Expanding ACES in child and family service systems: Incorporating context and resilience

Ana Maria Meléndez Guevara , Stephanie Cottam , Charlie Wall , Sarah Lindstrom Johnson
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Abstract

The Adverse Childhood Experiences (ACEs) framework has been instrumental in illustrating the profound and long-term impact of early-life stressors in the developmental trajectories of children and families and well-being of our communities. However, despite its groundbreaking contributions, the ACEs framework predominately adopts a deficit-oriented lens, focusing on risk factors while often neglecting the protective and positive experiences children and families also experience. In the United States, communities that have been historically marginalized, including racial and ethnic minorities, are disproportionately impacted by ACEs due to systemic inequities and historical injustices, leading to persistent sociodemographic health and social disparities. Recent advances to the ACEs framework argue that the traditional ACEs model inadequately addresses the broader socio-structural, political, and economic contexts that influence adversity, including living in under-resourced communities, ongoing community violence and poor access to service systems. As a result, child, and family service systems (CFSS) may fail to consider how socio-structural factors, may potentially reinforce disparities in service access, delivery, and outcomes. This paper discusses the limitations of the traditional ACEs framework and advocates for a more comprehensive approach that incorporates socio-ecological and strengths-based perspectives like the Social Determinants of Health Framework and the Protective and Compensatory Experiences (PACEs) Framework. By shifting towards this holistic perspective, researchers and practitioners alike can better understand the interplay of systemic inequalities and socio-structural conditions in shaping ACEs exposure and outcomes, and, therefore, inform more effective practices, policies and services that can address both the immediate impact and root causes of adversity.
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在儿童和家庭服务系统中扩展 ACES:纳入背景和复原力
童年不良经历(ACEs)框架在说明早期生活压力对儿童和家庭发展轨迹以及社区福祉的深远和长期影响方面发挥了重要作用。然而,尽管 ACEs 框架做出了开创性的贡献,但它主要采用了以缺陷为导向的视角,关注风险因素的同时往往忽视了儿童和家庭也会经历的保护性和积极的经历。在美国,由于系统性的不平等和历史性的不公正,历史上被边缘化的社区,包括少数种族和少数民族,受到 ACEs 的影响尤为严重,导致了持续的社会人口健康和社会差异。ACEs 框架的最新进展认为,传统的 ACEs 模型没有充分考虑到影响逆境的更广泛的社会结构、政治和经济背景,包括生活在资源不足的社区、持续的社区暴力和难以获得服务系统。因此,儿童和家庭服务系统(CFSS)可能没有考虑到社会结构因素可能会如何加剧服务获取、提供和结果方面的差异。本文讨论了传统 ACEs 框架的局限性,并主张采用一种更全面的方法,将社会生态学和基于优势的观点(如健康的社会决定因素框架和保护与补偿经历(PACEs)框架)结合起来。通过转向这种全面的视角,研究人员和从业人员都能更好地理解系统性不平等和社会结构条件在形成 ACEs 暴露和结果方面的相互作用,从而为更有效的实践、政策和服务提供信息,以解决逆境的直接影响和根本原因。
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