Should K-8 schools give students an ACE survey?

 

Perhaps you read this well-reported and -written article by Julie Wootton on MagicValley.com, published by the Times-News in Twin Falls, Idaho, about how Heritage Academy, a K-8 public school in nearby Jerome, gave the 10-question ACE survey to its students. The older students took the original 10-question ACE survey, while younger students were given a modified version of the sex abuse question. 

The brouhaha erupted after a couple of students asked their mother to explain oral and anal sex.

This episode raises at least three questions:

  1. Should schools give kids in grades K-8 an ACE survey? If so, why? If not, why not?
  2. Do you know of other schools that are giving kids in grades K-8 an ACE survey?
  3. If you were to tell the superintendent that giving an ACE survey to K-8 kids isn’t a good idea, what would you say? (I’m assuming you’d approach her in a trauma-informed way, but it’s no surprise that the comments on the article weren’t.)

I’ll give you my answers below, but I’m really more interested in what you think. If you’d add your answers in the comment section, that would be terrific. 

My two cents: I think it’s important for us as a community to discuss this, for a couple of reasons. One, the results of the ACE survey at Heritage Academy show that 70 percent of the students had an ACE score of 3 or higher, according to the article. That’s important information for the school and parents, since we all know that, without intervention, these kids’ health, well-being and future success are at risk. 

But is there another way to do the survey?

I think another way to obtain that vital information would be to do a school-wide campaign that educates teachers, staff, administration, parents, counselors, school board members, superintendent, and school nurses about ACEs science. And THEN organize a parents group to figure out how best to ask parents about their own ACE scores, so that school counselors or staff can provide assistance to families who need it.

I don’t think schools need kids’ ACE scores if they know the parents’ scores, since research shows that parents pass their ACE scores onto their kids, if there’s no intervention. If teachers are trained in ACEs science, trauma-informed and resilience-building practices, know the kids and the families, and teach in a school that’s integrated policies and practices based on ACEs science, then knowing kids’ ACE scores isn't necessary. (Here's a list of articles about schools that have done this.) They just know what to do when a kid displays symptoms of stress, and the school has different levels of response in place, depending on what’s happening with the kid and the family. 

This approach wouldn’t stigmatize children or families. It would be a transparent and trauma-informed approach. And it would help everyone have more empathy for people who have high ACEs, especially if it was part of a community-wide effort. 

However, I think it’s really useful to give elementary school kids the language to describe what’s happening to them, as Cherokee Point Elementary in City Heights, San Diego has done. As Jen Hossler explained in an article she wrote last year, "Cherokee Point Elementary School youth leaders learn about Child Abuse Prevention month", kids “talk about trauma and how it impacts their minds, bodies, actions, and reactions”.

“Getting hit or hurt,” “when someone uses drugs or alcohol,” and “not having someone to love you” were some of the answers these kids gave. What amazed me most is that none of the kids were shy about it. This was a conversation they were comfortable having, partly because for many, they have seen first hand what abuse, neglect, poverty, and violence have done to their community and to the people they love the most. But this is also because the adults in their lives — including principals, teachers, support staff, interns, and parents — have developed a shared language and safe spaces to talk about difficult topics like abuse and trauma with them.

The kids also learn about how ACEs can be prevented, and what the resilience factors are in their lives.

I asked the kids to think about what makes them feel safe and loved. “Cookies” was probably my favorite answer (so honest!), but I heard things like “my mom and dad,” “my brother,” “my neighbor,” “my school,” “my stuffed animal,”…the list goes on.

In Jerome, Idaho, the superintendent of Heritage Academy has sent a letter to parents that they won’t be repeating the survey, and says they will get parent input “on how to create a supportive school environment and how to deal with controversial material”.

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Hi, Laura: Are you also having the teachers, admins, and staff at the school do the ACE and resilience surveys? I think that's where organizations have the most success-- starting with their own employees and working out. There are elementary schools that have done that, then provided parents with information about ACEs science, asked them to fill it out (and expand the questions, according to the demographics and experiences of the community), as well as the ACE survey, and arranged a time for parents to talk with teachers/counselors about it. Some high schools have had great success at educating their students about ACEs science, then having the students develop their own ACE and resilience surveys (building on the existing surveys), having students take it anonymously, and also having the high school students develop an ACEs science education module for middle school students.

Laura Sharp posted:

We would like to use the ACE survey with our students K-12. Does anyone have an example of a parent letter or the adapted survey they used with students elementary aged? Thanks for any help!

