Adverse Childhood Experiences Among Licensed Social Workers

Abstract

Adverse childhood experiences (ACEs) are predictors of deleterious outcomes in adulthood. Studies of childhood maltreatment among various populations and professions assess the prevalence and scope of ACEs. This article presents findings from a survey of 5,540 licensed social workers in 13 states. The study found that social workers’ mean ACE score was 2.1, and more than 23.6% reported exposure to more four or more ACEs, figures that are higher than ACE scores in most populations. In addition, ACEs were negatively associated with wellness and workplace issues, including physical health, mental health, alcohol and other drugs, tobacco, sleep, and workplace stress. The need for additional exploration of ACEs among social workers and implications for social work education and practice are discussed.

Keywords

adverse childhood experiences social workers wellness workplace issues

Childhood maltreatment can have devastating effects, and studies show that exposure to adverse childhood experiences (ACEs) may have far-reaching consequences throughout the life span. Larkin, Felitti, and Anda (2014) described two decades of research related to ACEs, identifying implications for prevention and intervention. They recommended that social workers advance ACE-informed approaches to professional practice with individuals, families, and communities, but did not comment on ACEs among social workers themselves. Given the prevalence of childhood maltreatment in the general population, inquiries of ACEs and their impact can be extended to the personal and professional lives of social workers and other health professionals. Using data from an online survey of licensed social workers in 13 U.S. states, this article presents results regarding ACEs among 5,540 licensed social workers, measuring rates of maltreatment and identifying ways in which these experiences have affected their wellness and workplace-related issues.

A Brief Review of the Literature

A substantial body of literature examines ACEs, the exploration of childhood maltreatment occurring during the first 18 years of life, and adulthood outcomes. Conducted by Kaiser Permanente and the Centers for Disease Control and Prevention (CDC; Felitti et al., 1998), the original ACE studies entailed examinations of more than 17,000 patient health records, followed by subsequent waves of interviews and data collection. Their research identified 10 types of ACEs, separated into three categories that strongly predict deleterious adulthood outcomes: abuse, neglect, and household dysfunction. All 10 types of ACE items were highly correlated with each other, and exposure to one ACE predicted the likelihood of another (Dong et al., 2004). This 10-item scale has been utilized in a great many studies over the past 15 years (Dong et al., 2004). These studies have examined the prevalence and nature of ACEs. For instance, calculations from a composite of ACE data from Kaiser Permanente health records (n = 17,337) found that 63.9% of respondents had encountered at least one ACE, and 12.5% reported four or more ACEs (Anda et al., 2006). Presently, ACE data are collected annually through the Behavioral Risk Factor Surveillance System, a multistate inventory that tracks retroactive childhood maltreatment and informs public health priorities (Asmundson & Afifi, 2019; Merrick et al., 2018). This state-based assessment noted that 62% of the population had at least one ACE, and 15.2% had four or more ACEs. These findings are similar to results from the original ACE studies (D. Ford, 2014).

Many deleterious outcomes are associated with exposure to ACEs. Germaine to the present study, ACEs are highly correlated with problems related to physical health (Monnat & Chandler, 2015; Wu et al., 2010), mental health (Manyema et al., 2018; Merrick et al., 2017), alcohol and other drug (AOD) use (Dube et al., 2002; Hadland et al., 2012), tobacco use (Anda et al., 1999; E. S. Ford et al., 2011), sleep (Kajeepeta et al., 2015), and workplace experiences (Anda et al., 2004; Liu et al., 2013).

ACEs and Social Workers

A small number of studies with limited samples have examined ACEs among social work students, social workers, and allied professionals. A case study of three social work students with histories of ACEs described the ways in which these experiences may benefit and limit professional training and practice (Zosky, 2013). Gilin and Kauffman (2015) administered the ACE scale to 162 MSW (Master of Social Work) students and Thomas (2016) administered the ACE scale to 79 MSW students, and both found that nearly 80% of their samples had been exposed to at least one ACE. In the latter study, 58.2% of the students had experienced three or more ACEs. Interviews with 10 undergraduate social work students in South Africa noted that students with ACEs experienced behavioral and emotional struggles as they encountered clients with similar personal histories (Dykes & Green, 2016). Elevated rates of secondary traumatic stress and training retraumatization were found among graduate social work students (n = 195) with histories of childhood maltreatment (Butler et al., 2018).

