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Lancaster County ACEs & Resilience Connection (PA)

Working collaboratively with schools, business, healthcare, government agencies, social services, criminal justice systems, healthcare organizations & faith communities to become a trauma-informed community. We invite all concerned citizens, professionals & advocates to partner with us to raise awareness about trauma & its effects, to build resilience, and offer hope & healing.

Inside the Adverse Childhood Experience Score: Strengths, Limitations, and Misapplications

Many organizations are committing to the work of becoming trauma-informed. One of the early questions that often arises in these organizations is whether to adopt some type of screening or assessment tool to gather information on the trauma histories of clients/consumers/patients/students.  Some organizations, after learning about the original ACES Study, consider using the ACES questionnaire or some variant of it as this type of screening or assessment tool. 

In our trauma trainings, we discuss a long list of "cautions" and important factors for any organization to carefully consider and discuss prior to deciding whether they need to adopt any trauma assessment/screening tool or process for the people they serve.  (see  

Here's important perspective from Dr. Robert Anda, one of the researchers from the original ACES study, and Dr. Laura Porter, about attempting to use the ACES questionnaire and resulting "ACEs scores" as a screening tool and/or to make decisions about the need for services or treatment.

Here's a brief article by the authors, explaining the concerns, limitations and risks:

Notably, they write: 

"the ACE score is not suitable for screening individuals and assigning risk for use in decision making about need for services or treatment."


"The authors are unaware of research assessing the conditions for appropriate administration of an ACE questionnaire or research assessing the ability of any given ACE score to accurately identify individuals at risk for negative health and social outcomes. Although increasing ACE scores are associated with increasing population risk of health and social problems,14 it is currently unclear how ACE scores make sense for decision making as part of a community screening program. Under the type of guidelines employed by the USPSTF, the extension of ACE-related risks from epidemiologic studies to individuals using their ACE score for the purposes of individual screening and clinical decision making is not appropriate."

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