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Taking an ACEs History -- Who's Doing It and How?

If you're doing ACEs histories, please do a short blog post or contact one of the community managers so that we can do so for you.

Are you screening for ACEs?

 Ascreen1

More and more people from across different sectors are screening people for ACEs. They’re also educating them about ACEs at the same time. I’m working on a couple of stories — one is about home visiting programs in Washington State, Illinois, Michigan, Vermont, and North Dakota that are screening and educating clients. The other is about The Family Center in Nashville, TN, which is screening and educating people in parenting classes. Parents who attend these are either in jail or are mandated by the court to attend the classes. Of the 600 parents who’ve done their ACE scores since last April, 74% have an ACE score of 4 or higher; 54% have an ACE score of 6 or higher. And what do they want to know after they’ve done their score? How to prevent high ACE scores in their kids. 

 

And more people are recommending screening. Recently, ACEsConnection.com members Nathan Epps, senior analyst at the Florida Department of Juvenile Justice Research & Planning Bureau, and Dr. Michael Baglivio, senior management analyst at the Florida Department of Juvenile Justice, and two of their co-authors suggested that ACEs could be used as a “first-line screening tool to identify children at risk of serious, violent and chronic offenses before significant downstream wreckage occurs”. That’s because they found that with each additional ACE, a delinquent youth’s risk of becoming a serious, violent and chronic offender increased 35 times.

 

 

And in “Health consequences of adverse childhood experiences: A systematic review”, in the Journal of the American Association of Nurse Practitioners, Dr. Karen Kalmakis and Dr. Genevieve Chandler from the University of Massachusetts (Amherst) College of Nursing concluded that nurse practitioners “are encouraged to incorporate assessment of patients’ childhood history in routine primary care and to consider the evidence that supports a relationship between ACEs and health. Although difficult, talking about patient's childhood experiences may positively influence health outcomes.”

 

If you’re screening for ACEs, please help us create a resource for others who are thinking about screening for ACEs and post your information in the new group ACEs Screening — Who’s Doing It and How? or contact one of us, and we’ll talk with you and post it for you. You can also fill out this quick and easy 8-question survey and we’ll be in touch. 

 

Thanks!!

 

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When I read the item Tina posted about the Indiana University ACE screening item, and the other suggested / proposed ACEs, such as school bullying, I thought about one other that I hadn't yet seen suggested: A parent[s] who smoked cigarettes, especially indoors one's home or automobile...-we had so much television and magazine advertising that glorified smoking, back then.....

I also concur with including Tina's other item about Adolescent Homelessness. And yes, my bias is also based on my adolescent experience of homelessness-before I graduated from high school...

Thank You Tina, for noting those additional proposed ACE criteria.

Last edited by Robert Olcott

Jane (and any other readers)

     I didn't see any item here, in this Screening for ACEs Group, about the recent post from the World Health Organization, that screened Turkish college students for ACEs....

Case 1: Eighteen Month Old Head Banging, Violent Temper Tantrums
 
•Maternal ACE Score – 8
–Domestic Violence
–Emotional, Physical, Sexual Abuse
–Emotional, Physical Neglect
–Alcoholic Parent, Parental Mental Illness
•Child ACE Score – 6
–Parental Loss
–Domestic Violence
–Alcohol Use in Home, Parental Mental Illness
–Emotional, Physical Neglect

 

Before behavioral evaluations, I ask about parental ACEs by using an edited 14 page modified developmental screener from Indiana University to which I have added a cover sheet explaining how parental experiences in childhood affect children’s health and the 10 ACE questions to which I have included being in foster care or a homeless adolescent, witnessing violence against siblings or other family members, food insecurity, community violence, and experiencing school bullying. In the body of the developmental screener, I  get information about current ACEs the child is experiencing – such as domestic violence, abuse, mental illness in the family, substance use, loss of a parent and incarceration of a parent as these ?’s are part of the edited developmental screener. 

