ACE scores in nurses

We just did an survey of our staff in our outpatient clinics that included knowledge and attitudes about ACEs and trauma informed care.  The survey included a personal ACE score (anonymous).  Nurses had the highest average score, by far, at 4.  I don't see much in the literature about ACE scores of nurses in the community.  Anyone have references on this?

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I think you are on to something! There is a dearth of articles focused on nurses or other "helping professionals".  

During an ACEs presentation to 150 "helping professionals" we conducted an ACEs screening (anonymous) and found participant's scores were higher in 9 of the 10 categories when compared to the original study. Additionally, 1:3 reported that they experienced childhood sexual abuse - there seemed to be a recognition that it is not them, it is us.

Another group of 125 "helping professionals" had an average ACE score of 7. Together we agreed to do a Resilience screening and the results were reassuring. They scored high in each category for sources of positive support. When they reflected back they thought this provided a buffer to the ACEs they experienced. Them seemed to be inspired to apply this understanding when working with their at-risk populations. 

Attached and linked below are a few articles on the subject:

Title - Adverse Childhood Experiences in Medical Students: Implications for Wellness. N=98 To read more click HERE 

Title - Nursing students who were exposed to more Adverse Childhood Experiences have higher rates of burnout and depression. N=200 To read more click HERE

Title - Consideration of Personal Adverse Childhood Experiences during Implementation of Trauma-Informed Care Curriculum in Graduate Health Programs. N=967  See attached

Title - Prevalence of adverse childhood experiences (ACE) among child service providers Approximately 70% reported at least one, 54% reported two or more, nearly 16% reported four or more. To read more, click HERE

I hope we can explore this further! Karen

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@Robin M Cogan: Did you see this? I wonder what it is for school nurses and if that isn't something NASN might be interested in collecting at the National School Nurses Conf. in CO, if possible, at least among school nurses who'd like to volunteer to provide some info? I wonder if the data folks would have an interest at NASN? 

Also, @Karen Clemmer (ACEs Connection Staff): This seems like great stuff to share in a few slides at the MA Nurses Assoc. Clinical Conference when we present on ACEs at the bedside and beyond: Adverse Childhood Experiences & Adverse Community in early May.

Wow...my brain just went into high alert from this information! I don't know why I am so surprised. That data point that Karen shared about "125 "helping professionals" had an average ACE score of 7," really hit home. I think this would be really important to do at NASN, along with Resilience Screen. 

Karen Clemmer (ACEs Connection Staff) posted:

I think you are on to something! There is a dearth of articles focused on nurses or other "helping professionals".  

During an ACEs presentation to 150 "helping professionals" we conducted an ACEs screening (anonymous) and found participant's scores were higher in 9 of the 10 categories when compared to the original study. Additionally, 1:3 reported that they experienced childhood sexual abuse - there seemed to be a recognition that it is not them, it is us.

Another group of 125 "helping professionals" had an average ACE score of 7. Together we agreed to do a Resilience screening and the results were reassuring. They scored high in each category for sources of positive support. When they reflected back they thought this provided a buffer to the ACEs they experienced. Them seemed to be inspired to apply this understanding when working with their at-risk populations. 

Attached and linked below are a few articles on the subject:

Title - Adverse Childhood Experiences in Medical Students: Implications for Wellness. N=98 To read more click HERE 

Title - Nursing students who were exposed to more Adverse Childhood Experiences have higher rates of burnout and depression. N=200 To read more click HERE

Title - Consideration of Personal Adverse Childhood Experiences during Implementation of Trauma-Informed Care Curriculum in Graduate Health Programs. N=967  See attached

Title - Prevalence of adverse childhood experiences (ACE) among child service providers Approximately 70% reported at least one, 54% reported two or more, nearly 16% reported four or more. To read more, click HERE

I hope we can explore this further! Karen

Karen, Thank you for sharing this important information. I am actually stunned by this information, but I am not sure why. This is important and the implications are far-reaching.

Reminds me of Dr. Burke Harris in her Ted Talk: We're not dealing with it in the health care sector because it's too close to home. 

I know when I first started my ACEs Awareness campaign here in Nova Scotia the resistance I received from "the establishment" was strong and still is for the most part. 

My argument for offering my personal experiences with ACEs was that by doing so I could help "the affected" relax a little during the self-reflection process, because I model a shame free perspective. 

In the end my approach has been for the most part rejected for 4 years, and yet the effect of implementing #TraumaInformedCare across institutions has still not reached into the hearts of the health care providers in my region. 

The stories that continue to come out in the news about patient - both adult and child - treatment in our health care system is to a huge extent inhumane. And of course our government enables all that. 

