Clinical Practice, Social Justice, and ACEs: Bridging the Gap With Science

by Cayce M. Watson, MSW, LAPSW, MAC, Kate M. Chaffin, MSW, LAPSW, & Kim C. Mallory, MSW, LAPSW

     Social work practitioners have historically recognized the social, political, and economic environment and its contribution to client well-being across the life span. In fact, it is this focus that is both a cherished attribute and foundational core value the profession is ethically bound to uphold. According to the Council on Social Work Education (CSWE), the mission of the social work profession is achieved through pursuing social and economic justice, eradicating poverty, and upholding human rights for all persons (CSWE, 2015).

    Central to sustaining this mission is the active engagement of social work practitioners in policy practice and advocacy. However, this can be a challenge when the majority of social workers entering the profession become focused on clinical practice (CSWE, 2015).

    Of course, promoting active engagement in social policy and social justice among clinical practitioners is not new. Even the “mothers” of social work engaged in fairly dichotomous approaches to solving complex social problems. During the Progressive Era, Jane Addams focused on addressing structural inequality through organized social policy advocacy, while Mary Richmond believed that individual casework was the answer. Both paradigms are central to the social work profession, but the latter is a much narrower focus that can ignore the systemic issues contributing to social issues such as poverty, racism, gender-based violence against women, and food insecurity.

    Throughout the years, the profession has had its shifts and even internal disagreement on the focus of practice. However, since adopting both a clinical and community model, social work practitioners have consistently recognized that an individual’s environment shapes life choices, access to resources, and opportunities for success (Watson, 2014).

    There is currently a robust amount of scientific evidence affirming our integrated approach to clients, as well as the pursuit of social justice and social policy advocacy. Results from the CDC-Kaiser study (ACE Study) revealed that stressful environments and trauma can harm the developing brain and increase one’s risk for developing negative coping behaviors and poor health throughout the life span (Felitti et al., 1998). This type of trauma, known as Adverse Childhood Experiences or ACEs, can result from toxic stress related to envitonmental circumstances, including childhood exposure to domestic violence, abuse, neglect, substance misuse, parental conflict, and incarceration of a family member (American Academy of Pediatrics, 2014; Sacks, Murphey, & Moore, 2014; SAMHSA, 2015). Additional environmental risks include chronic socioeconomic hardship, racism, and witnessing violence in one’s neighborhood (U.S. Department of Health and Human Services, 2015).  

    Empirical research on the neurobiology of toxic stress and poverty also reinforces the relationship between environmental press, vulnerable clients, and the need for policy advocacy. Exposure to poverty has significant implications for brain development of a child (Harris, 2014) as well as stress on the family unit (U.S. Department of Health and Human Services, 2015). Concentrations of poverty can become fertile ground for trauma markers and can increase the likelihood that adverse experiences will occur. Disorganized neighborhoods, community violence, overcrowding, pollution, and unequal access to fresh foods compound the exposure to toxic stress in low-income households (Evans & Kim, 2013).

    Additionally, chronic exposure to poverty diminishes a child’s regulatory system, so she is unable to cope with both the toxic stress and environmental demands associated with socioeconomic hardship (Evans & Kim, 2013).  In 2016, the American Academy of Pediatrics released a statement affirming that poverty leads to adverse health outcomes across the life span. Furthermore, the AAP states, “The causative relationship between early childhood poverty and adult health status should inform and influence the decisions of policy makers, researchers, and community pediatricians” (AAP, 2016, p. 9).

    As social work practitioners, we are committed to evidence-based interventions; interpersonal and social empathy; and the development of knowledge, skills, and values in social work practice. It is an ethical imperative to view clinical practice within the macro context as we strive to become life-long advocates and effective practitioners. The research compels social workers to continue to engage in our clinical practice through a social justice lens. Promoting advocacy and understanding the impact of social policy is critical to both individual and community-based practitioners, not just because of our professional mission and ethical mandates, but because of our knowledge of person-in-environment (Watson, 2014).

    Social workers must be well informed not just about the science itself, but also about social policies that adversely affect families and communities. We have a professional obligation to stay abreast of emerging research, and we must translate the evidence into social policies that better meet the needs of vulnerable populations.

    The research on trauma, toxic stress, and ACEs should prompt a critical examination of social policies including those directed at poverty, environmental justice, affordable housing, immigration, public education, human rights, access to health and mental health services, and a living wage. We can actively move from thinking about decreasing trauma and increasing resiliency on only an individual practice level to thinking about building strong communities and supporting policies that increase resilience and prevent trauma collectively.

    What policies are contributing to ACEs in your community?  

References

AAP Council on Community Pediatrics. (2016). Poverty and child health in the United States. Pediatrics, 137 (4): e20160339

American Academy of Pediatrics. (2014). Adverse childhood experiences and  the lifelong consequences of trauma. Retrieved on February 18, 2016 from: https://www.aap.org/enus/Documents/ttb_aces_consequences.pdf

CSWE. (2015). 2015 educational and policy accreditation standards. Retrieved  on February 18, 2016 from: http://www.cswe.org/File.aspx?id=81660

Evans, G., & Kim, P. (2013). Childhood poverty, chronic stress, self-regulation and coping. Child Development Perspectives, 7 (1), 43-48.

Felitti, V., Anda, F., Nordenberg, D., Williamson, D., Spitz, A., Edwards, V., Koss, M., and Marks, J. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Prevention Medicine, 14 (4), 245- 258.

Harris, N. B. (2014). The chronic stress of poverty: Toxic to children. The Shriver report. Retrieved on February 18, 2016 from: http://shriverreport.org/the-chronic-stress-of-poverty-toxic-to-children-nadine-burke-harris/

Sacks, V., Murphey, D., and Moore, K. (2014). Child trends: Adverse childhood

experiences: National and state level prevalence. Retrieved on February 18, 2016  from: http://www.childtrends.org/wpcontent/uploads/2014/07/Brief-adverse-childhood-experiences_FINAL.pdf

SAMHSA. (2015). The role of adverse childhood experiences in substance abuse and related behavioral health problems. Retrieved on February 18, 2015 from: http://www.samhsa.gov/capt/sites/default/files/resources/aces- behavioral-health-problems.pdf

U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration, Maternal and Child Health Bureau. (2014). Child Health USA 2014. Rockville, Maryland: U.S. Department of Health and Human Services. Retrieved from: http://mchb.hrsa.gov/chusa14/

Watson, C. (2014). Generalist social work: A unified approach to practice. Social Justice Solutions. Retrived from: http://www.socialjusticesolutions.org/2014/06/09/generalist-social-work-unified-approach-practice/  

Cayce Watson, MSW, LAPSW, MAC, is a Licensed Advanced Practice Social Worker and Master Addiction Counselor. Her practice experience is in mental health and the treatment of substance use disorders, specifically opioid use among pregnant women. She is currently an Associate Professor and Field Coordinator in the Social Work and Sociology Department at Lipscomb University in Nashville, TN.

Kate M. Chaffin, MSW, LAPSW, is an Associate Professor of Practice and the Director of the Online and Nashville MSSW program for the University of Tennessee, Knoxville. She joined the College of Social Work in 2008 to develop the online MSSW program, which has become a leader in online education. Her primary teaching area is in policy practice and her research interest includes best practices in online education.

Kim Crane Mallory, MSW, LAPSW, is an Assistant Professor of Practice and the Field Education Coordinator for the Nashville campus of the University of Tennessee College of Social Work MSSW program.