GIBM Addresses ACE Survey with CDC

September 20, 2020

(Updated January 1, 2021)

by Sean Kullman

Blair Daly, a supporter of Union Gospel Mission in Seattle

The Adverse Childhood Experience Survey, used since the mid-1990s, has been a staple for institutions nationwide to address adverse childhood experiences that contribute to higher physical and emotional health risks later in life. A detailed review of the survey shows the domestic violence component has an essential flaw.

Seattle’s Union Gospel Mission (UGM) is a refuge to Seattle’s homeless. With over 12,000 homeless men, women, and children in Seattle, UGM provides meals and shelter for a large populace. UGM makes a point of referring to those without a home as neighbors as a way to place them in the light of community. In doing so, UGM has expanded the notion of neighbor and the community has responded with the type of support that allows UGM to carry out its mission.

Blair Daly believes he first visited Union Gospel Mission when he was a high school student. Now 33, Blair finds himself donating to the homeless shelter and becoming more engaged with his community in Seattle.

While reading a Homelessness in Seattle write-up that explains Union Gospel Mission’s take on the homelessness situation, Daly saw information that addressed domestic violence against mothers but not against fathers. He learned the mission uses information from the Adverse Childhood Experience (ACE) Survey in its literature: A survey that aims to identify childhood experiences that contribute to higher physical and emotional health risks later in life. The questionnaire and content from the study (used by UGM) seemed incomplete to Daly, so he brought his concerns to the UGM staff.

“I noticed there was information regarding mothers being treated violently, but it didn’t include language around fathers being treated violently,” said Daly, who has firsthand experience with female domestic violence against males. And with 70% of the homeless in the United States being male, Daly had a point. Daly asked the mission to expand its understanding of domestic violence, and Union Gospel Mission did change its language to be more inclusive, acknowledging, “domestic violence is traumatizing to a child witnessing the assault of the father or the mother.”

Although UGM was open to Daly’s concerns, the real questions needed to be directed at the Centers for Disease Control and Dr. Vincent Felitte and Dr. Robert Anda who conducted the original study regarding adverse childhood experiences. Studies like the Adverse Childhood Experience Survey fail to include questions about witnessing abuse against men despite the mounting evidence that violence against men is on the rise. According to experts, men are less likely than woman to report abuse for fear of shame and ridicule. Men also fear not being believed and suddenly going from victim to perpetrator. It’s one of the reasons the Adverse Childhood Experience Survey plays a vital role in the awareness of domestic violence against males and females in the eyes of law enforcement, government researchers, media, and academic institutions .

In phone calls and emails with the Centers for Disease Control (CDC), the CDC acknowledged changes were made in an updated module of the ACE Survey, but the new module did not specifically address father victims; instead, introducing a broader question: “How often did your parents or adults in your home ever slap, hit, kick, punch, or beat each other up?” The new question gathers information about intimate partner violence (IPV) and the childhood experience in a more generic way, but the generic approach continues to leave men behind as the CDC continues to publish data and surveys specifically focused on female victimization with little attention focused on male victimization. By failing to ask children about witnessing the abuse of fathers at the hands of mothers, the CDC misses adverse childhood experiences that shape children’s lives and impact health risks into adulthood. The disproportionate lack of attention paid to male victims additionally allows for an amplification of the amount of attention paid to female victims, influencing public opinion regarding domestic violence actualized in policies such as the Violence Against Women Act, Title IX, and institutional actions on college campuses nationwide.

In the ACE Survey conducted “between 1995-1997, over 17,000 people receiving physical exams completed confidential surveys containing information about their childhood experiences and current health status behaviors.” The study identified three categories. One of its measures failed to identify father treated violently[1] while addressing “mother treated violently,” creating an infographic that identifies domestic violence against mothers when no measure was taken to acknowledge and quantify household environments prone to domestic violence against fathers. Important context is missing from the infographic and creates some challenges we will address later regarding the reporting of information.

