Talking about trauma: Findings and opportunities from an analysis of news coverage

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Talking about trauma: Findings and opportunities from an analysis of news coverage

Wednesday, October 28, 2015The findings were paradigm-shifting: In the 1990s, the Adverse Childhood Experiences (ACE) study, conducted by the Centers for Disease Control and Prevention and Kaiser Permanente's Health Appraisal Clinic in San Diego, provided conclusive evidence that when children face trauma (such as witnessing domestic violence or drug abuse, or experiencing sexual abuse), they may experience damaging physical and mental health consequences as a result. Indeed, the higher an individual's "ACE score," the greater his or her risk for poor mental and physical health outcomes in adulthood, including diabetes, cancer, substance abuse and suicide.1 Yet, in spite of the profound implications that ACEs research has for nearly every sector in our society — especially those dealing directly with children and youth — describing the problems ACEs uncover, and how to address them, has proved challenging. One step toward developing more effective strategies to communicate about ACEs is to find out how ACEs and childhood trauma currently appear in the media. Investigating news coverage in particular can provide important clues about what information the public and policymakers are likely to be exposed to about the issue. Although new media platforms are changing the way people consume the news, newspapers (including their online components) continue to influence local and national policy debates, and traditional news outlets remain a key source of information for the majority of news consumers.2 News coverage can set the agenda for debates regarding public policies that could prevent or address childhood trauma.3-6 If news coverage doesn't discuss childhood trauma or doesn't make connections to the societal conditions that foster childhood trauma, it is less likely that policymakers and the public will see the issue as a priority or recognize it as a problem that can be prevented. Comprehensive strategies to prevent and address ACEs and build resilient communities require the participation of multiple sectors, including education, business, health care and criminal justice. However, the connections between these sectors and childhood trauma may not be visible in the news, obscuring the fact that schools, businesses and other actors have an important role to play in preventing or addressing ACEs and their impact on individuals and communities. In other words, news about childhood trauma may discourage positive action and reinforce assumptions that the problem is intractable if it obscures the interconnections among trauma and various sectors of our society. The larger social context in which childhood trauma occurs, and the many stakeholders who are impacted by it, could be explained in stories about crime and violence, but also in business news, in education news, or in stories about any sector that has a role to play in preventing or addressing trauma. The question, then, is how do ACEs appear in news coverage, and do connections to childhood trauma appear in stories from multiple sectors? For this study, we first established how ACEs currently appear in news coverage. We then asked, does childhood trauma appear in articles about education and business, and if not, where could it appear in the news about these sectors? We examined the business and education sectors for this analysis because we know that trauma can interfere with employee productivity and retention7, 8 as well as educational outcomes,9-11 and both sectors can play an important role in preventing or addressing childhood trauma. Both businesses and schools, for example, can mitigate the impact of employees' or students' past trauma by becoming trauma-informed.12-16

What we did

To understand how ACEs appear in the news, we searched for news stories that mentioned adverse childhood experiences from 2008 to 2014 in more than 500 U.S. newspapers, wire services and blogs archived in the Nexis database. We analyzed a random sample to determine how these stories characterized ACEs, why they were in the news, who spoke about ACEs, and how, if at all, they discussed preventing or addressing ACEs. Then, to explore how ACEs could appear in the news about education and business, we conducted a content analysis to identify stories that explicitly mentioned, or were closely related to, ACEs or childhood trauma in six major California newspapers (the San Francisco Chronicle, San Jose Mercury News, Contra Costa Times, Oakland Tribune, Sacramento Bee, and Los Angeles Times) and used the Nexis and NewsBank databases to collect all stories that were tagged "business" or "education." We used a constructed week sampling methodology to accurately reflect patterns in the news cycle and avoid oversampling a slow news day or undersampling a heavy news day.17, 18 To determine what themes about childhood trauma a reader might reasonably expect to see in the news, we consulted public health literature and with experts in ACEs and violence prevention.7, 8, 19-23 For example, unaddressed childhood trauma can hinder children's academic achievement,9-11 and so education stories about test scores could use that knowledge to mention the effects of untreated trauma. We then read a preliminary sample of business and education stories and further refined our list of themes after doing a scan of the literature on business and education news framing,24-30 and after consulting with education and journalism professionals, as well as communication consultants who work with the business sector. We organized the final list of education and business news themes based on the Haddon Matrix,31 a tool developed to assess points of intervention that could prevent injury before, during and after an incident (see Table 1 and Table 2). We coded each article in the constructed week sample for the presence or absence of the business or education themes we had identified. Continuing with the example from above, if an article reporting on test scores or other areas of academic achievement explicitly connected these topics with childhood trauma, we noted the explicit mention; if not, we noted whether the article included themes related to childhood trauma.

