The True Cost of Adverse Childhood Experiences

Do you know what an A.C.E. is? It’s not your local hardware store, the winning card in your hand, nor your friend who plays professional tennis. It’s an increasing used acronym for an adverse childhood experience.

I know, you’re thinking, “just what I need, another acronym to remember.”

But plumb your own childhood and if you recall a deeply traumatic emotional event that altered who you are today, you’re familiar with A.C.Es.

They include:

• sexual, emotional, or physical abuse, bullying, and domestic violence,
• extreme poverty, abandonment, homelessness, and hunger,
• family break-up, mental illness, or addiction of a family member

Data analysts working on this estimate that untreated A.C.E.s in Vermont in 2018 led to remediation costs of at least $410 million, $190 million of which are special education costs. It is difficult to impute the costs of A.C.E.s in the criminal justice system, mental health treatment (such as it is), and emergency room visits.

Not all A.C.E.s originate in families or communities. Some are the unintended consequences of ill-thought-out local, state, and federal policies.

Surely, ICE’s policy of separating children from their parents for months, if not years, and keeping them in cages would count.

Inordinate and ill-justified terminations of parental rights by Department of Children and Families (DCF) also count.

Technical and administrative violations for single parents monitored by corrections that return them to prison leaving their children as wards of the state would count. Currently, there are upwards of 5000 children in Vermont whose parents are overseen by corrections.

The lion’s share of A.C.E.s, however, originate in families.

Many reasons have been given, including the loss of religious practice and family adhesion. But religious and family institutions have ebbed and flowed throughout history and many children have thrived in non-nuclear families and outside of religion’s influence and become mature, humane parents themselves.

If one were to impart responsibility for the prevalence of A.C.E.s, one would see the headings of addiction, poverty, lack of access to mental and physical health care, and intergenerational abuse.

When I was 42 and my weight was idling just below 500 pounds and I finally realized I needed help, I entered an addiction treatment facility for eating disorders. Most of the patients were women. My first day in group therapy we were asked to raise our hands if we had been sexually abused as youngsters. Of the eighteen of us in the room, only three of us kept our hands in our laps. The therapist went on to correlate sexual abuse with massive obesity and one very large woman confessed that overeating both dulled the pain of her abuse and, she believed, made her sexually unattractive to her predator uncle. I know from my own battles with an eating disorder the emotional, physical, and actual cost of my and my mother’s codependent addiction.

Think of A.C.E.’s as a form of social disease, the cost of which follows a predictable upward curve: from prevention, to early diagnoses and treatment, to remediation and treatment– no different from a physical disease. Early opiate use detection and treatment is considerably less expensive than incarceration. Inpatient rehab can cost from $6-28,000 for a month. Whereas, average incarceration cost for men in Vermont is $50,000 and for women about $85,000 per year.

Recognizing the immense cost of remediating A.C.E.s’ impacts in social, criminal, educational, and health care systems, significant work is underway to quantify the extent and impact of A.C.E.s here in Vermont.

A cross-sector partnership between government, nonprofit, and business is in the planning stages to better understand the relationship between whole-family wellness and early childhood development. Vermont is exploring partnering with an initiative in California and that could involve the UVM Health Network as a research partner.

The initiative would be based on work being done by a number of Vermont organizations that have come together to focus on the well-being of children and on refining a new model of care-taking in Addison County: Building Bright Futures,  Let’s Grow Kids, Addison County Early Care and Learning Partnership, Addison County Parent Child Center, and Resilience Transformation Partners (RTF).

Their goal is prevention or early discovery of A.C.E.s and treatment in a family setting that minimizes damage to the child and optimizes their chances of recovery and later success.

This model, supported by such pioneers in childhood well-being as Dr. Jody Brakeley, Cheryl Mitchell, Charlie Smith (chair of RTF), and South Burlington Schools Superintendent David Young will advance our social, educational, and health care investments upstream and should become a vital part of meeting Governor Scott’s “affordability” agenda.

If we go on ignoring this well-documented problem, we will face much larger costs down the line and will go bankrupt trying to manage the damage done by our failure to manage forward and invest in the well-being of our children and families.