In addition to studies of social work students, ACE inquiries have been conducted among social work and other human service professionals. Comparing social workers to professionals from other disciplines, Olson and Royse (2006) did not find differences in rates of exposure to childhood maltreatment. In a survey of 751 social workers in North Carolina, Pooler et al. (2008) examined personal histories of respondents. While the ACEs inventory was not administered, the authors examined several types of childhood trauma that are included in the ACE inventory. This study found that histories of physical abuse, emotional abuse, having a troubled parent, and AOD use among family members were predictors of professional impairment. Esaki and Larkin (2013) administered the ACE inventory to a sample of 94 indirect and direct caregivers at a children’s service organization and found that 70% of respondents reported at least one ACE. Howard and colleagues (2015) administered the ACE scale to 192 child welfare workers employed in 48 organizations. Unlike the results of other studies, individuals with high ACEs reported less burnout and greater levels of compassion satisfaction than those with low ACEs. Lee et al. (2017) also explored ACEs in a sample of child welfare professionals and found elevated levels of workplace stress among those with higher ACE scores. Steen (2017) found that among 444 social workers with a history of substance problems, exposure to physical neglect predicted lower levels of career success. Keesler (2018) administered the ACE scale to 386 direct support professionals who worked with individuals experiencing intellectual and developmental disabilities. The study found that ACE scores among these professionals were higher than those reported in the general population.

Purpose of Study

The generalizability of previous ACE-related studies of human service workers is limited due to small sample sizes and overreliance on participants who were employed in the same organization or who resided in a single geographic region. Moreover, past research measured ACEs of professionals from a variety of disciplines, obfuscating any social work–specific findings that might have been present. The purpose of the current study was multifaceted: (a) to measure ACEs in a large, multistate sample of licensed social workers; (b) to compare the study’s ACE scores with findings from CDC–Kaiser Permanente research by assessing the frequency of the 10 types of ACEs and the distribution of ACE scores; (c) to examine differences in ACE exposure by age, race/ethnicity, sex, and sexual orientation; (d) to analyze associations between ACEs and wellness factors, including physical health, mental health, AOD use, tobacco use, and sleep; and (e) to explore correlations between ACEs and two indicators of workplace experiences: workplace stress, which measures the fit between the individual and the work environment (The Marlin Company & the American Institute of Stress, 2001), and compassion satisfaction, which examines the pleasure helping professionals derive from performing their work, including “liking the feeling of being able to help others and to spend time with people who are committed to [helping others]” (Stamm, 2012, p. 3).

Method

Procedures and Study Respondents

In 2015, 6,112 licensed social workers in the United States responded to a 75-item online questionnaire that explored their behavioral and physical health problems, ACEs, workplace issues, and demographics. In the prior year, professional boards of all 50 states were contacted regarding the availability of licensees’ email addresses, with 13 states responding in the affirmative: Arkansas, Connecticut, Florida, Minnesota, New Jersey, New Mexico, Ohio, Oklahoma, Oregon, Rhode Island, Washington, West Virginia, and Wyoming. These 13 states are located in all four federal U.S. Census Bureau regions. Nearly 70,000 email addresses were obtained from these states, and a random sample of one half of these individuals (n = 34,831) were emailed regarding participation with a link to the survey. As some social workers were licensed in multiple states, professionals credentialed in all 50 states were represented in the study’s sample. To incentivize participation, five randomly selected respondents received gift cards from Amazon. Qualtrics was used to collect and manage data, and statistical analyses were conducted using IBM SPSS Statistics 23 software. The two institutional review boards of the researchers’ universities approved the methods of this study. The informed consent indicated that the study explored wellness and adverse childhood events. Respondents were notified that they could discontinue participation for any reason, including concerns related to emotional distress caused by the survey, and the phone number for the National Helpline of the Substance Abuse and Mental Health Services Administration was provided. After adjusting for emails that were returned as undeliverable, the survey participation rate was 28%. This article is based on findings from the 5,540 social workers who responded to all 10 ACE items in the online questionnaire.

