The phrase ‘refer people to services’ is a warning sign

_copyright”>Katherine Ortega Courtney

and Dominic Cappello

Imagine you’re a state or local elected official, committed to the people who voted you into civic duty. A child neglect case hits the headlines and, soon after, a little girl dies of abuse in your district. You’ve been reminded, in the saddest way possible, of the huge emotional and financial costs associated with childhood adversity, abuse, neglect and trauma.

Suddenly on your computer screen comes a message from the Centers for Disease Control (CDC) focused on preventing adverse childhood experiences (ACEs) and trauma. You find yourself looking at the prevention message, called “The Way Forward,” and think to yourself, “This all sounds very reasonable … we just need to get our folks to services.”

What the CDC recommends will be helpful, but there’s only one problem. What the CDC recommends has an important first step that can easily be missed. Here’s why.

First, the CDC recommends that health care providers “Anticipate and recognize current risk for ACEs in children and history of ACEs in adults.” Who is supposed to train all our health care providers on ACEs screening and assessment?

And when the CDC writes, “Refer patients to effective services and support,” what services are they talking about?

All states suffer huge shortages of health care providers and support agencies. Middle-class folks with insurance might wait months to see a provider if they can find a quality caregiver. Those with fewer resources may not be seeing providers for even longer, if ever. If only “referring to services” was as easy as getting a Starbucks latte in a drive-through. Sadly, we know that it is not that simple, especially for families in New Mexico.

Second, the CDC suggests that we “Link adults to family-centered treatment approaches that include substance abuse treatment.” Unless you are the 1% living like a royal prince, accessing quality, local substance abuse treatment is a financial hardship even for middle-class two-income families. And that is only possible if those services are available.

Third, we find the CDC suggesting that we provide to our moms and dads “parenting interventions.” If they mean parent supports, that’s an excellent idea – except that most counties don’t have a seamless system of affordable and accessible child care, home visiting programs or support for all parents.

Fourth, the CDC suggests that we should “Enhance connections to caring adults.” Are localities to build a system of mentoring programs? Or accessible behavioral health care? If so, will the federal government pay for that with our tax dollars?

Then the CDC shares “… and increase parents’ and youth skills to manage emotions and conflicts using approaches in schools and other settings.” If the feds want to truly help students and family members who are traumatized and struggling with many forms of social adversity, we certainly must use the schools as hubs for care. But “managing emotions” takes more than workshops with third-grade moms, it requires that localities invest in school-based behavioral health care.

Most parents don’t live in a world where “services” are just a click away on some dream-like app. Our families work hard, often with two jobs and two income earners in a household, and can still barely pay all the monthly bills. Whenever you hear “refer people to services,” that should set off huge warning bells.

There is a danger, and a very real chance for, complacency when initiatives start with “connecting people to services” without first determining whether there is an adequate, accessible and available network of services.

We’re working hard to implement our “100% Community” model of agency capacity-building, starting by asking parents and families whether they have access to 10 vital services for family members in our pilot sites in Doña Ana, Socorro and Rio Arriba. Armed with real data, communities will then be able to research solutions and advocate to fill the gaps. These counties are creating a future when the phrase “connect people to services” will be meaningful because they will have built them.

Katherine Ortega Courtney and Dominic Cappello are the co-directors of the Anna, Age Eight Institute and co-authors of “Anna, Age Eight: The Data-driven Prevention of Childhood Trauma and Maltreatment,” free of charge to download for New Mexcian residents at

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