 

When the family comes in we discuss how ACEs and toxic stress affect brain development and behavior. When working with ACE exposed parents and children we MUST KNOW OUR COMMUNITY RESOURCES.  This mother was referred to a local  parenting program, social services for addiction, domestic violence services, housing and food assistance.  Multiple web resources were provided to the mother and reviewed. Follow-up was arranged for the next week.  On follow-up, the mother had lots of questions about how to avoid harming her child through ACEs exposure.  After reviewing the web resources on how trauma affects children’s behaviors and brain development and can lead to poor adulthealth both for her and her children, she wanted to know everything she could learn about how to better support her son and two other children. 

 

For High ACE exposed parents and children, Frequent follow-up is the Key…. Along with an understanding of trauma – a compassionate tone and empathetic understanding of the parent’s own childhood suffering.  This child stopped the temper tantrums and head banging and was more manageable for mother, leading to healthier interaction between  parent and child. 

 
CASE 2: 5 YEAR OLD BOY SEVERELY AGGRESSIVE TOWARDS STEPMOTHER, LEARNING PROBLEMS, SCHOOL AGGRESSION
•Maternal ACE Score – Cannot be Calculated as the Child was in Foster Care and History is Lacking
•Child ACE Score – 7
–Domestic Violence
–Alcoholism/Poly-Drug Use in Parent
–Mental Illness in Parent
–Emotional, Physical Abuse, Emotional Neglect
–Parental Loss

 

This child was being cared for by his birth mother until 3 years. He was removed by Child Welfare and custody terminated for maternal drug use, domestic violence, mental health issues, severe physical and emotional abuse, emotional neglect.  He also suffered from the  loss of a parent – his biological mother and recently his biological grandmother and grandfather who had adopted him. His biological grandmother had recently passed away of cancer and the Boy’s biological grandfather felt he was getting too old to care for the boy and was interested in  travel.  Grandfather then passed care of the child to his Biological father and his new wife. Due to severe aggression at school and in the home, the child has been recently seen by CMH and was been placed on stimulant medications for ?ADHD.  Due to persistent aggressive and externalizing behaviors, along with nightmares and becoming hysterical when separated from his grandfather, CMH placed the boy on a Mood Stabilizer, one week before I see this child in the pediatric clinic.   The parents are hoping that I can help with his behaviors and wonder about my thoughts about a child this young being placed on a mood stabilizer.

 

This boy is obviously experiencing severe trauma. We stopped the mood stabilizer but continued the stimulants.  The first step in cases like this is to educate the entire family (including the grandfather, father, and step-mother) on toxic stress, childhood adversity and developmental trauma.  The family is given two parent friendly videos by child psychiatrist Bruce Perry and I actually take time out of my work schedule  to review  these videos  with the parents educating them about normal behaviors in  children exposed to severe trauma and attachment disruption.  As grandfather wants to travel and transfer care to the child’s father, I ask them to go slowly in the transition and have the child and grandfather stay at the father’s home. We schedule weekly follow-up visits to continue education about the affects of trauma on young children and answer questions that come up.   I help the family understand that the acting out behaviors aren’t purposeful but based out of fear of abandonment. We get the child enrolled in karate lesions after school and encourage lots of exercise.  His teachers are educated about trauma reactions and his trauma exposure.  He does great with parental psycho-education on ACEs and toxic stress, with significantly decreased aggressive outbursts at school and at home.   He is also does very well in school and is in fact no longer considered delayed.

 

My hope is that this child has been given the opportunity  to pursue whatever career he wishes including becoming a physician.  If he were to become a pediatrician, I believe he certainly would understand the obstacles millions of our pediatric patients experience every year.  Regardless of his adult educational pursuits, I believe his adult potential in life has been strengthened by recognizing and treating his severe early childhood trauma. 

 

STEP-MOTHER’S NOTE TO ME:

Hi Tina you saw my son at ARMC. You are truly an amazing person and  doctor…….. We recently got sent to u of m and as we already knew they said everything you did. You have a gift that a lot of doctors don't have, you care.   (This really made my day and it is the type of reward that recognizing and not being afraid to take on trauma can offer anyone willing to learn and willing to care). 

