ACEs and Children’s Environments

The tumultuous first half of 2020 has raised many questions for us as individuals and as a society. The COVID-19 pandemic has resulted in an economic crisis and thrown households into chaos while the protests sparked by the murder of George Floyd at the hands of police officers in Minneapolis on May 25th have heightened interest in a range of social justice movements. The protests against George’s death (along with the deaths of many other people of color killed by law enforcement) and the attitudes and beliefs of the anti-Black Lives Matter movement have people questioning how racism continues to affect our lives and those of our children. It’s clear that not all communities in the United States are created equal and not all people are treated as equals. How do environments—both physical and atmospheric—affect our children and do Adverse Community Environments place our children at as much risk as Adverse Childhood Experiences?

For the first few years of life, children grow up within relatively small spheres of influence. They are most often surrounded by their parents or caregivers and siblings. Most childhood experiences occur within these small household environments. The original ACE study conducted by the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente Insurance in the mid-1990s was chiefly concerned with these household environments when they began to identify whether experiences at home had a long-term detrimental effect on children’s future mental and physical health.

At that time, the research showed that sustained exposure to toxic stress had a clear correlation to lifelong mental and physical health impacts. In the absence of positive, buffering influences from the adults in a child’s life, the negative impacts could be dire. Studies connect child abuse and household dysfunction to many of the leading causes of death in adults. We have discussed these situations throughout this educational blog series, and it forms the basis of Center for Child Counseling’s work, but it’s time to look beyond the small sphere of influence of the household to the greater environments that might impact our children.

A Child’s Spheres of Influence

Think of a child as living in the middle of a series of concentric circles. The household makes up the circle that immediately surrounds the child. This circle is made up of the people with whom they interact in their everyday lives. The next circle might be the neighborhood in which they live or the school or kindergarten they attend. As they grow, children’s circles expand, they begin to include places further from home to which they travel and experiences away from home to which they were exposed. Often, distant influences enter children’s lives via television reports and the ever-present sway of the internet and social media.

Along with Adverse Childhood Experiences, countless recent studies have sought to look at Adverse Community Environments, another kind of ACE, that can dramatically affect the lives of our children and the outcomes they can hope to experience.

Clearly, children grow up in different communities and, in many ways, economic status determines the quality of those communities. According to a USA Today article entitled: Faces of Poverty: What Racial, Social Groups are More Likely to Experience It, “some factors outside of the control of the individual–including being a woman, black, Hispanic, a child, or a disabled person–are an indicator that one is more likely to live in poverty.” In fact, a study conducted by the Robert Wood Johnson Foundation showed that the ZIP code in which a child is born is often a better predictor of their future lives than their own genetic make up. You can view the organization’s life expectancy calculator by zip code here. In other words, nurture (environment) may well play a greater part in our success or failure than nature (our genetic material). You can learn more about “Epigenetics and ACEs” in our previous blog.

Infrastructure and Opportunity

The neighborhoods of lower income families are less well-stocked with community resources for success like quality schools, access to health care, social amenities and services like fire stations, libraries, child- and elder-care facilities, and opportunities for employment with fair wages. Lower-income neighborhoods are less likely to enjoy these advantages. Disadvantaged neighborhoods share certain physical characteristics such as lack of affordable, quality housing, few open spaces for play like parks, inadequate street lighting that can facilitate crime, poor maintenance of abandoned or derelict buildings, and even broken sidewalks that make walking difficult. These neighborhoods have less access to public transport and can even be what are known as “food deserts” where there is little access to nutritious, fresh food. People who live in these neighborhoods suffer disproportionate levels of stress and their children do, too. Children raised in disadvantaged neighborhoods are at greater risk for trauma and tend to have less opportunity to be exposed to positive, life-expanding experiences that other children may take for granted like visiting parks, zoos, museums, theaters, etc.

Over- and Under-Policing and Racism

Aside from the physical environments of such neighborhoods, there are social issues at play, too. Lower-income neighborhoods (which are often communities of color) are disproportionately policed. While deprivation and need may result in higher rates of crime in certain neighborhoods, it may also be possible that these neighborhoods are over-policed and therefore disproportionately represented in crime statistics. So, what exactly is over- and under-policing? It involves the presence of too many potentially negative police tactics and too few potentially positive ones. Over-policing generally results from the imposition of police control on individual or community activities in certain minority communities at a level unlikely to occur in the dominant society. Under-policing usually involves a lack of preventive and supportive police services that might make the police more welcome in a community. This means children in disadvantaged neighborhoods are exposed to the presence of an often overmilitarized police force. They are more likely to associate the police with distrust and a fear of law-enforcement, which perpetuates difficult relationships between citizens and law-enforcement, generation after generation.

