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Free of Violation of Rights - Legal Imperatives That Could Address the Impact of ACEs

Last week, I took a call from a passionate suicide prevention advocate, James Gallant who wanted to discuss an approach for reducing ACEs.

"Do you assess kids with disabilities for violations of their legal rights?" James asked.

I was stumped at how to answer this, and didn't immediately see the connection to ACEs.  

But as James went on to share his expertise on the subject, I felt more compelled to find out what we are doing locally.  

James makes the case that kids with an ACE score of 1 are 50% more likely to commit suicide (he said "an ACE score of 1 from divorce", but the ACE Study does not say that, and he is looking for reference for that). James asserted that the Developmental Disabilities Act of 2000 gives a legal pathway to prevent suicide for at least some of the kids with divorced parents. Developmental disabilities includes the common, modern day diagnosis of ADHD, much of which may actually be behavior as a result of ACEs, so this may be a large group of kids.  

The disability act asserts that kids with developmental disabilities should live free of violation of their legal rights. James says this means providers should be screening for such violations when kids have divorced families.   

Divorce proceedings include a court-ordered standard of care, which spells out custodial rights of both parents. He believes that many kids are not able to spend time with both parents even given this order from the courts. He believes this leads to suicidal feelings. However, this does not address the issue of when one parent has -- and continues to -- maltreat the child, which complicates the idea that being separated from an abusive parent leads to suicidal feelings. The ACE Study showed that it was the increase in types of childhood adversity -- the ACE Score -- that resulted in higher risk of suicide attempts and other health consequences, and that, on a population level, no one ACE had a greater impact than any other. It did not look at the relationship between one specific type of abuse and health or behavioral consequences.

He asserts that social work and behavioral health workers should include exploration of such violations of court orders as part of a standard assessment. He believes this is required by the code of ethics for such workers. He says if court orders were upheld and a child was connected to both parents, suicide rates would go down. 

James, who works for the Marquette County Suicide Prevention Coalition, later wrote in,

"Please consider reaching out to the other MARC Communities to assess their local networks to get a clear picture of how the entire system of care around the country is dealing with the court-ordered legal rights of the people they serve. Maybe the Health Federation would be interested in requesting the information from across the program and compiling it into a single report?

Your County Board of Supervisors is a local legislative body that can implement the policy to protect the legal rights of the people served at the Public Health Dept. and Community Mental Health Department. The other providers in the community could follow their lead. 

This is a summary of the parts I think apply to Trauma-Informed Care and assessment of needs:

PROGRAMS FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES  (see attached documents for more details)

Subtitle A—General Provisions

42 USC 15001. SEC. 101. FINDINGS, PURPOSES, AND POLICY.

 (a) FINDINGS.—Congress finds that—

(1) disability is a natural part of the human experience that does not diminish the right of individuals with developmental disabilities to live independently, to exert control and choice over their own lives, and to fully participate in and contribute to their communities through full integration and inclusion in the economic, political, social, cultural, and educational mainstream of United States society;

(5) individuals with developmental disabilities are at greater risk than the general population of abuse, neglect, financial and sexual exploitation, and the violation of their legal and human rights;

(6) a substantial portion of individuals with developmental disabilities and their families do not have access to appropriate support and services, including access to assistive technology, from generic and specialized service systems, and remain unserved or underserved;

(9) family members, friends, and members of the community can play an important role in enhancing the lives of individuals with developmental disabilities, especially when the family members, friends, and community members are provided with the necessary community services, individualized supports, and other forms of assistance;

(10) current research indicates that 88 percent of individuals with developmental disabilities live with their families or in their own households;

(14) as increasing numbers of individuals with developmental disabilities are living, learning, working, and participating in all aspects of community life, there is an increasing need for a well trained workforce that is able to provide the services, supports, and other forms of direct assistance required to enable the individuals to carry out those activities;

(16) the goals of the Nation properly include a goal of providing individuals with developmental disabilities with the information, skills, opportunities, and support to—

(A) make informed choices and decisions about their lives;

(B) live in homes and communities in which such individuals can exercise their full rights and responsibilities as citizens;

(C) pursue meaningful and productive lives;

(D) contribute to their families, communities, and States, and the Nation;

(E) have interdependent friendships and relationships with other persons;

(F) live free of abuse, neglect, financial and sexual exploitation, and violations of their legal and human rights; and

(G) achieve full integration and inclusion in society, in an individualized manner, consistent with the unique strengths, resources, priorities, concerns, abilities, and capabilities of each individual;

********** 

Thanks again for the work you are doing in Sonoma!

Jim Gallant, Marquette County Suicide Prevention Coalition"

Update on 12/20/16:  when asked for a source for the divorce and suicide statistic, Mr. Gallant responds:

  • Jane Stevens asked about the 50% increase risk for a youth dying by suicide. That isn't addressed in the ACE Study, it's an adult retrospective study. I'll try to track down that information.
  • The original ACE Study (pg. 252) states that a child experiencing 1 ACE has a 100% increase in lifetime risk of attempting suicide. 
  • Table 4 shows an ACE Score of Zero (0) has a {1.2%} lifetime prevalence of attempting suicide and an ACE Score of one (1) creates a {2.4%} lifetime prevalence of attempting suicide.
  • On page 205 of the Chadwick Manual, Dr. Felitti is quoted as saying that " Surprisingly, the ten ACEs turned out to be essentially co-equal in terms of long-term effects".
  • Therefore, if a child has zero (0) ACEs today and their parents get Divorced tomorrow, they would have an ACE Score of 1 (one) which increases their lifetime risk of attempting suicide by (essentially) 100%.  

That last point is inaccurate, because the ACE Study results are for a population level, not an individual person. There are some children for whom divorce actually improves their lives (comment by Jane Stevens).

 

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So many thanks to James for caring about and working on this incredibly important issue! I have a couple of thoughts to share.

Legally, this is a very difficult case to make because we don’t have a way to tie ACEs exposure to emotional or mental health problems in any one specific child. We know as a matter of population that exposure increases the risk of short and long term health problems, and that the rate of incidence is relatively predictable on a population level. But as to any one individual, it’s a matter of risk—not destiny—and depends on so many factors, not least of them resilience. So arguments that rely on tying together exposure and health for a specific individual will have a tough time surviving legal scrutiny, I think.

From a policy point of view, I have some doubts about the wisdom of characterizing ACEs exposure as a disability. We know it places kids at a higher risk for a range of ills, yes. But again, we don’t want to argue that ACEs exposure is a disability, particularly where the ACEs in question include societal/environmental factors like racism or poverty. We don’t want to present kids of color or poor kids, to take two examples of kids who often face higher ACEs exposure, as less able, and I fear that would be one result.

As to the specific question of divorce, the analysis is a little different. Unfortunately, as we know, you can’t make parents treat their children appropriately. If parents are angry at each other, in my experience there’s very little to be done to get them to focus on what’s best for the kids instead. But I have some hope that if parents were required to learn the basics about ACEs, and especially about the impact of high-conflict divorces, we might be able to make inroads. A certain number of parents will (I hope) be horrified to learn that kids don’t “just get over it” and even those kids who seem “fine” could well not be OK at all, in the context of a high-conflict divorce. And I do agree that social workers and case workers should analyze for violations of children’s rights, but frankly, I’m not optimistic that ordering parents to do anything in particular will result in compliance. I suspect the better route is to try to help the parents understand the permanent impact of their conduct on their children.

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