In the original survey, people were asked about mothers, stepmothers, and father’s girlfriends being treated violently (see question 41 of survey), but there was not a question that asked about fathers, stepfathers, and mother’s boyfriends being treated violently.

The survey and its data continue to be used as a survey-tool and source despite this essential flaw. GIBM mentioned the following to the CDC: recognition should be made on infographics and other documents stating that the CDC failed to include questions asking children about seeing their fathers, stepfathers, and mother's boyfriends being abused, so instances of domestic violence against men is not included in the original study. The CDC acknowledged in an email to GIBM that "we agree that this is an important clarification when interpreting the original results of the Kaiser-CDC study published in 1998."

Real Experiences

John Dow (who chose to use a pseudonym) regularly witnessed his mother physically and emotionally abuse his father.

“My mother physically abused my father several times a week. That does not include the emotional abuse. After watching it for years, I developed a tendency to instinctively resign a little emotionally as an adult and in my marriage. My father always told me to keep a low profile in my marriage. I think it’s been unhealthy and the reason I crave intimacy with my children and wife. I’m worried it’s seen as controlling on my part but it’s not my intention. I just want a more intimate relationship with my family.”

John is luckier than most and credits finding a wife with great empathy, even after she personally witnessed the harmful environment John grew up in on her first visit to his parents’ home. “After witnessing my family’s disfunction, she nearly broke up with me. I guess I was able to charm her,” he said with a chuckle, knowing it had much to do with her empathy and his introspection.

Source: U.S. Department of Health & Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2020). Child Maltreatment 2018.

John’s fear and emotional resignation speaks to a growing reticence of men to come forward and the failings of the institutions around him to openly address the topic. There is a general reluctance on the part of government, academia, and media to pursue deeper inquiries into male victimization and pursue women as perpetrators of violence, even though studies show mothers are nearly twice as likely (39.4%) as fathers (21.5%) to perpetrate violence against children in instances of child abuse, according to the 2018 Child Maltreatment report by the U.S. Department of Health and Human Services. John, who witnessed the abuse of his father, also suffered at the hands of an abusive mother. “We never knew when the switch would turn, and she’d beat us,” said John, who has a brother.

These unrecognized experiences are the function of a reverse-sexism that does not openly recognize violence against men. The fact that men fear coming forward for fear of not being believed speaks to the underlying systemic causes of the problem.

The ACE Survey Today

In 2018, Michael Windle, PHD, et al completed a study of “2,969 college students from seven universities in the state of Georgia…. Data collection began in Fall 2014 and consisted of individual assessments every four months for two years.” The study, “A multivariate analysis of adverse childhood experiences and health behaviors and outcomes among college students,” relied on the ACE Survey that quantified “mother treated violently” but not father treated violently. This happens, in part, because the ACE "questionnaires are not copyrighted, and there are no fees for their use." In other words, the CDC is encouraging the use of the original questionnaire with the knowledge that fathers and males impacted by intimate partner violence are not included in the original survey and that the CDC has added a more gender-neutral question in an updated survey. The CDC has told GIBM “the study is referenced on the CDC’s website because of its historical significance to the field.” That supposition downplays an important fact that the old survey, in use today, continues to ignore intimate partner violence against males. The CDC is not in the historical preservation game, particularly when its notion of significance goes against its own science, policy, and mission. In its pledge to the American people, the CDC promises to "place the benefits to society above the benefits to its institution, and to "treat all persons with dignity, honesty, and respect." Encouraging the use of the old survey actually places the benefits of the institution over the benefits of society and does not treat all persons' adverse childhood experiences equally.

GIBM has asked the CDC to remove the original questionnaire or recommend that it not be used because it fails to address the adverse childhood experience of witnessing the abuse of fathers, step-fathers, and mother’s boyfriends.

There are other complications that may impact reporting, such as interviewers listing “mother treated violently” when it was a father treated violently as a way to acknowledge an adverse childhood experience. The possibility exists that participants in the study wanted to address their adverse childhood experience and listed “mother treated violently” because there was not an option to address father treated violently.