I would read some of the pitfalls below in the administration of ACE surveys. There is a Resilience survey which is not so direct.  It might be enough to survey the parents in a way to bring awareness. A parent may suffer a shame hangover, while the student feels the insult of shame over. I do one on one ACEs awareness and watch for nuances that tell me to back off. I don't believe you can use it as a hand out. 

Enough can be found from the Resilience Survey to see what is going on with a child's mind.

I had some additional thoughts. In Sonoma County, we have a community clinic that is located on a high school campus. They offer a modified ACE test (includes concerns about deportation of family members, for example) and I'm all for the program. It differs from the K-8 program in a couple of ways.

First, students at the clinic take the test individually and privately. Unlike a situation where everybody knows you took an ACE test that day, there is no pressure to reveal your score. When I got my college SAT results (dates me, they are called something different now) we all discussed and compared our scores. You should reveal your ACE score when you want to, not because everyone knows you took the test, and others are pressuring you to "give it up."

Second, students often have younger and older siblings, often in the same school. "Your older brother admitted he has a five, and you're in the same family, then you must have at least a five too!"

Finally, the ACE score the clinic collects is part of a medical record, with well-established confidentiality law. What is the legal status of a school-administered ACE test? Could it be subpoenaed for divorce, child custody, or deportation hearings? 

I'm not opposed to ACEs testing in schools, just concerned that, once collected,  the information could be used to harm an already fragile child. We need to think through the safeguards. 

I think, giving out this "research survey" to students out of context without support systems being available may be more harmful than helpful. screening for ACEs should never be the focus of whatever we do in clinical practice. It should only be part of a holistic evaluation that should encompass, resiliency/strengths assessment as well as current needs assessment. Furthermore, following the screening process, immediate face to face support must be available for questions, for arousal as a result of going back to traumatic events, psychological first aid to help kids and parents put this experience into resiliency context.

secondly, only screening children is not adequate, two generational ACEs, resiliency and family needs must be the focus of our practices. I still feel strongly that ACEs scoring approach in clinical practice should be seen as traumatic in and of itself in many circumstances.

Brian Alman posted:

Hi Jane,

I created an ACE questionnaire for kids with the guidance of Dr. Felitti.  I did this 5 years ago because I was writing my book, Less Stress for Kids.  I included the original ACE questionnaire in 2 of my previous books, The Voice and Thin Meditations.  

I've included the ACE for kids in many schools around the world via Less Stress for Kids program.

I'll be happy to share the questions.

Best wishes,

Dr. Brian Alman

www.trusage.com

 

 

P.S. We always include solutions, techniques and follow-up via TruSage with the ACE and our programs in the schools when they utilize Less Stress for Kids courses.

 

 

Dr. Alman,

I would be grateful for the ACE questionnaire for kids that you created with the guidance of Dr. Felitti.

Thanks,

Greg Sumpter

I very much liked your approach -- not something I would have thought of but should have. I worry about the unintended consequences of having students take an ACEs test, even if it's adapted to their ages.

Hi Jane,

I created an ACE questionnaire for kids with the guidance of Dr. Felitti.  I did this 5 years ago because I was writing my book, Less Stress for Kids.  I included the original ACE questionnaire in 2 of my previous books, The Voice and Thin Meditations.  

I've included the ACE for kids in many schools around the world via Less Stress for Kids program.

I'll be happy to share the questions.

Best wishes,

Dr. Brian Alman

www.trusage.com

 

 

P.S. We always include solutions, techniques and follow-up via TruSage with the ACE and our programs in the schools when they utilize Less Stress for Kids courses.

 

 

Thanks for sharing this, Jane.  I hadn't heard of this issue, but am not surprised to hear it did not go over well.  We all have heard similar concerns about doing the survey with adults (many worry it will trigger or bring up bad feelings) when, in fact we know the opposite to be true.  That being said - it's no surprise to hear there are concerns of sharing this with such young kids.  

As I learned from first hand experience working with Cherokee Point Elementary in San Diego - kids and parents can talk about these things in very open and safe circumstances, but there needs to be a lot of work done upfront before you just start handing out the ACEs survey (or reading questions aloud in a group) and asking kids these questions.  Cherokee Point works with parents to educate them about trauma, giving them language to also discuss with their children.  This is not something the school just take on.  This is a school/parent partnership, which is what I believe may have been missing in this Idaho scenario.  By sidestepping the parents, the school missed an invaluable opportunity to teach the parents about the ACE study, the importance of it, what it tells us, and what we do with that information.  If parents had that lens upfront, I think much of this could have been avoided.  At the very least, the parents would have had more of a say about if and how to introduce this to their children once they had learned about ACEs.  

