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Reply to "The use of ACE scores for individuals"

Hello Andrew. 

You pose a great question which has direct implications across settings.  I appreciate the question and also the controversy cited by Dr. Pachter.   I do not have formal medical training myself, and I know of no peer-reviewed papers linking a simple numeric score to a specific intervention. 

Nevertheless, without specific interventions, if you will humor me, I do have some add-on queries:

Could one value of the "simple score" in a clinical setting (and other one-on-one settings) be as simply a "discussion-starter"? 

I am thinking particularly of those patients who are hesitant to speak directly in a "history" or in a routine office visit.  They also may not otherwise think to make connections with somatic issues.  The process could be adaptable for children, or parents of children also.  It would seem that sharing a simple number (from a pencil "survey" in waiting room) may be a more private, tenable start than a bold statement face-to-face about specific interpersonal adversity or even community violence. 

Likewise, could the simple score have potential value as an avenue for those patients who are  internalizing (so they aren't presenting any obvious external clues), camouflaging or even actively covering up (behaviorally) ? 

Beyond "discussion-starter",  then it seems that sometimes there may come an opportunity for "painlessly" beginning patient awareness and "education" regarding the mind-body connection and the power of adversities, as general information, now that the patient has interacted personally with the concept?   (I'm thinking like a teacher).

Of course, ultimately the discussion momentum could lead to a cascade of more specific aspects of a particular patient history and presentation.  If the process is only helpful with specifics on five times out of ten, would that be a nuisance or would it be useful in your particular setting?

 

Lastly,  could the "simple number" (with no specificity) add some perspective on cumulative stress(ors) or allostatic load?  It seems like a simple score could have value as a warning "flag".   It would only be one diagnostic input, but the proxy (score) for cumulative experience may shed light on seemingly eclectic somatic presentations.  The research has much to say about the systemic effects of accumulated adversity.  Might it be useful to understand the patients cumulative burden irrespective of specifics, at least as a starting point ?  

 

Maybe more later.  Thank you for humoring me.

Last edited by Daun Kauffman
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