Measures

The questionnaire included five sections related to this article: (a) exposure to ACEs; (b) problems with physical health, mental health, and AODs; (c) tobacco, gambling, and sleep problems; (d) professional background and work experiences; and (e) demographics and personal information. The independent variables utilized in the analyses of this study were the number of ACEs of the participants, as well as their age, race/ethnicity, sex, and sexual orientation. Wellness (physical health, mental health, AODs, tobacco, and sleep) and workplace issues (compassion satisfaction and workplace stress) were included as dependent variables. Descriptions of these measures are provided below.

ACEs

The measures of childhood maltreatment are listed in Table 1. The study utilized the 10 retrospective factors that were included in the original ACE papers (Anda et al., 2006). Study respondents were instructed to select “1” for each item that occurred during their first 18 years of life. The scores could range from 0 to 10.

Table 1.

ACE Scores of Respondents.

Type of Adverse Childhood Experience	%
ACE 1: Emotional abuse	30.5
ACE 2: Physical abuse	16.3
ACE 3: Sexual abuse	20.5
ACE 4: Emotional neglect	26.1
ACE 5: Physical neglect	6.6
ACE 6: Parents divorced or separated	32.5
ACE 7: Mother victim of domestic violence	9.8
ACE 8: Lived with substance abuser	30.9
ACE 9: Household member mentally ill or attempted suicide	36.2
ACE 10: Household member incarcerated	4.9
Total ACE score: M (SD)		2.1 (2.2)
Total ACE score: Median		1.0

Note. ACE = adverse childhood experience.

Demographic and work-related factors

The survey asked respondents a number of demographic and work-related questions, including age (any numeric value), race/ethnicity (Black and/or African American, East Asian, Latino and/or Hispanic, Middle Eastern, Native American and/or Alaska Native, Native Hawaiian and/or Pacific Islander, South Asian, White and/or European American, Other), sex (female, male, other), sexual orientation (bisexual, gay or lesbian, heterosexual, other), number of years employed as a social worker (any numeric value), and highest level of education (bachelor’s degree in social work, master’s degree in social work, doctoral degree in social work). Only demographic categories selected by more than 1% were included in the analyses. Therefore, regarding race/ethnicity, only differences between Black, Latino, and White were examined. Regarding sex and sexual orientation, respondents who selected “Other” were not included in the analyses of those variables.

Physical health

Respondents who indicated they had experienced serious physical problems were posed the following: “Over the course of my social work career, there has been a time when I experienced one or more physical health problems.” Response options were strongly disagree, disagree, agree, or strongly agree.

Mental health

Participants were presented with the following item: “Over the course of my social work career, there has been a time when I experienced mental health problems,” with the following response options: strongly disagree, disagree, agree, or strongly agree.

AODs

The following item was posed to assess substance misuse: “Over the course of my social work career, there has been a time when I experienced problems with alcohol or drugs.” Options included strongly disagree, disagree, agree, or strongly agree.

Tobacco use

Tobacco use was assessed with the following question: “Over the course of your social work career, how often have you used tobacco?” Response options included hardly ever or never, in the past but have completely stopped, off and on, and throughout my social work career.

Sleep

Sleep was measured with the following question: “Over the course of your social work career, have you had a problem with sleep?” Response options included never, rarely, sometimes, or often.

