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.”