As you mentioned, the school got some very valuable information by doing this (70% had a score of 3 or more!), but it seems that the process left parents feeling so upset and angry that I wonder if the school will even be able to have conversations about what this data means.  

Martina Jelley posted:

One thing that hasn't been mentioned is that the original ACEs survey from the Kaiser Permanente study, was written for adults.  It was not meant to be used for children.  Yet the Heritage Academy gave the survey as is - which makes no sense at all.  I work only with adults, but I'm sure there are more appropriate adaptations of the ACE survey that are meant to be used with children.  This is an example of good intentions but poor implementation.  

Many that took part in administrating the ACE survey, I'm sure woke up with what I call an ACEs hangover. They took on more than what they expected, but no real damage was done. Two aspirins and plenty of water and all will be well. 

I agree with the question; "Why would you give the ACE questionnaire to students in K-8?" How would knowing student's ACE scores, change your approach to the student's you serve?  From my perspective, the risk of triggering a deep seeded wound that could go unnoticed, is to big of risk to take.

Trauma-informed practices are "Best Practice" for all students regardless of their age. With this knowledge, I know how critical it is for me as an adult to stay regulated.  If I'm self-regulated, and I approach all my students with positive intent, then I know I have an opportunity to develop a significant caring adult relationship. I use the research to stay calm, because I know it leads to helping the student de-escalate and bring them back to calm.  A student that is calm, knows their voice is valued, their feelings are validated, and their brain is capable of problem solving and learning.

When I put these traum-informed strategies into practice, I am able to teach the student about their brain, I'm able to teach them breathing strategies to help calm themselves, and I provide them the safety and tools to begin learning how to use this knowledge to self-regulate.

If I am consistent with these strategies.., they lead me into a positive caring adult relationship with my students.  My whole motivation is to be in relationship, that's the foundation for healing, hope, and change.

I don't have to know a specific ACE score... I simply strive to be that one caring adult relationship, that teaches resilience and can influence a negative belief system into becoming a positive belief system. I want to be that adult who can impact a life path from hopelessness to HOPE...a priceless gift that everyone deserves. 

 

 

 

One thing that hasn't been mentioned is that the original ACEs survey from the Kaiser Permanente study, was written for adults.  It was not meant to be used for children.  Yet the Heritage Academy gave the survey as is - which makes no sense at all.  I work only with adults, but I'm sure there are more appropriate adaptations of the ACE survey that are meant to be used with children.  This is an example of good intentions but poor implementation.  

I appreciate the intent of informing students and gathering this information, but I worry about unintended consequences. An ACEs test was given to an audience of primarily health care and social workers in our county and even this audience was stunned by the overall results. They actually had to stop the presentation, regroup and set aside time for people to process the results, and these were adults knowledgeable about ACES.

For me, the key question is, "Why are you collecting this information and what are you going to do with it?"  I would be concerned about the following: Does the school has counselors available to assist any student who was upset by taking the test? What steps were taken to minimize other students mocking or making fun of the perceived or actual scores of other students? (Especially in the K-8 level.)  If a student has a high ACE score, where is that information kept and how widely is it shared? Do the parents have the right to refuse having their child take the test, and do they have the right to see and to protest the results, or protest it being included in any official records?

I'm not against offering ACEs education, but I am concerned about how personal ACEs information, once collected, can be abused. Oh, and don't even get me started about whether it includes Adverse Community Environmental factors! 

Thanks Jane for your imperative post! Absolutely concurring with you, when students, parents and school staff understand the impact of ACEs sciences, it is not necessary to give the individual ACE quiz. Rather, the deepened depth of understanding increases empathy and resilience with our own self-compassion and creating a caring culture for others to feel safe, connected and heal.

Blessed to be engaged for over six years at Cherokee Point Elementary, and facilitating Youth Leadership with Principal Higa's 3rd/4th/5th grade students over the years, they were the youth engaged with Jen Hossler's post, Cherokee Point Elementary School youth leaders learn about Child Abuse Prevention month. Weekly, we engage with and support their deepened understanding of how they can heal and be upstanders with other's healing. Working presently on "empathy", I invited them to share their thoughts on why people become homeless. One response was, "because they're traumatized".