Compassion satisfaction

Two instruments were used to assess workplace issues. The Compassion Satisfaction subscale of the Professional Quality of Life Scale (Stamm, 2010) measures the positive feelings health care providers experienced as they engaged with clients during the past 30 days. Scores on the 10-item inventory ranged from 1 = never to 5 = very often, and included items such as “My work makes me feel satisfied” and “I have happy thoughts and feelings about those I help and how I could help them.” Only participants who reported that they worked in direct practice with clients were asked to respond to this scale. The Cronbach’s alpha value for this scale in this study is .93.

Workplace stress

The Workplace Stress Scale (The Marlin Company & the American Institute of Stress, 2001) consists of eight items assessing levels of stress at respondents’ current places of employment. Examples of items are the following: “I have too much work to do and/or too many unreasonable deadlines” and “I feel that my job is negatively affecting my physical or emotional wellbeing.” Responses included options ranging from 1 = never to 5 = very often. As this scale only measures workplace stress in institutional settings, participants who reported only working in private practice settings were not directed to respond to this measure. In this study, the Cronbach’s alpha for this scale is .83.

Analysis

The percentage of respondents who were exposed to each of the 10 ACEs is reported, as well as the mean and median of the total number of ACEs they experienced. The frequencies of ACE scores of the current study were compared with data from Wave I and Wave II of the Kaiser Permanente–CDC study (Anda et al., 2006). The mean number of ACEs reported by this study’s age groups (21–39; 40–59; 60 and above), racial/ethnic groups (White; Black; Latino), sex groups (male; female), and sexual orientation groups (heterosexual; gay; bisexual) were compared together using multifactor analysis of variance (ANOVA) with Tukey post hoc analyses. ANOVA was also utilized to determine correlations between the participants’ ACE scores and their reporting of physical health problems, mental health problems, AOD problems, lifetime use of tobacco, and sleep problems. For greater clarity and succinctness, all of the wellness variables were dichotomized into yes/no responses. For example, response options to the physical health question strongly disagree, disagree, agree, or strongly agree were collapsed into “yes” and “no” categories, with strongly agree and agree coded as “yes” and strongly disagree and disagree coded as “no.” Last, Pearson’s r was used to determine correlations between the respondents’ ACE scores, compassion satisfaction, and workplace stress.

Results

The mean age of respondents was 46.1 (SD = 13.2) years. A majority of respondents indicated that they identified as White (83.4%), with 6.0% identifying as Black, 3.9% as Latino, and 6.6% as mixed or other categories. Participants were most likely to identify as female (88.8%) and heterosexual (90.7%). Regarding professional background, 80.2% of respondents reported that a Master of Social Work degree was their highest level of education, whereas 17.7% reported that their highest degree was a Bachelor in Social Work. Only 1.6% reported achieving a doctoral degree. On average, the length of time employed as a social worker was 16.1 (SD = 11.3) years. Table 1 indicates that the three most commonly occurring types of ACEs were mental illness in the home (36.2%), parental divorce or separation (32.5%), and having lived with a substance abuser (30.9%).

Table 2 displays the distribution of exposures to ACEs, comparing findings from the current study with data from Wave I and Wave II of the Kaiser Permanente–CDC study (Anda et al., 2006). In the current study, 29.7% of respondents had not encountered childhood maltreatment, and 20.7% of respondents scored a 1 on the ACE scale. In comparison, 36.1% of participants in the Wave I and Wave II studies reported an ACE of 0, and approximately one fourth of individuals had an ACE score of 1. The difference between participants of these two studies becomes particularly pronounced at the higher levels of ACE exposures. In the Kaiser Permanente–CDC waves of ACE research, 12.5% of respondents indicated four or more ACEs. In contrast, 23.6% of licensed social workers who participated in the current study reported exposure to four or more ACEs.

Table 2.

Comparison of ACE Score Distributions, Kaiser Permanente–CDC Study Versus Current Study.

Number of ACEs	Kaiser Permanente–CDC study^a (%)	Current study (%)
No ACEs	36.1	29.7
1 ACE	26.0	20.7
2 ACEs	15.9	14.4
3 ACEs	9.5	11.6
4 or more ACEs	12.5	23.6

Note. ACE = adverse childhood experience; CDC = Centers for Disease Control and Prevention.

