Student tries to persuade politician to take action on the issue of ACEs

Persuasive letter advocating for a policy with an audience of a politician or government administrator.

Adverse childhood experiences (ACEs) have been studied since the mid-'90s and recognition of their importance has grown over the past two decades. Exposure to ACEs alters cognitive development of children and is associated with many lifelong issues faced in adulthood such as increased risk of suffering from chronic health problems, impairment of executive functioning, poor self-regulation, and mental illness. ACEs are categorized as potentially traumatic events that occur in a child's life, and there are three forms of experiences: abuse, neglect, and household dysfunction. Whether it be physical or emotional abuse and neglect, mental illness, substance abuse, or violence in the family, these are all forms of toxic stress that count as adverse childhood experiences. One in six adults experiences four or more types of ACEs (CDC, 2021) and struggles as a result of trauma in their childhood. Exposure to adversities in their childhood is linked to increased health problems in their adulthood, including higher chances of heart disease, depression, cancer, and behaviors such as smoking, alcoholism, and drug use—all are linked with early death. While this affects many children and their futures, ACEs can be passed across generations, reaching beyond just themselves. 

The studies conducted about ACEs all conclude very similar results: despite the negative effects of adverse experiences, we can reduce their effects, and we have the power to prevent the outcomes by providing resources and educating health providers to recognize the risks of ACEs. I speak on behalf of those affected and call for action to prioritize preventative measures. You can do this by supporting passage of laws or regulations that require healthcare providers to become familiar with the research on ACEs and techniques for recognizing when children have experienced ACEs. Healthcare providers need to assess for ACES, know their potential impacts, and have the ability to provide resources to families and children to minimize the adverse impacts of ACEs.

We are facing a great healthcare crisis; studies done on adverse childhood experiences show the link between toxic stressful experiences and health issues later in adult lives. We see the connection between these experiences and risky behaviors. Exposure to violence and other adversities has a great influence on the cognitive development of a child, and effects on the mind show through the health of the body as well. The best course of action to reduce the number of individuals facing health issues (as a result of ACEs) is to prioritize preventative measures and screenings through healthcare providers and those who work with children. I propose that you sponsor or co-sponsor any sort of policy that requires healthcare professionals to be trained to screen for ACEs so that we can identify children who can be referred to the resources that support their needs. Policies need to recognize the correlation between these negative outcomes and the root of the issue. 

The Centers for Disease Control identify six strategies for preventing ACEs: 

1. strengthen economic support for families; 
2. promote social norms that protect against violence and adversity; 
3. ensure a strong start for children; 
4. enhance skills to help parents and youths handle stress and manage emotions and tackle everyday challenges; 
5. connect youths to caring adults and activities; and 
6. intervene to lessen immediate and long-term harms  (CDC, 2020). 

By supporting the needs of the families, we not only prevent an ACE, but also such supports would benefit the economy. As explained by the information provided by the CDC, stopping an ACE before it starts would "benefit the economy and relieve the pressures on healthcare systems. ACE-related illnesses account for an estimated $748 billion in financial costs in North America each year. A 10% reduction in ACEs could equate to an annual savings of $56 billion" (CDC, Oct 2018). Furthermore, we know that intervention programs are already seeing results. The ACE Response Organization has found that: "Intervention programs with disadvantaged children are already demonstrating significant benefit-cost ratios, with $5.70 for every dollar spent on a child by the time the child became an adult aged 27 and, when projected into the rest of their lives, $8.70 cost savings in crime reduction (see Schweinhart et al., 2011)." (Ace Response, 2020). As a legislator, I understand your concerns about the costs of a policy and whether it can be afforded, but I can assure you that all the benefits that come from these preventative measures are well worth the investment of time and resources.

As a politically involved social worker, the welfare of families is at the top of my list of priorities. When creating a solution to this issue, I cannot stress enough how important it is to look to the root of these adverse experiences. Rather than address the issue in the aftermath, we must allot resources to the prevention of ACEs in the first place. These adversities stem from strains in the family. For example, strengthening economic support for families was one preventative measure. Parents facing poverty are under immense pressure, and more often than not, the children feel the stress of that pressure on the family. In a much similar light, youth subjected to witnessing violence, substance abuse, and other negative exposures in their families are bound to be affected by the toxic stress of those experiences. The second and third strategies for preventing ACEs address these very issues. We need to promote positive parenting practices and help children experience a very strong and healthy start to their lives. In addition to supporting the children, providing resources and support for the parents is crucial as well. Healthcare providers who are trained to recognize the risk factors for ACEs must utilize their power to empower families to seek support and put to use the resources available. Not only should it be the job of healthcare providers, but any professional who works closely with children and families should be trained to evaluate and assess risk factors for ACEs—that should include staff at licensed daycare and early childhood centers, as well as all our elementary school teachers. Resources must be allocated to this cause, and training is so important because these professionals must be equipped and prepared to notice the potential risks. I believe the public has an interest in assuring that social workers, teachers, counselors, agency workers, and anyone who sees that they can make a difference in the lives of children receives training on ACEs and their prevention.

