Martha Chiavetta posted:I think Finklehor's points are valid when taken into the context of generalization. I believe he is speaking to a larger model. If you wanted to screen everyone in the United States medical system tomorrow for ACE's you would not have the resources, educated staff (that have addressed their own ACE's), and standardized questionnaire to do it. You would also have pandemonium. I think his article is taken harshly here because you are taking for granted that you already have groups of educated practitioners in community doing this work. But those here are maybe forgetting what it took to get where you are. And what Finlehor is bringing some awareness to is that it's going to take a lot of work to get this to EVERYONE. Which is the goal.
I think you're absolutely correct, Martha.
And despite what some people think, I wasn't being a smart alec with that article. Unfortunately, very little research -- academic, and hardly any practice-based, research -- is done looking at cost-effectiveness. Look for reviews of the Scandinavian experiment into widespread nationalized support for CBT -- the approach with "the best evidence base" -- not in national outcome studies there.
So for people to take this "ACEs Science" approach seriously we need more practice-based research including cost-effectiveness outcome data to answer "By doing what, with whom, using what resources, can we produce these outcomes for people with histories of childhood adversity?"
and we must be prepared to give up, when the data shows it's necessary, some of our preconceptions. Who would have dreamt the outcomes of studies such as that of Nathaniel Lewis? Incarceration --- effect of race or class, Lewis 2018 Somewhere in all that data there'll be a link to ACEs (or there should be!) just as, getting back to Colette's original question, poverty and substance abuse are linked to domestic violence, and ACEs, documentary "Nigel Latta: Killing Our Kids" but for a lot of "traditionally trained" (thus less-informed) people in the medical system, we'll need the evidence to show what needs to, and can be, done.