We're moving towards prevention, especially with elementary school students, through our collaboration with an amazing Principal, Godwin Higa, exceptional school staff, Parent Leaders, Understanding Trauma Inspires Parents to Become Leaders and from inception of Youth Leadership at Cherokee Point Elementary in 2011, we now have several families who have siblings engaged in our after school trauma informed - resilience building skill building.

I think that you always have to take into account the "why" are we doing this? What is our objective? I don't believe that the ACE screen should just be done to get a score, for the sake of getting a score to show this is how many ACEs our kids are experiencing. I believe that there are other ways of getting some ACEs information.(eg. have teachers, counselors, other staff fill out info on what they know to be true, not an assumption)

 Doing this type of screen demands having a level of safety in a relationship established before presenting it and then, an explanation of why it is being done.  I think the oral and anal sex questions were not even appropriate for this age of children and as a parent, I would be furious that my child had been asked such questions without a 'heads up' on the what, where, why around the gathering of information. The other thing is that you need to be able to have the conversation afterwards about how any of these things that happen to a child are not their fault, you can't just have "anyone" doing this screen if they don't have a working knowledge of trauma sensitivity and how a child may respond......there needs to be some knowledge of therapeutic communication skills, child development, mental health, and emotional regulation.

Thinking on my own experiences as a volunteer at an elementary school that has a wide range of social and economical statuses, what if, like you said, there is a pre-test for K-6 or K-4 with simpler, subtler questions. If these answers indicate trauma, then parents are brought in to discuss and ask about the family or just parents or just kids taking the complete ACEs survey?

I do think it's important for parents, schools and teachers to have that information to make their classroom a safe and thriving environment for all students.

Resilience questions would have given the school staff what they needed on a student support level in my opinion. I hope this does not make the staff intimidated in the future for polling future generations of students. It will be important to see how the community will improve as family social capital is changed in time. The results of 70% scoring over 3 is disheartening and very sobering for the state of this nation.

I hope Ivie and staff were ACEs schooled more than, "Ivie received a copy of the survey at a training she attended with professionals that included school administrators and counselors."  I can see the rush to use such a powerful tool. But one needs to be ready for the results.

Hi Jane:

I did hear about this story. It raises so many questions that I'm sure will come up more often as the ACE test is shared, in various forms and settings. 

I'm not a fan of kids taking the test in K-8 (or at least K-6). I think it's appropriate, in middle and high school, to talk about the ACE test and study (and one can do both without administering it). That can help educate kids and talk, generally about topics that aren't always addressed. 

I don't know if/how schools do or don't talk about sexual abuse and sexual violence currently, and if so, at what ages. Are these things addressed in school or in health classes? I've never seen a letter from a school or nurse on this though I've received info. about colds, flu, lice and particular viruses that go around. There's so much silence about sexual abuse and some of the reaction to the survey, to me, is linked to that. 

I think working with families and talking more about the ACE science, the power of parenting for promoting lifelong health and the ACEs test and study, as background, but not the main point might help. Learning about the ACE test and study, for me, was fabulous because it was more of a health/CDC thing and less of a psych/labels things. It neutralizes a LOT of shame and stigma by not being all that personal. It's more math and science and has less of that energy of this is very special, hard, medical or pathological and can only even be discussed, considered and heard by well-trained professionals. That, for many, makes it SO much more stigmatizing because it's often stuff people have already lived and coped with, privately, for years or decades, and being made to feel as though it is something nuclear that might be contagious or need special ops level containment is part of what feeds shame, silence and stigma. .

So I like it being taught about in schools and shared, for families, but can see that collecting scores, even if anonymous, can make families defensive and protective, depending on how things are worded.

I look forward to hearing/reading what others think/feel/do.

I think teens and older kids can benefit from the test, conversationally, kind of like as was done in Paper Tigers and letting kids kind of do it (on their own), if they want, but not collecting that info.

I think a lot of good can happen without families feeling assessed or graded or feeling in any way that the school is trying to find out about the family, through the kids, rather than talking and working with families about how to make schools something that works better for all kids including those with lots of toxic stress. 

For some kids, the saving grace of school is that it's a place free from a lot of the stuff at home and where one can just be a student and that might be the most healing thing of all. It might help to feel safe and comfortable talking, in school, about what's happening at home. But that's not necessarily true for everyone, especially in younger ages, if that's not how things are done at home. For some, school just being a safe, routine, structured place, with responsive and warm adults and offering access to basic info. about wellness and well-being and doing that well IS the HUGE buffering for what's going on at home. 

I can't wait to hear from others, especially those working with teachers and parents and kids, in schools, already. There's so much to think about and learn and so many to learn from here!

Cissy

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