Anda et al. (2006).

Table 3 demonstrates that statistically significant differences in mean ACE scores by age, race/ethnicity, and sexual orientation were found. In regard to age, respondents who were 40 to 59 had statistically significant higher ACE scores than those who were 21 to 39 and those who were 60 and above. The mean ACE score of White respondents was significantly lower than ACE exposures reported by Blacks and Latinos. Regarding differences between sexual orientation groups, heterosexual participants had lower mean ACEs scores than both gay and bisexual participants. No statistically significant differences were found between mean ACE scores of females and males.

Table 3.

ACE: Scores of Respondents by Age, Race/Ethnicity, Sex, and Sexual Orientation (Multifactor ANOVA Analysis; n = 4,880).

Demographic Feature	n	Mean ACE score (SD)	Sum of squares	Mean square	F	df	p
Age^a			89.82	44.91	9.88	(2.5332)	.001*
21–39	1,774	1.99 (2.14)
40–59	2,123	2.23 (2.22)
60 and above	983	1.85 (2.05)
Race/ethnicity^b			153.97	76.98	16.93	(2.5064)	.001*
White	4,368	2.01 (2.15)
Black	308	2.47 (2.12)
Latino	204	2.68 (2.43)
Sex			10.88	10.88	2.39	(1.5399)	.12
Female	4,345	2.08 (2.16)
Male	535	1.97 (2.19)
Sexual orientation^c			417.45	208.73	45.90	(2.5339)	.001*
Heterosexual	4,485	1.98 (2.12)
Gay	251	2.84 (2.40)
Bisexual	144	3.31 (2.34)

Note. ACE = adverse childhood experience; ANOVA = analysis of variance.

Tukey post hoc analysis reveals statistically significant differences between “40–59” and “21–39”; and “40–49” and “60 and above.” ^bTukey post hoc analysis reveals statistically significant differences between White and Black; and White and Latino. ^cTukey post hoc analysis reveals statistically significant differences between Heterosexual and Gay, and Heterosexual and Bisexual.

p ≤ .05 represents statistical significance.

Table 4 displays results from analyses of ACEs and wellness variables. ACEs were correlated with all markers of wellness at statistically significant levels. Regarding physical health problems, respondents experiencing these issues had higher mean ACE scores (2.32) than those without physical health problems (1.83). Approximately one half of study participants reported mental health problems (51.8%), and those with these issues reported higher ACE scores (2.58) than those without mental health problems (1.64). A small minority of respondents indicated a history of AOD problems (7.5%), and these individuals had higher ACE scores (2.85) than the 92.5% of individuals without AOD issues (2.07). About one third of the social workers had a history of tobacco use (29.7%); their ACE scores (2.49) were significantly higher than social workers who had not used tobacco (1.97). Approximately 60% of respondents had sleep problems, and their ACE scores (2.43) were higher than those without sleep issues (1.66).

Table 4.

ACEs and Wellness Problems.

Wellness Problem	n	%	Mean ACE score (SD)	F	df	p
Reported mental health problems				268.70	1.5528	.001*
Yes	2,866	51.8	2.58 (2.31)
No	2,664	48.2	1.64 (1.96)
Reported substance misuse problems				48.25	1.5525	.001*
Yes	412	7.5	2.85 (2.35)
No	5,115	92.5	2.07 (2.18)
Reported serious physical health problems				63.87	1.5119	.001*
Yes	3,365	60.8	2.32 (2.27)
No	2,166	39.2	1.83 (2.04)
Reported history of tobacco use				65.14	1.5532	.001*
Yes	1,640	29.7	2.49 (2.31)
No	3,881	70.3	1.97 (2.13)

Note. ACE = adverse childhood experience.

p ≤ .05 represents statistical significance.

Among the 4,061 social workers who completed the eight-item Workplace Stress Scale, the presence of workplace stress was correlated with reports of exposure to ACEs (see Table 5). Among respondents engaged in direct practice with clients (3,566), there was no statistically significant relationship between their childhood maltreatment and compassion satisfaction, an indicator of positive feelings toward working with clients (see Table 5).

