RESEARCH

Adverse Childhood Experiences

Implications for Social Work Practice

BY DR. NANCY ROSS, RSW

This brief article argues that the prevalence of adverse childhood experiences in Nova Scotia is an urgent public health ‘epidemic’ and signals a need for a paradigm shift in healthcare and community-based responses that can be defined and led by the profession of social work.

Our team, funded by Research Nova Scotia, conducted the first adverse childhood experiences (ACEs) and resilience study in Nova Scotia within the Lunenburg Family Health Centre, and found that among the 226 patients who completed the survey 73 per cent reported one ACE and thirty one percent reporting four or more. These results differ significantly from ACE surveys in both the United States and Canada where typically the range of survey respondents reporting four or more adverse childhood experiences is between 13 per cent and 18 per cent, and signifies the need for further research.

The ACE questionnaire identified ten categories of childhood adversity including: physical, sexual and emotional abuse; physical and emotional neglect; and five measures of household dysfunction that included domestic violence; parental mental illness and/or substance abuse; an incarcerated relative and separation/divorce.

Our research found that the four most commonly reported ACEs were living with someone who abused drugs and/or alcohol (39.8%, n =90); living with a household member with mental health challenges or attempted suicide (39.4%, n=89); parents separated or divorced (34.5%, n=78) and verbal abuse and afraid to be physically hurt (32.7%, n=74).

Research has demonstrated that persons who experience one ACE are potentially at risk for long term health and social consequences and that there is a dose-response relationship where persons with total ACEs score of four or more are twice as likely to be smokers, seven times more likely to be alcoholic, have a 400 per cent increased risk of emphysema and are 1200 per cent more likely to attempt suicide. Persons with an ACE score of six or more are at risk of shortening their lifespan by 20 years. Outcomes most strongly associated with multiple ACEs, including interpersonal violence, mental illness, and substance use, pose ACE risks for the next generation by causing disruptions in parental ability to provide safe, stable and nurturing family relationships, and pose risk for trauma and chronic and toxic stress for their children.

The Adult Resilience Measure measures socio-ecological factors that include having people you respect in your life and a sense of belonging within your community.

Our research found that people with high ACE scores and high resilience reported significantly fewer health problems compared with those who had high ACE scores and low resilience. Bethell et al. (2017) indicate that evidence from assessments of ACEs in adults suggest adult respondents do not object to it and find dialogue about ACEs empowering with some even seeing failure to inquire about ACEs as denying their occurrence and effect.

Adverse childhood experiences occur in the context of relationships as do factors that support resilience. A social and relational focus is central to social work practice and therefore, I argue social workers are best positioned to lead a paradigm shift in healthcare.

REFERENCES:

Ross, N., Gilbert, R., Torres, S., Dugas, K., Jefferies, P., McDonald, S., Savage, S. & Ungar, M. (2020) Adverse Childhood Experiences: Assessing the Impact on Physical and Psychosocial Health in Adulthood and the Mitigating Role of Resilience. Child Abuse and Neglect Journal, 103(2020) 104440.

Felitti, V., Anda, R., Nordenberg, D., Williamson, D., Spitz, A., Edwards, V., Koss, M. & Marks, J. (1998) Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults. American Journal of Preventive Medicine, 14 (4): 245 – 258.

Poole, J. C., Dobson, K. S., & Pusch, D. (2017). Childhood adversity and adult depression: The protective role of psychological resilience. Child Abuse & Neglect, 64, 89-100.

Hughes K, Bellis MA, Hardcastle KA, Sethi D, Butchart A, Mikton C, Jones L, Dunne MP (2017). The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. Lancet Public Health.2(8):356-e366.

Bethell, C., Carle, A., Hudziak, J., Gombojav, N., Powers, K., Wade, R., & Braveman, P. (2017). Methods to Assess Adverse Childhood Experiences of Children and Families: Toward Approaches to Promote Child Well-being in Policy and Practice. Academic Pediatrics, 17(7), S51-S69.

Ungar M & Liebenberg, L (2011) Adult Resilience Measure (ARM) User’s Manual: Research. Halifax: Resilience Research Centre.

NANCY ROSS, PhD, RSW, is an assistant professor in the School of Social Work, Dalhousie University. Her previous work as a clinical therapist in Mental Health and Addiction Services informs her research interests which include a focus on the role of social work in mental health, gender-based violence, adverse childhood experiences and resilience. She applies a peacebuilding and intersectional lens to analysis of justice system responses to domestic violence and systemic and policy responses to adverse childhood experiences. She has produced a short film, Women of Substance, which profiled stories of women meeting challenges of substance misuse, and co-produced a second film, I Work for Change, which explored the complexity of social work while celebrating the profession. Dr. Ross is also a co-author of Repositioning Social Work Practice in Mental Health in Nova Scotia, the mental health research paper published by NSCSW in January 2021.