So much of our future is dictated and influenced by the experiences we have in our primary years; while these experiences do not cement the course of our lives, they do live with us and have a profound impact on our mental, physical, and behavioral health. There must be an intervention to lessen immediate and long-term harm from the adversities faced. While there is a lot of evidence showing the positive outcomes of addressing ACEs, there is some opposition to the use of ACE testing and screenings. Some studies argue that informing children of the adverse effects of ACEs in their lives will paint a bleak picture of their futures. It is argued that it teaches these children to anticipate the continuation of hardships. Research from the Center on the Developing Child at Harvard University stated that "[I]n some cases, the cumulative burden of multiple risk factors early in life may limit the effectiveness of later interventions, thereby making it impossible to completely reverse the neurobiological and health consequences of growing up poor (Shonkoff & Garner, 2012, p. 2255)" (Winninghoff, 2020) . This completely disregards the power of prevention work early in a child’s life and even interventions made after. There has been an overwhelming amount of research done that proves the many positive outcomes of the intervention. Even if there is a late intervention for the child as an adult, it means a world of difference to provide that support. However, I do want to reiterate how crucial it is that we now focus on creating policies that implement these screenings earlier so that earlier prevention can be accomplished.

A policy for ACE prevention would realistically mandate screening in healthcare and child-family settings. There would also need to be mandated training for those workers to ensure their capability to identify these risks. This bill would enhance primary care and increase referrals to victim-oriented services and treatments. This would not only serve the children but also their families as well and bring awareness to the long-term potential risks of adverse childhood experiences. We must implement these risk assessments, screenings, and training in healthcare and family settings. This allows these professionals to notice the signs and intervene on behalf of the child and their families. By taking early action, we can minimize the effects of adverse childhood experiences. Not only will the mental, physical, and behavioral health of these individuals be positively affected, but we will also nurture better habits for future generations and educate and spread awareness of the effects of adverse childhood experiences.

As policymakers and legislators, I am confident you can now see the significance and value of addressing this concern for the public health and safety of children and families now and in the future. If you choose to support a policy such as this, you are supporting a momentous movement—a policy that applies the knowledge we have now to better our society and care for future generations of leaders and citizens. By not being in support of this bill, your decision would be greatly consequential. It would mean the continuation of a toxic cycle now that we have the research and proof to show the repercussions of these realities. We have the power to reduce the number of children dealing with the aftermath of their adverse childhood experiences, prevent further hardships, and create a better future. I urge you now to take action and strongly support policies that implement ACE screenings in the previously mentioned areas. I even urge you to cosponsor this bill and work directly with it to make the change. With your support, we can begin to heal and proactively help the children in our society to become greater than their situations and help nurture better practices in policy that will make a real and significant change.

 

Works Cited 

Bowen, E. A., & Murshid, N. S. (2016, February). Trauma-informed Social Policy: A conceptual framework for policy analysis and Advocacy. American journal of public health. Retrieved March 8, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4815621/

Centers for Disease Control and Prevention. (2018, October 19). Preventing adverse childhood experiences. Centers for Disease Control and Prevention. Retrieved March 8, 2023, from https://vetoviolence.cdc.gov/apps/aces-training/#/resources

Centers for Disease Control and Prevention. (2020, September). Retrieved March 9, 2023, from https://www.cdc.gov/injury/pdfs/priority/ACEs-Strategic-Plan_Final_508.pdf

Centers for Disease Control and Prevention. (2021, August 23). Adverse childhood experiences (aces). Centers for Disease Control and Prevention. Retrieved March 8, 2023, from https://www.cdc.gov/vitalsigns/aces/

Centers for Disease Control and Prevention. (2022, April 6). Fast facts: Preventing adverse childhood experiences |violence prevention|injury Center|CDC. Centers for Disease Control and Prevention. Retrieved March 8, 2023, from https://www.cdc.gov/violenceprevention/aces/fastfact.html 

Winninghoff, A. (2020). Trauma by Numbers: Warnings Against the Use of ACE Scores in TraumaInformed Schools. Occasional Paper Series, 2020 (43). DOI: https://doi.org/10.58295/2375-3668.1343

www.spiraldesign.com, S. D. S.-. (n.d.). Give your support. Policy. Retrieved March 8, 2023, from http://www.aceresponse.org/give_your_support/Policy-Examples_52_pg.htm#:~:text=Adverse%20childhood%20experiences%20(ACEs)%20are,high%20individual%20and%20societal%20costs. 

You are being very thorough in this policy paper.  I have some recommendations:

1) in addressing a political leader or executive in an agency, it is important to make your request right away.  In this case, the letter sometimes refers to a bill, and sometimes just outlines a problem and suggests generally that certain types of bills or regulations are necessary.  If you were to write an actual letter advocating this, I would start with:

I write to you with the intention of encouraging you to support legislation, or introduce legislation, that would require state licensing examinations and state university curricula for certain professions to require content ensuring a range of professionals understand the concept of adverse childhood experiences (ACEs), research about the ways ACEs harm individuals and society, prevention of ACEs, and how to help children who have been exposed to ACEs.  Prevention of adverse childhood experiences will improve our society in many ways, and we need the state to use its regulatory power to encourage a widespread understanding of this topic.