Table 5.

Correlation of ACEs With Compassion Satisfaction and Workplace Stress.

Adverse Childhood Experience	Compassion satisfaction^a			Workplace stress^b
Adverse Childhood Experience	n	Pearson’s r	p	n	Pearson’s r	p
Total ACE score	3,566	−.02	0.19	4,061	.15	.001*

Note. ACE = adverse childhood experience.

Only respondents working in direct practice with clients were asked to complete this scale. ^bAs this scale applies only to workplace stress in organizational settings, respondents working exclusively in private practice were not asked to complete this scale.

p ≤ .05 represents statistical significance.

Discussion

This study demonstrates that ACEs influence many areas of social workers’ lives, which undoubtedly affect their clients and organization in which they work. Findings from this study are consistent with the results of previous ACE studies which found that social workers and other human service professionals tend to have ACE scores that are higher than the general population. For example, the mean number of ACE exposures in this study was 2.1, a figure identical to what was found in Esaki and Larkin’s (2013) survey of child service providers. The differences in the ACE scores between the social workers in this study and those reported for the general population are substantial. Whereas the Kaiser Permanente/ACE studies (Anda et al., 2006) found that 12.5% of respondents reported four or more ACEs, this was the case for nearly twice as many (23.6%) of the social workers in this study. The effects of ACEs are particularly deleterious at higher levels of exposure. As a considerable number of social workers reported elevated exposure to ACEs, there is great risk for multiple wellness problems, issues that may pose challenges to the workplace and the profession as a whole. As can be seen in Table 4, a substantial number of study respondents have been affected by wellness problems, with over half of the participants reporting problems with physical health (60.8%), mental health (51.8%), and sleep (60.6%) at some point in their social work careers. Therefore, given the elevated rate of ACEs and substantial problems with wellness, it is imperative to consider their implications for individual social workers and the workforce.

Regarding workplace issues, there was no relationship between ACEs and compassion satisfaction. This suggests that exposure to childhood adversity did not influence respondents’ ability to derive pleasure from helping others. On the contrary, ACEs were associated with workplace stress, such that higher ACEs scores were correlated with greater levels of workplace stress. Workplace stress measures conditions like having control over one’s level of work, relating with colleagues, experiencing a safe workplace environment, and balancing work–life obligations. This suggests that childhood maltreatment may compromise one’s ability to manage workplace duties and relationships, findings that warrant additional investigation.

Newcomb et al. (2015) discussed a number of negative ramifications of social work students’ childhood adversities in regard to their work with clients, such as an increased number of difficult countertransference reactions and the potential for vicarious traumatization and burnout. However, the authors also note that the resilience of having survived childhood adversities can be a significant strength when working with clients. In this regard, Dykes (2016), who found high levels of ACEs among social work students, described post-traumatic growth from these challenges. Students identified ways in which their development was enhanced as a result of childhood difficulties, including renewed appreciation of life, enhanced personal growth, improved relationships with others, and spiritual change.

Another noteworthy finding from the study was the disparities in ACE scores according to age, race/ethnicity, sex, and sexual orientation. Although there have been inconsistent findings in the literature regarding disparities in ACE scores by these variables, it is worth noting that the middle age cohort had higher ACE scores than the younger and older groups, a finding calling for further exploration. White respondents reported lower ACE scores than Black and Latino participants, a result that may be explained by childhood socioeconomic status or community dynamics, such as exposure to neighborhood violence. Higher ACE scores among gay and bisexual respondents in comparison with their heterosexual counterparts have been consistently reported in the literature among the general population (Anderson & Blosnich, 2013).

