ACE (Adverse Childhood Experience) Scores: Part of the “Pay for Success” Plan?
A red flag for me in Gavin Newsom’s “child-friendly” proposed budget was the $45 million he allocated to screen children and adults in Medi-Cal for ACEs. I’m writing this post to express serious reservations I have about the process of developing ACE (Adverse Early Childhood Experiences) scores for people. ACEs are getting tremendous media exposure of late. While I believe this to be a crucial pubic health concern, my fear is that ACE prevention and mitigation interventions will become vehicles for “innovative” finance and will expand profiling of vulnerable populations.
I want to make it clear from the outset that I acknowledge childhood trauma does result in long-term negative health consequences for individuals. I’ve seen it in my own family. I also recognize that systems of structural racism have inflicted stress and violence on communities of color and indigenous peoples for generations, resulting in high rates of chronic illness that make them attractive targets for “social impact” schemes. People have a basic human right to treatment and care, which should not be conditioned on surveillance and having data harvested to line the pockets of social impact investors.
What concerns me about ACEs is the “scoring.”
Why should a standardized rubric developed under the auspices of one of the largest managed healthcare systems, Kaiser Permanente, label clients and structure the way a doctor, therapist, social worker, or educator can care for them? How did this tool come to have such a far reach, and whose interests will it ultimately serve?
Is a reliance on “scores” an intentionally-constructed framework that allows providers to limit their scope to “fixing” individuals and families rather than advancing a more radical approach whereby systemic causes of community trauma, trauma rooted in our country’s deep racist history, can be acknowledged, holistically assessed, and begin to be ameliorated?
And finally, will this “scoring” system be used to transform the treatment CONTINUE READING: ACE (Adverse Childhood Experience) Scores: Part of the “Pay for Success” Plan? – Wrench in the Gears