In a recent study in Pediatrics, researchers discussed the ways in which involvement with the carceral system can increase ACE scores and lead to poor long-term health outcomes.
What Are Adverse Childhood Experiences?
Adverse childhood experiences (ACEs) can include household dysfunction and various forms of abuse and neglect occurring before the age of 18. This is a framework that aids medical and mental health professionals in better understanding the impact that negative childhood experiences have on an individual’s health. Traumatic childhood experiences can negatively influence health into adulthood due to disruptions in social and neurodevelopment. They can also increase the odds of social, emotional, and cognitive impairment.
The ACE Pyramid and Linking Trauma to Health Issues
These childhood experiences are placed into a categorical pyramid: psychological, physical, or sexual abuse; violence against mother; living with household members who were substance users, navigating mental illness or suicidality, or were ever incarcerated. These categories are numbered zero through seven and are then compared to outcomes later in life. These factors can lead to increases in risky behaviors in addition to physical and mental health problems, all of which have the potential to ultimately result in a premature death. A 2017 study published in The Lancet Public Health showed that participants who had experienced four or more categories of adverse childhood exposure had significant increases in risks to their health, including smoking, substance use, depression, and suicidality. There was also a link between increased numbers of adverse experiences and chronic conditions like heart disease, cancer, and respiratory disease.
How Criminal Justice System Contact Fits In
Researchers in the new study found that health effects stemming from involvement with the carceral system occur on both individual and community levels. Both mental and physical health are impacted by varied levels of justice system involvement, ranging from chronic illness and infectious disease to substance use and early death. Katie Moffit, LCSW says, “Youth interaction with the juvenile justice system becomes yet another ACE to add to the youth’s overall score. I also believe we’re not just increasing their score by one point due to separation or placement; we’re adding far more points to their scores by placing them into a system that re-exposes them to violence, to isolation, to negligence, to abuse, and does little to work towards rehabilitation or healing." Moffitt adds that these efforts may often feel like band-aids meant to control more than help, especially when you consider high recidivism rates.
Incarceration as Trauma
Awareness of PTSD is often confined to war veterans and survivors of sexual assault. Multiple studies have shown, however, that around 30% of incarcerated youth meet the criteria for post-traumatic stress disorder (PTSD). Given that even youths facing incarceration are branded as criminals, incarceration as a form of trauma may not engender the level of understanding and sympathy that other traumas might. When youths are then discriminated against on the basis of their incarceration, the effects can be dramatic and long-lasting. Research has shown that experiences of chronic discrimination have significant effects on the mental health of Black and other marginalized communities. Data shows that Black Americans are more likely to have suicidal behavior, leading to higher rates of death by suicide. This data, in tandem with the racial disparity within our prison system, suggests a significant mental health concern in marginalized communities, and points to ACE scores as an important area of investigation. Moffitt says, “…during my time working with youths who’ve interacted with the justice system (whether it be through juvenile detention, probation, or removal from family and subsequent placement in a youth shelter/treatment facility) I recognized that many, if not all, of these youths had trauma histories." The opposite also is true. Many of those who reported to have engaged in illicit activity also were mistreated as youth, and those with heightened exposure to the system have heightened risky behavior in adulthood. Moffitt says, “What other people may describe as angry or oppositional behavior was often a form of survival and coping that was masking the abuse and neglect that they had experienced in their homes and/or communities." Essentially, exposure to adverse childhood experiences increases the risk of future exposure to more such experiences, including incarceration, which in turn further increase those risks. Moffitt continues, “Youths presented with a wide range of behavioral and emotional issues including: anger, depression, anxiety, PTSD, running away, truancy, substance use, abusive and aggressive behaviors towards others, sexual reactivity, eating disorders, teen pregnancy, and suicidal ideation.”
Disparities With Carceral System Involvement
On a community level, despite a justice system ostensibly designed for safety and prevention, we see that the end result is often families in disarray, poverty, substance use, and mistrust of public officials. It is important to note that much of the heightened involvement of police and the criminal justice system within communities of color is due to institutional bias and discrimination, effects of structural and systematic racism. This means that while interventions and alterations to the approaches we take with youth who have engaged in risky behavior should undoubtedly change, there are larger factors that impact those same youth and their communities on a daily basis. “The longer ACEs go unaddressed, the more at-risk youths become for recidivism, for future victimization, and for poor health outcomes (both mental and physical). We can intervene when ACEs are present to ensure better outcomes for youths and we can prevent future ACEs for the individual by responding in more trauma-informed and less carceral ways." says Moffitt.
The Importance of a Restorative Approach
Data shows that there is a tangible connection between discrimination and trauma responses, trauma responses and chronic disease, and discrimination within communities of color. In an effort to adequately address the issue of increased ACE scores due to carceral system involvement, addressing the problem at its root is vital. Moffitt says, “Unless we’re providing youths with comprehensive, holistic, trauma-informed, restorative care, along with family and community support, we’re not addressing the roots of the trauma that led to their behavior. Currently, we’re not getting to what they actually need. Instead, we’re thrusting youths into a system that isolates them from family, from protective adults, from community, and other possible supports. The system currently mimics and re-exposes youths to the ACEs that first led them to juvenile system involvement." She continues that a system that only begets more violence doesn’t do anything to help with rehabilitation and reducing health risks. “We can do work in our communities to address the inequities in our systems so that kids don’t experience the ACEs that often lead to incarceration in the first place,” she says. “Prevention of ACEs current and future is where our attention should be; which means intervention and services should include less carcerality and more healing for individuals, families, and communities.” ACE prevention programs can lessen the contact of youth, the carceral system, and ultimate improve the health of youth and young adults.