There is no doubt that the United States is currently experiencing a groundswell movement for social justice. Systemic racism has been in the news frequently since the murder of George Floyd and the subsequent protests that are ongoing. This movement is a reflection of generations of fear and resentment over entrenched racism, the disproportionate policing of black communities, and the growing gulf between the wealthy and the disadvantaged in this country. According to the Pew Research Group, “the wealth gap between America’s richest and poorer families more than doubled from 1989 to 2016.”

While the original ACE study did not discuss racism (it was, after all, limited to just 10 questions), subsequent studies have directly asked about bullying and exposure to racism among children under the age of 18. The Philadelphia Urban ACE Study added racism, bullying, living in an unsafe neighborhood, exposure to violence outside the home, and involvement with the foster care system as potential ACEs. The results of this study confirms what most of us would expect: Exposure to racism can clearly be considered a profound adversity that will affect a child later in life. (ACEs Connection: “Racism and Its Impact as an ACE.”)

Health Disparities

Another glaring disparity in children’s environments is the type of healthcare received by the wealthy and that available to the disadvantaged. Access to quality healthcare is a basic human right; in a just society, healthcare should be available at affordable rates to all. However, studies show that children raised in disadvantaged environments are less likely to receive the quality care they need to meet their developmental milestones, especially in the first few years of life when monitoring these milestones is crucial. Health disparities are one of the areas of childhood that can make or break a child’s future.

Disparate health outcomes based on different communities or neighborhoods are an example of health inequity, which the World Health Organization defines as “differences in health status or in the distribution of health resources between different population groups, arising from the social conditions in which people are born, grow, live, work and age. Health inequities are unfair and could be reduced by the right mix of government policies.” Health inequity is a systematic difference in the opportunities groups have to achieve optimal health. Tens of thousands of children in the United States alone are born disadvantaged simply because the opportunity to achieve optimal health is not built into their communities.

Clearly, there exists in the United States a glaring and self-evident inequity among people; that inequity is drawn along economic and racial lines in most cases, with Native Americans, African-Americans, and Hispanic Americans often bearing the brunt of economic disadvantage, racism, health disparities, and the poor outcomes that so often come along with them.

Working for Solutions

It may seem like an insurmountable task–addressing the painful legacy of our past–but in Palm Beach County, we are making strides in the right direction. Community-wide training and initiatives through Birth to 22, United Way of Palm Beach County, Children’s Services Council of Palm Beach County, and many other partner agencies have been working on these issues for years now. Examples include community-wide training through the Racial Equity Institute and access to local workshops, like the one recently offered by the Youth Services Department of Palm Beach County on Implicit Bias and Microaggressions.

At Center for Child Counseling, we are proud to be a part of these efforts, from grassroots to grass-tops. Last year, with funding from Quantum Foundation, we released a White Paper on tackling the impact of ACEs in Palm Beach County. Combining years of experience, research, and a year-long process of gathering feedback from the community, including key stakeholders and experts, the paper (entitled: “Fighting ACEs in Palm Beach County: Opportunity and Levers for Change”) was released. It is specific to Palm Beach County and offers opportunities for improvement for the sectors that work with or touch the lives of children in our community.

Last month, our CEO released a statement, saying: “The current state of the world does not make our young black and brown children feel the safety they should. They deserve to feel safe and protected, especially by those in authority. Until we get to the root of systemic racism, many issues will remain unresolved in our society, especially the mental health of our children.” As an organization, we strive, along with our community partners, to create equity, for it is at the root of building healthy children, families, and communities.

The Future 

While some may argue that racism and inequality are “no longer a thing” in America, and others may question why the social justice protests they are seeing seem so “angry” or “violent”, the fact can no longer be ignored that many issues that have affected our children for hundreds of years have not been addressed, and we continue to suffer because of it. If we are interested in Adverse Childhood Experiences beyond the original 10 identified in the CDC/Kaiser Permanente study, then we must look not only to the households in which children are raised, but also to the communities in which they live, that wider circle of influence that affects their everyday development. Adverse Community Environments must be addressed if we hope to raise the kind of healthy, hopeful children who are free to pursue the happiness that is guaranteed to us in our Constitution and which is a part of the spirit of opportunity that the United States promises all of its people.

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