As a clinician, researcher and policy specialist devoted to the prevention and treatment of the ill effects of child abuse and neglect (CAN) I read “Recommendations for Population-Based Applications of the Adverse Childhood Experiences Study: Position Statement by the American College of Preventive Medicine” (Sherin KM, Stillerman A, Chandrasekar L, Went N, Niebuhr DW. Recommendations for Population-Based Applications of the Adverse Childhood Experiences Study: Position Statement by the American College of Preventive Medicine DOI: https://doi.org/10.1016/j.focus.2022.100039 ) with dismay. After a meta-analysis of the current literature and an assessment of the risks and benefits of screening “ACPM recommends against individual ACE screening in clinical settings. In contrast, population-level ACE surveillance can provide opportunities to raise public, clinician, and politician awareness of the prevalence and impact of ACEs and help advance practice and policy change that supports individuals and families,” without recognizing that more than 20 years of excellent population data has been inadequate to optimize public health and clinical attitude, policy and practice. They make no suggestions about how best to facilitate outreach to the many folks with illness and turmoil in their lives from the cause that is often avoided.
Furthermore, the ACPM importantly asks “What is the effectiveness or harm of interventions for elevated ACE scores (tertiary prevention)?.....There appears to be limited evidence for the effectiveness of most of the interventions studied for children and young people who have experienced childhood adversity." Since we know that there are home nurse visiting programs, parents as teachers programs, community or neighborhood resource centers, trauma informed cognitive behavioral therapy, trauma focused cognitive behavioral therapy, parent-child interaction therapy, child-parent psychotherapy among many others compiled in readily available resources such as Dorsey S, McLaughlin KA, Kerns SEU, et al, Evidence Base Update for Psychosocial Treatments for Children and Adolescents Exposed to Traumatic Events,J Clin Child Adolesc Psychol. 2017 ; 46(3): 303–330. doi:10.1080/15374416.2016.1220309. Evidence-Based Treatments Addressing Trauma, Trauma Informed Care: Perspectives and Resources, JBS International and Georgetown University National Technical Assistance Center for Children’s Mental Health, Georgetown University Center for Child and Human Development, gucchd@georgetown.edu and California Evidence-Based Clearinghouse for Child Welfare. http://www.cebc4cw.org/) all of whichhave been as well documented as standard psychotherapy interventions.
The question arises why would a Preventive Medicine Society would put forward such a critical position, without acknowledging the broad importance of clinical ACES screening and therapies that have served so many victims of childhood trauma so well. Worse their skeptical, selected attention may raise barriers and opposition to expanded therapeutic resources.
As I see it there are 5 main problems retarding the knowledge and practice of effective treatment for child maltreatment. The American College of Preventive Medicine would make a much better contribution to health policy and to remediating the effects of child abuse and neglect by pointing out these problems and advocating for needed change, rather than being a naysayer.
(1) The biologically minded NIH avoids funding studies of clinical research into child maltreatment and its remediation ($30 to $50 million/year for the past 8 years - half as much as for cystic fibrosis and one tenth of that spent on childhood cancer).
(2) Anything not pills or surgery gets dumped outside the medical clinic/office as "mental health" or a "social problem" not a medical one. This is the rigid medical silo.
(3) The same siloing prevents the knowledge, skills, and accomplishments of the psychology, social work, counseling world from impacting the house of medicine.
(4) There is still no mental health parity in US medical care because it is too threatening to our commercial insurance system's profits.
(5) There is a massive national shortage of mental health counseling personnel
The American College of Preventive Medicine which influences medical training and public health practice should take a broader view and advocate for major changes rather than criticizing the shortcomings of current practice.
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