 

I would also like to incorporate ACEs screening into selected pediatric infant well visits. I did the SEEK program (safe environment for every kid) from Howard Dubowitz at the University of Maryland -- It won the Ray Helfer award in 2013 or 14. Using Dr. Dubowitz's model -- ACEs screening in the pediatric office with infants would be really simple to implement.  There is only one obstacle (I need to get closer to a city so I can get appropriate trauma therapy for my aces-- I hope neurofeedback --- but ACEs screening --- I don't know why everyone in pediatrics thinks it is so hard??? ).  

 

SEEK: http://umm.edu/programs/childr...tection/seek-project

 

I do not use the McGinn and Cairns (spelling) Resilience questionnaire however. I really think it only reflects backwards in time as the ACE screener does which  essentially doesn't  provide more information.  I don't think it offers much if anything in the way of understanding current resilience (in fact when I get time, I am writing a long blog about this) and I think it is metaphorically a " terrible stick in the eye" for those of us whose ACEs came from sadistic parents who have told us they never loved us as kids and wish we had never been born and didn't allow us to engage in school activities or have friends or leave the yard etc.  For me it is really painful to answer. RJ Gilespie stated at the January AVA conference, that his clinic uses the Cairns scale because it was free... I can certainly understand that.  I try to use as many free things as I can... But this is such an important topic... I believe it needs much more thought.

 

I like this questionnaire better.  This tells about current resilience in my mind and makes sense.  It does cost to use institutionally and that is probably why something similar was not chosen.... 

 

Resilience Scale (RS) (Wagnild & Young, 1993) available from www.resiliencescale.com

 

The Resilience Scale™ is considered to be one of the most accurate instruments currently available to measure resilience. It is used by counselors, coaches, therapists, researchers, and educators all over the world.

 

Our purpose is to help people and organizations thrive through resilience. We do this by helping them recognize, build, and strengthen their resilience using our highly reliable and valid measures and evidence-based products and services.

 

We define resilience as the capacity to live with purpose, authenticity, perseverance, equanimity, and self-reliance. Living resiliently leads to lives that are rich, rewarding, and satisfying.

 

When I take this test, I don't feel like I have a stick in the eye. I also get good ideas (though I already know these I just am not doing them) about what I could do to increase my resilience which scores at moderately poor.  

 

Thanks Everyone

Last edited by Former Member

Hi Jane,

     Vermont House Bill 762 (2013 session), called for ACE screening by all Vermont Health Care providers-and while it didn't pass in its entirety, One of our ACEs Connection members began working on how they would select and word the questions.... 

     The World Health Organization adopted the ACE screening tool, in its 2013 assessment of the world's healthiest children (Netherlands was # 1, many if not all of Scandinavia followed,...U.S. was 25th, Canada 26th,-if I'm not mistaken.

Originally Posted by Harry Allen:

Our agency(NET)is using the ACES as part of our Bio-psychosocial assessment which is completed when they are seen for an Intake for OP services. Scores of 3 or more will have a prompt in our electronic record system to put a treatment goal on the plan to address some of the identified trauma or to do a follow up screening with a different tool. Our hope is this will assist all clinicians in being more sensitive to these issues as part of all phases of our treatment process.

Harry this is very exciting and had no idea this was going on at NET. Would love to have you talk to you about this in more depth since it's happening right her in Philadelphia!  I'd like us to post a longer article about this on the Philadelphia ACEs Connection Page and share with members of the Philadelphia ACEs Task Force.  Let's get in touch.

Our agency(NET)is using the ACES as part of our Bio-psychosocial assessment which is completed when they are seen for an Intake for OP services. Scores of 3 or more will have a prompt in our electronic record system to put a treatment goal on the plan to address some of the identified trauma or to do a follow up screening with a different tool. Our hope is this will assist all clinicians in being more sensitive to these issues as part of all phases of our treatment process.

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