Or, something like this:

I write to you to share with you some information about the concept of adverse childhood experiences (ACEs), and what research tells us about the ways we might prevent ACEs, and what price we pay as a society if we fail to intervene to identify who has experienced ACEs.  As a legislator, I hope that you will find this information inspiring, and since you serve on the House Health Care Licenses Committee and the Higher Education Committee, I hope that you will propose, co-sponsor, support, and advocate for any legislation that might address the concerns I raise in this letter.

It's really important to do three things in most persuasive communication or assessments with people: identify yourself, establish some credibility by explaining what you are associated with or whom you represent, and explain what you are doing—describe what is your purpose and motive in the communication that follows.

Another thing is that you repeat yourself on a few points in this letter, which is a great technique in persuasive oral communication, but doesn't work as well in written communication.  On a few occasions you mention the consequences of exposure to ACEs.  Once might suffice.  On a few occasions you explain that certain professionals need to be familiar with ACEs, know how to recognize risk factors, know how to prevent ACEs, know how to refer families or children exposed to ACEs to help, and so forth.  The letter would be more persuasive and have a greater impact if you had edited and organized the paper so that this suggestion was clearly made once.

I think the overall letter follows a good strategy.  You explain what ACEs are and describe how they damage people.  You refer to research and scholarly sources with authority.  Good techniques!  You might have said something about the duty of government to promote the general welfare and promote domestic tranquility, and therefore the state should have policies to reduce exposure to ACEs.  You do mention the cost savings projected from interventions to prevent ACEs, and that could have been done in close proximity to the moral argument made around assumptions of the purpose of government (promoting general welfare), since the cost savings are related to the duty of politicians to use wise policies that are efficient and spend revenue (taken coercively from the public through taxes) in ways that are clearly going to benefit the general public in significant ways.  

It would help if you had decided for yourself if you were going to write about the general problem, go over the suggestions from the CDC, and then say some general things about the types of legislation or policies that would help implement the suggestions of the CDC. Such a letter would have taken a general concept or problem and helped the politician audience understand how the ideas from the CDC could be translated into policies or laws a legislator in the General Assembly could vote to enact. Alternative, you might have stuck to one policy, such as mandate that higher education institutions in the state who offer degrees leading toward professional qualifications and licensure provided by the state teach particular subjects.  You might have merely suggested that requirements of licensure require testing on the topic of ACEs, and assumed that this policy change would motivate the universities to cover ACEs in their curricula.  It's easy to argue that the state should not tell teachers exactly what they need to teach their students, but it's difficult to argue that a state has no business setting up standards of competency and knowledge when conferring licensure through professional examinations. The state board of professions and licensure might defer to committee of academic and administrative experts in a field (professions should be self-regulating), but I believe the governor of the General Assembly could push regulatory boards to incorporate certain areas of assessment and requirements for competence in some subject areas.

There is a counter-part to ACEs, which might be called a "Developmental Asset" approach (https://searchinstitute.org/). It seems to me that people in government need to be concerned with preventing children's exposure to ACES and also promoting children gaining access to the developmental assets.  Prevent the bad; promote the good.

The intervention of screening to asses for risks of experiencing ACEs would be a good policy, I suppose. You are suggesting health-care professionals do this, which works to the extent that children see nurses or doctors.  But, it seems to me the six preventive strategies suggested by the CDC imply a wider variety of interventions, and if you kept the letter in the realm of "explaining a problem, suggesting what might be done about it" you could have written about a wider variety of desirable policies.  The letter comes off more as in the style of "explaining a problem and advocating for one particular technique to address the problem", which in this case, is the approach of mandating that people become better informed about the problem.  This has been used in several issues in our state.  There was a problem with unethical behavior by state employees, and so now all state employees are mandated to take an online ethics training course each year.  The problem of child-maltreatment was identified as one that needed greater attention, and so the scope of who is defined as a mandated reporter of child abuse was greatly expanded, and a law or policy requires all the mandated reporters to receive training on recognizing child maltreatment.  Sexual harassment and discrimination in workplaces worry us, and so the university has a policy that all employees must each year take an online course on sexual harassment, discrimination, sexual assault, and so forth. So, there is a precedent for this sort of policy that you are advocating.

I appreciated the effort you put into the paper, the way you cited good sources, and the passion with which you wrote. I hope my comments can assist you in communicating with decision-makers in ways that will see your excellent ideas and suggestions catch the attention and support of your audience, because we really do need to go beyond this clichéd support of well-worn phrases such as "the children are the future" or "children are most important" and replace such blather with policies related to what you are trying to push in this letter—policies that directly address the things we know have the greatest detrimental (or positive) influence on human development.