Implications for Practice and Education

This study found that social workers’ experiences of childhood adversity and problems related to these exposures are common occurrences, and not aberrations. Before social workers can be better able to help their clients address their childhood traumas and reduce and prevent intergenerational transmission of ACEs (Larkin, 2014), the profession needs to recognize and address the relatively high rate of ACEs among licensed social workers, as well as social work students. Institutions where social workers are employed need to be sensitive to the ACEs of their staff, providing appropriate supports and supervision to enable optimal success. As Zerubavel and Wright (2012) pointed out, clinicians with high ACE scores need far more support from their supervisors to process their own mental health problems emanating from early life adversities, without the stigma that often accompany such disclosures. Future quantitative studies exploring the perceived impact of social workers with high ACEs would provide important data on the best way of helping such workers deal with their own countertransference and minimize their secondary trauma and retraumatization (Pooler et al., 2008; Straussner & Calnan, 2014). Although the role of the workplace is not to provide treatment to their “wounded healers” (Straussner et al., 2018), agencies can offer in-service training and encourage staff to attend continuing education in the community that can provide knowledge regarding ACEs and teach problem-solving skills and self-care, including utilization of behavioral health resources (Pooler et al., 2008; Steen, 2017). National policies requiring the provision of mental health insurance coverage for all are essential in helping social workers with histories of childhood maltreatment.

The findings of this study point to the need for effective trauma-focused education in social work schools. Given the probability of a large number of students entering programs with a history of ACEs, students need to be taught about vicarious traumatization and be prepared for the possibility of experiencing disturbing thoughts and emotions, as well as difficult somatic responses (Gilin & Kauffman, 2015). Introducing the notion of self-care as an important practice to reduce negative effects of trauma should be part of the curriculum in every school. Moreover, as pointed out by Zosky (2013), social work faculty, as well as supervisors, need to have the self-awareness and ability to help their students resolve trauma in effective and appropriate ways.

Finally, it is important to remember that despite their ACEs, the participants in this study have been able to overcome their early life traumas to become licensed social workers and contribute to the profession and society (Butler et al., 2018). Future mixed-methods research exploring dynamics of resilience among social workers could make a significant contribution to our understanding of the process of assessing and overcoming ACEs.

Limitations of Study

There are a number of limitations to this study. It is likely that social desirability bias influenced participants’ responses to the sensitive topics explored in the study. Although the study’s 28% participation rate is considered acceptable for web-based research (Tourangeau et al., 2013; Van Selm & Jankowski, 2006), it cannot be determined how the characteristics of those who responded to the survey differed from those who did not. Regarding generalizability, respondents from only 13 states participated in this study and all participants were licensed social workers. Therefore, this study cannot make claims to represent the experiences of the entire social work workforce. A majority of respondents were White, female, and heterosexual. Although it may be useful to collect data from underrepresented groups, it is important to note that the characteristics of the study’s respondents were similar to the demographics of the latest national survey of licensed social workers, conducted by the National Association of Social Workers (Whitaker et al., 2006). Another limitation of this study pertains to the ACE instrument itself. Issues such as parent death, exposure to community violence, poverty, and racism are not captured in the ACE scale but are being explored in other scholarship (Evans & Kim, 2007; Finkelhor et al., 2015). Furthermore, Lacey and Minnis (2019) noted that the ACE measure does not take into account severity, frequency, duration or timing of childhood maltreatment, factors which may significantly impact interpretation of ACE-related outcomes.

Conclusion

This study of more than 5,500 licensed social workers contributes to the expansive body of ACE-related literature. Compared with the respondents in the Kaiser Permanente–CDC inquiries, participants in this study were more likely to report histories of childhood maltreatment. ACEs were strongly associated with nearly all factors that were examined, including wellness and workplace stress. As organizations and communities institute ACE-informed practices and programs for clients, it is essential that they also turn awareness to the professionals developing these initiatives and the impact of their own histories of childhood adversity.

Footnotes

Acknowledgements

The authors wish to acknowledge Ortal Wasser and her contribution to the literature review.

Disposition editor: Sondra J. Fogel

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The funding for this study was provided by the Office for Research at the New York University Silver School of Social Work.

ORCID iD

Jeffrey T. Steen

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