How do adverse childhood experiences appear in U.S. news?

We found a total of 414 articles that mentioned adverse childhood experiences in U.S. newspapers and wire services from 2008 to 2014 (Figure 1). We analyzed a random sample of the coverage that included 96 articles.
News coverage of ACEs has steadily increased
While the overall volume of coverage remained modest throughout the time period we analyzed, the coverage began increasing dramatically starting in 2012. The term "trauma" appeared in the majority of these articles (80%), though "toxic stress" was rarely mentioned. Half of the stories in our sample were news articles, and the other half were opinion pieces (op-eds, columns, blogs, letters to the editor and editorials).
Figure 1: U.S. news coverage mentioning ACEs, 2008-2014 (n=414)
Health and social services initiatives and events drive coverage of ACEs
We wanted to know: When adverse childhood experiences are covered in the news, why? Twenty-two percent of stories were in the news because of an event, such as a workshop or conference. Stories also routinely appeared in the news on the occasion of a milestone, such as the launch, expansion or anniversary of a program or initiative to address or prevent childhood trauma.
Health professionals dominate the news about ACEs
Health and mental health professionals were quoted most often in the news about ACEs. They included clinicians, researchers and advocates from nonprofit organizations like Child Abuse Prevention Services or National Alliance on Mental Health. Other speakers, such as representatives from the criminal justice or education sectors, rarely appeared in the news.
Figure 2: Who speaks in articles about ACEs? (n=96)
More coverage focused on treatment than on prevention
Unlike most news coverage that focuses almost exclusively on problems, more than 80% of the news articles mentioned strategies to address or prevent childhood trauma. Most often, these stories focused on services for victims of past trauma, such as health and mental health services. Strategies to prevent trauma before it happens appeared significantly less frequently (33% of all articles).

How could ACEs appear in the news about business and education?

Our constructed week sample yielded 171 education articles and 310 business articles from California newspapers. Due to the high volume of business stories, we randomly selected 50% of the business stories to code for a total of 155. For analysis, we weighted the results from business stories to represent the complete universe of coverage. We discarded all articles that were not substantively about education or business but had been tagged as such by Nexis because of a word or phrase. For example, a community calendar was included in the education sample because it listed an event to be held in a high school gymnasium, while an article about community politics was tagged "business" because it mentioned the Chamber of Commerce in passing. We removed 29% of business articles and 26% of education articles.