For people like John, the ACE Survey would not have asked him about his mother abusing his father.

Marc Angelucci, recently murdered men’s rights attorney and former Vice President of the National Coalition for Men, knew all too well that government agencies and universities ignore male victims. Angelucci joined the National Coalition for Men (NCFM) as a law student in 1997 after a friend of his was denied domestic violence services for being male. This moment would shape Angelucci’s career, and he would go on to dedicate his time and ultimately his life advocating for boys and men.

A decade after joining NCFM, Angelucci won a landmark appellate case (Wood v. Horton) against the State of California which held it is unconstitutional to exclude male victims of domestic violence from state funding for victim services. Angelucci was not alone in his observations. Patricia Shanley Overberg, MSW, was instrumental in Angelucci’s success. Although Overberg “was subjected to continuous abuse by other shelter directors for sheltering battered men,” she would eventually encourage NCFM to sue the state of California.

The 2008 court Remedy for Violation of Equal Protection would include the following language:

“In reforming the statutes that provide funding for domestic violence programs to be gender-neutral, we do not require that such programs offer identical services to men and women. Given the noted disparity in the number of women needing services and the greater severity of their injuries, it may be appropriate to provide more and different services to battered women and their children. For example, a program might offer shelter for women, but only hotel vouchers for a smaller number of men.”

Overberg, like the great Erin Pizzey, was treated with contempt by those unwilling to see the broader more complicated nature of domestic violence. Pizzey, who founded the first women’s refuge in Britain, would later be labeled a pariah of the women’s movement for offering to help battered men, even though her contributions were instrumental in the success of the women’s movement. Pizzey’s willingness to address the underplayed female nature that is prone to violence would do more than impact her career. It would shape the narrative, funding, and research regarding domestic violence today.

The Wood v Horton ruling states “domestic violence services provided to men and women need not be identical because women are battered in significantly greater numbers than men and suffer greater injuries when battered.” This type of opinion is predicated in part by studies such as ACE, that do not ask about male victims. The current court system follows suite and turns a blind eye to the willful ignorance of male victimization.

Although the ACE Study, its data, and other replicated studies using the ACE model are flawed in the sense of intimate particular violence against males, it should be noted that the ACE Study has been instrumental in identifying that adverse childhood experiences contribute to later health risks. (That outcome should not dismiss the willful-ignorance of male victimization.). It should also be noted that much of the attention regarding adverse experiences related to domestic violence still focuses on female victims. In doing so, the abundance of attention, resources, and public perception flows primarily in one direction.

There is an immense gap that still exists within universities, government agencies, and the media when it comes to domestic violence against males and the adverse childhood experiences that impact physical and emotional health. With institutions and individuals relying on the ACE Survey and its results to gather and share information, one has to question whether it’s time for a new CDC study more inclusive of children and men who witness and are victims of domestic violence and abuse. Instead, we rely on people like Blair Daly and others to notice these short-comings and address them institution by institution, an affective but slower process that does not place the burden on government and other agencies to effectively create the necessary change.

It’s important to address the entrenched, systemic institutional processes and narratives that take hold and continue to dictate social practices. We are culturally sensitized to accept domestic violence as a man’s problem and a woman’s burden when we need to see it as a human problem and a human burden. There are hundreds of peer reviewed studies that show “women and men in intimate relationships initiate assault and actually assault each other at equal rates,” says Philip W. Cook, author of Abused Men: The Hidden Side of Domestic Violence. For Mr. Cook, the fix is a fairly simple one: “take the same question that asks about mothers and simply add another one that asks about fathers.”

GIBM has asked the CDC to include a visible infographic that states the following: The original ACE Survey did not address the abuse of fathers, step-fathers, and mother's boyfriends at the hands of mothers. Therefore, intimate partner violence information against males was not collected and a reason the CDC needed to add a more gender-neutral question in an updated survey.

GIBM has made a few other requests and the CDC is sharing our notes with its researchers.

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