before age 18, almost all of them due to false reports. (Anyone who knows what those investigations are like should realize that enduring it is one hell of an adverse childhood experience.) 

As this suggests, like so many of my fellow liberals, Gordon has a blind spot when it comes to child abuse – and a misunderstanding of how “child protective services” really works. 

The comments I’ve been quoting are under a response Gordon wrote to my CalMatters column, which he sent to me, and then posted at PACEs Connection, when CalMatters declined to run it in full (they published an abridged version).  It’s a useful example of what the Left keeps getting wrong. 

After acknowledging that the original questionnaire “was not intended to be comprehensive nor scientifically balanced and valid” he argues for using a not scientifically balanced and valid instrument in the way California is using it anyway because “it was intended to be a risk screen, not a diagnostic instrument. It is similar to asking if a patient smokes - not a healthy habit, but not indicating a diagnosis of emphysema or lung cancer.” 

Here’s the difference.  If you tell your doctor you smoke, there is no chance the doctor will call a hotline that will send government agents into your home where they may awaken you in the middle of the night, ask traumatic questions, stripsearch you and, possibly, take you away from everyone you know and love and put you in a factory that manufactures carcinogens. 

If you score too high on the ACEs questionnaire, and your doctor decides that’s reason to call the hotline that’s exactly what could happen. Because that’s what the adverse childhood experience of a child abuse investigation is really all about (except, of course, the toxic environment would be foster care, not a carcinogen factory).  

Gordon goes on to claim all sorts of benefits from ACEs screening in general, none of which requires having mandated reporters misuse the questionnaire as California is doing.  Most alarming, though, he says “Being a mandated reporter from a medical point of view is preventive medicine, not ‘surveillance.’” 

Imagine anyone on the Left, let alone anyone prominent in a self-proclaimed “anti-racist organization”  saying that “stop and frisk” policing is preventive, not surveillance. 

But somehow, when you say “child abuse” suddenly everything from midnight raids on homes, to stripsearching children (which, if anyone else did it would be sexual abuse), to poking through cupboards and closets, to asking children about the most intimate aspects of their lives, (and doing all this over and over again when families are placed under “supervision”) to inflicting foster care – which the California questionnaire itself acknowledges is an adverse childhood experience -- is all just “preventive medicine.” 

But we don’t have to worry about harm to families, Gordon writes, because “neither my clinical colleagues nor ACES Aware report instances of patient harms or complaints associated with the routine use of the ACE questions.”  

So the people who came up with this scheme and the people gleefully enacting it report no problems.  I’ll bet few police officers report harms or complaints about chokeholds or stop-and-frisk either. 

Gordon concludes by demonstrating exactly why the medical profession has done so much harm to so many families by imposing a medical model on a social justice problem. He writes: 

I also strongly agree with Mr. Wexler that there is strong evidence that provision of concrete and economic supports to poor, stressed families is very efficient and effective in mitigating abuse and neglect (ACEs). However, so far no government agency has offered to put dollar bills in my pharmacy along with the various vitamins and other medications." 

For decades, that’s been the excuse for keeping the massive child welfare surveillance state going: Well we should do something different, of course, and we would do something different -- if government handed us everything we need on a silver platter! 

Here’s why that’s so misleading: 

● You don’t need a lot of dollars.  Because poverty itself most often is confused with neglect, not simply a cause of neglect, a distinction Gordon fails to acknowledge, startlingly small amounts are needed to prevent it. 

● Those dollars don’t belong in your pharmacy anyway, Dr. Gordon, to be dispensed to those you deem worthy.  They should be administered by community-based community run organizations that don’t patronize the recipients.  New York City’s “unintended abolition” shows how well it can work. 

● The primary reason the dollars aren’t available is because doctors and so many others have been urging that scarce funds be spent elsewhere.  The California ACEs Aware program alone costs $300 million!  If the PACES Connection community pushed to use that money for basic cash assistance it would do far more to curb neglect than anything in Dr. Gordon’s pharmacy.  

Decades ago, in his book Families in Distress, Malcolm Bush explained exactly why that doesn’t happen: 

The recognition that the troubled family inhabits a context that is relevant to its problems suggests the possibility that the solution involves some humble tasks … This possibility is at odds with professional status. Professional status is not necessary for humble tasks … Changing the psyche was a grand task, and while the elaboration of theories past their practical benefit would not help families in trouble, it would allow social workers to hold up their heads in the professional meeting or the academic seminar. 

And that goes double for doctors. 

Yes, there are rare cases that fit the stereotype that commenter so loves (and which Gordon is willing to accept). But overwhelmingly, the one “medicine” that works is money – even in very small doses.  When it comes to “treating” almost all child “neglect” the rest of what’s in a doctor’s pharmacy is not “vitamins and other medications,” it’s snake oil. 

But of course, the veneer of benevolence among the ACEs evangelists was ripped away by that commenter I quoted at the start of this post. Deep down, for all the patronizing talk about helping, a whole lot of the PACES Connection community apparently agrees with her. 

And that includes Gordon.  True, in his own comment in response he acknowledges that there also are many parents who do not fit the commenter’s ugly description, for whom the stress of poverty might cause neglect (but again, no acknowledgment of how poverty can be confused with neglect). But he begins his comment with “To a great extent I agree with you.” 

When I expressed alarm about the first of the two comments in an email to Gordon, I was hoping he would respond that the commenter was an outlier, he regretted that she was part of the group and no one pays attention to hyer.  Instead, he  replied: 

Alas, [the commenter’s] observations serve to re-enforce for me the need for ACE screening at all socioeconomic levels and all ages and promotes the assertive use of therapeutic institutions and agencies which you have so strongly criticized. 

In that earlier commentary about the California questionnaire I concluded this way: 

The tragedy is that it actually makes sense to explore trauma and try to do something about it. However, thanks to mandatory reporting laws, it is much more difficult to do just that. 

You can have questionnaires to detect childhood trauma and pave the way to providing real help — or you can have mandatory child abuse reporting laws. You can’t have both. Since evidence shows mandatory reporting is a failure, it shouldn’t be hard to decide which to choose. 

But that may have been too optimistic.  Now that some of the ACEs evangelists have shown who they really are, it may well be too risky for any impoverished parent to fill out this survey even if reporting is voluntary.  Particularly if, at best, you doctor of other heath practitioner thinks turning you in to the family police is “preventive medicine” and at worst, thinks children with high ACEs scores have parents who are “Alcoholics, Mentally Ill, Violent, Criminal, Deadbeats.”