Childhood trauma in education news

Childhood trauma rarely appears explicitly in education stories.
Only one education news story explicitly discussed the impact of trauma on students. The Los Angeles Times article discussed the influx of refugees enrolling in the Los Angeles Unified School District, noting, "L.A. Unified officials have warned schools to be prepared for students who may be afraid to enroll or who could experience separation anxiety and grief. Some have suffered trauma from witnessing violence."32
Many opportunities exist to connect education news to childhood trauma.
More than half (58%) of the education news sample contained themes connecting to causes of or solutions to ACEs. Stories that didn't contain these themes were primarily profiles of specific students or teachers, stories about school athletics, or stories about construction projects within school districts. The themes that appeared most frequently in education coverage related to how the education sector could prevent — or contribute to — future childhood trauma, such as whether or not the education sector is providing students with the academic and emotional tools to become healthy, economically successful adults and parents. The most common theme, which appeared in 35% of relevant articles, focused on opportunities for low-income students or students from communities of color. For example, a San Francisco Chronicle article described an Oakland program designed to address the needs of young men of color (including "community violence, mental health needs and lack of male role models"), with the ultimate aim of "increasing attendance and reducing suspensions."33 With just a few questions to the right sources, this article could explicitly demonstrate how such programs can help these young men build resilience which could help prevent or mitigate future trauma among those who have already experienced ACEs. Education stories also regularly focused on academic achievement, including test scores and graduation rates (32%), which are negatively affected when students suffer untreated trauma. For example, one op-ed from the Sacramento Bee that discussed efforts to prevent students from dropping out of Sacramento high schools noted, "As a nation, we've reached our best graduation rate by understanding who is most likely to drop out, why they leave school and which schools they attend."34 The author could have drawn explicit connections to help readers understand how trauma impacts educational outcomes, for example by highlighting childhood trauma as a predictor of why some students leave school or by mentioning that programs that address childhood trauma are one strategy that could improve graduation rates.
Figure 3: What themes that appeared in California education news could relate to childhood trauma?
(Click image to enlarge) Note: Omitted from chart: infrequent news themes (each less than 5%), such as mental health services, absenteeism, sex education, school environment, healthy relationship education, school discipline and adult education.

Childhood trauma in business news

Business coverage does not discuss childhood trauma explicitly, but it could.
None of the business stories we analyzed explicitly mentioned childhood trauma. However, 32% of the stories included themes that could be linked to ACEs: Most of these related to how the business sector could prevent future childhood trauma. The most common childhood trauma-related themes in business stories were wages, labor and union issues (46% of relevant business articles). In a typical story, a Transport Workers Union executive explained, "[F]light attendants will have a say on how to further improve ... their own work lives" due to Virgin America Inc.'s first union.35 Reporters could take stories like this one step further to discuss how labor policies can foster economic stability and improve workers' quality of life, potentially protecting against future trauma for their children. Another common theme in business news was health care and health insurance costs (23% of business articles). One article, for example, detailed how a large number of companies are self-insured, meaning that "the employer pays worker medical expenses out of pocket."36 Since health outcomes related to untreated trauma (such as stroke, cancer, and diabetes) can impact health care costs, there are opportunities in these articles to illustrate the financial impact of ACEs, and what it means for businesses. The theme of job growth (23%) could also connect with preventing future ACEs. For example, a Los Angeles Times story reporting on job growth data from the Labor Department37 could also discuss the impact of these jobs on the economic stability of vulnerable families and the implications for preventing future trauma.
Figure 4: What themes that appeared in California business news could relate to childhood trauma?
(Click image to enlarge) Note: Diversity in the workplace, productivity loss, and wellness programs were infrequent themes, each in 3% of stories. Oppression in the workplace did not appear in any stories.

Conclusions

Children experience trauma every day, and although we found that coverage of the issue is increasing, ACEs are rarely discussed in U.S. news coverage. ACEs are most often mentioned in the context of events or initiatives promoted by the health or social services sectors to address the issue, rather than, for example, individually focused stories about specific cases of childhood trauma. This represents a valuable opportunity for advocates to put the focus on prevention because articles about programs or events to address ACEs are a natural place to talk about how social and physical environments (including legislative and organizational policies and practices) can prevent or foster childhood trauma. We also uncovered opportunities for advocates to expand the coverage of ACEs beyond news about health. We found that when ACEs appear in U.S. news coverage, few speakers other than health professionals have a voice. However, we know that childhood trauma affects every sector in society, including education and business. When we looked at the news coverage of these sectors, we found that ACEs rarely appear explicitly in education news, and never in business news. However, several themes appear in coverage of both of these sectors that are related to childhood trauma. Articles containing these themes could make links to childhood trauma if journalists are able to ask the right questions and have access to sources and data that can illuminate the connections to childhood trauma.

Recommendations

Our findings suggest opportunities for advocates and journalists to expand the coverage of ACEs and increase the visibility of solutions that could prevent childhood trauma and build resilient, trauma-informed communities. To that end, we propose the following recommendations for prevention advocates:
Advocates can build capacity among ACEs leaders to connect their work with business and education stories.
There are many opportunities in the news for advocates, practitioners, public health leaders and reporters to connect business and education stories with childhood trauma prevention and bring members of those sectors into news coverage. Since business and education leaders may not be part of childhood trauma conversations and related work, it will be important to forge relationships with them to develop shared goals and communication priorities. Training and capacity building will be critical to inform advocates, practitioners and other community leaders about these opportunities and how they connect with work that is already happening at the community level around violence prevention. Such training will shape their work to raise the profile of ACEs as a critical — but preventable — problem in which the entire community, including the business and education sectors, has a stake.
Advocates can expand the range of stories that address ACEs and illustrate prevention.
Since ACEs contribute to or result from a variety of other public health issues, prevention advocates can increase ACEs coverage by connecting it to other health topics. For example, sexual violence regularly appears in the news:38 These stories present an important opportunity for advocates to alert reporters to the links between sexual violence and trauma, and the implications of that trauma for public health and safety. In fact, there are opportunities throughout a variety of sectors in society, in addition to education and business, to highlight connections to childhood trauma. Advocates can provide data, fact sheets, graphics and other resources to help inform journalists about these connections. Advocates can also create news to expand the range of stories about ACEs and how to address them, so that the problem is not understood as purely a medical issue to be dealt with after the fact. To do that, they can continue to release studies, create community events, give awards or find other newsworthy ways to bring attention to trauma and how to keep it from happening in the first place. While journalists, too, can expand coverage of ACEs and the far-reaching impacts of childhood trauma, it will require proactive guidance from advocates to help reporters "connect the dots" between their stories and the implications of ACEs. A major challenge to expanding coverage of ACEs could be newsroom skepticism and our cultural tendency to focus on personal responsibility. As with any effort to promote the prevention perspective, reporters will need assistance with looking beyond individuals to understand how systems and structures play a role in health. This framing is key to understanding how context and solutions can make a more complete story and may help address concerns about "advocacy journalism." Additionally, we suggest the following preliminary recommendations for journalists:
Journalists can explore ways to expand ACEs coverage to go beyond community events and health professionals.
Adverse childhood experiences have far-reaching implications for everyone. ACEs, then, could ground timely and compelling stories about a broad range of issues, such as trauma in institutions (like prisons, schools, and hospitals); the connections between trauma and hot-button issues like racism and immigration; and innovative approaches to addressing or preventing trauma.
Journalists can focus on prevention.
Since health stories routinely focus on treatment and intervention, stories about strategies to prevent trauma before they happen could be more groundbreaking and, therefore, newsworthy. For example, journalists could link school mental health programs, food security programs and after-school programs to violence prevention in schools.
Journalists can expand their source list beyond health professionals.
Trauma has many causes, and calls for a range of solutions that draw on every sector, not just physical and mental health professionals. Stories about ACEs, then, should include a range of sources. Whether advocates are creating news or responding to reporters, it will be important to refer journalists to additional sources from different sectors, and to make resources available to journalists that include a range of perspectives on trauma and what to do about it.

Acknowledgments

This report was written by Laura Nixon, MPH; Alisha Somji, MPH(c); Pamela Mejia, MS, MPH; Lori Dorfman, DrPH; and Fernando Quintero, BA. This work was funded by The California Endowment. We thank Mary Lou Fulton of the California Endowment and Jane Stevens of the ACEsConnection Network for their feedback and guidance in the development of this work. For their invaluable insights, we especially thank Louis Freedberg, Jane Adams and Denise Zapata of EdSource, Chris Soderquist of Pontifex Consulting, as well as Lisa Aliferis of KQED, Celeste Fremon of WitnessLA.com, Sylvia Paull of the ACEsConnection Network, and Venise Wagner of San Francisco State University. Special thanks to Alysha Aziz and Leeza Arbatman for their contributions and support, and to Heather Gehlert for copy editing. © 2015 Berkeley Media Studies Group, a project of the Public Health Institute

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