And yet these numbers you are sharing here are not surprising to me, but the affected are still in denial, and still not actually getting the concept of #TraumaInformed 

So thank you for this information and the conversation. The data exists, even if many of us have know the reality for a long time. 

I always marvel at how tenacious humans are to try every circumnavigation possible to deal with issues before finally having the courage to call a thing a thing and face it head on and deal with it well. I guess that's part of our evolution, but it's still frustrating as we see more and more people continuing to be hurt, when we could have stopped this years ago. 

Thanks for all your work.

In solidarity,

Elizabeth Perry 

Jane Stevens (ACEs Connection staff) posted:

Sometimes people who seem to be in denial are just scared: scared to face their own ACEs, scared to rock the boat, etc. By creating a safe place for talking about ACEs science, and talking about ACEs science with people who are trusted and speak the same "language", we have a better shot at changing mindsets. 

I totally agree Jane. That's why I started my peer support group. 

Robin M Cogan posted:

Wow...my brain just went into high alert from this information! I don't know why I am so surprised. That data point that Karen shared about "125 "helping professionals" had an average ACE score of 7," really hit home. I think this would be really important to do at NASN, along with Resilience Screen. 

I am a school nurse and I just finished my masters degree thesis on ACE scores in court and community school teachers and administrators (Masters in Education with a focus on administrative services).   I was thinking of replicating my study in school nurses.  I noticed that there will be a large focus on ACE/trauma at the national conference.  I really think that at least having the school nurses present at NASN calculate their ACE score would be incredibly valuable!  What better place than at NASN national conference!

This is all really interesting information. I'm presenting on resilience to a group of educators next week and realize it would be interesting to do an anonymous ACEs screening and Resilience screening as part of it. I know what the ACEs screening is, but not the resilience one. Can someone point me to a link that would give me more information? Thanks!

I'm so excited to see this discussion!  Our community collaborative, the Watauga Compassionate Community Initiative (WCCI) (like others' collaboratives), is comprised of school personnel, local mental health public and private providers, department of social services staff, non-profit staff, public health staff, university faculty and students, first responders, members of the faith community, and interested community members decided that we wanted to assess our own ACE scores as well as assess resiliency at our August 2018 monthly meeting.  We sought university Institutional Review Board approval, and distributed the ACE questionnaire, the Brief Thriving Scale (Smith, Erickson & Guzman, n.d.) and the Brief Resilience Scale (Smith, Dalen, Wiggins, Tooley, Christopher, & Bernard (2008) in Nov. 2018, and we just presented the findings to the WCCI last month.  While our "sample" was not large (n=48), the most dramatic comparison was to the Felitti et al., 1998 findings regarding 4 or more ACEs.  A total of 29.7% reported experiencing 4 or more ACEs in our study compared to 6.2% for the Felitti et al. study (1998, p. 251).  Also exciting were our findings on the BTS.  Our sample (n=48) had a mean score of 4.91 (out of 5 possible--higher scores indicate greater resiliency), compared to the mean score of 3.34 for the sample of undergraduate students that the scaled was first normed with.  We're hoping to present further at some national conferences as well as submit an article on our study--we're very excited to have this work expanded upon!  Research by Strait & Bolman (2017) in their study of health profession graduate students who completed an ACEs questionnaire, those who chose to complete a questionnaire in comparison to those who did not reported a better understanding of the concepts, and greater likelihood to incorporate trauma-informed care into their future health practice--I think that this says alot for we current professionals as well!  

Very interesting findings!  Looks like you have a somewhat traumatized yet resilient group.  We have found in our training sessions with health professionals that having a high ACE score can often help to understand patient's situations - but can be a hindrance when the clinician has a negative attitude towards patients/clients who are struggling with maladaptive behaviors and poor health - the attitude of "I pulled my self up by my own bootstraps so why can't you?"  More study needed about how clinicians own ACEs affect how they work with patients with ACEs.

(BTW - the more commonly quoted percent of participants with ACE of 4 or more in the  Felitti and Anda study is 12% - included both waves of the study.  See the CDC website data at https://www.cdc.gov/violencepr.../acestudy/about.html)

 

Fascinating!  We didn't collect demographic data on our small sample since it would have been identifiable, but typically those who attend represent a broad array of helping professionals, so it might be difficult to tease out the impact.  Anecdotally, in social work (I'm a social work professor), many of our BSW and MSW students "find" social work based on their own trauma experiences, and want to make a positive difference for someone else.  A study by Gilin & Kauffman (2015), Strategies for Teaching About Trauma to Graduate Social Work Students, found that 80% of the students who participated in their study reported at least one ACE and 27.3% reported 4 or more.  These findings support what I've observed anecdotally.  The researchers then discuss various teaching strategies to reduce vicarious trauma given the findings.  I think that this is just one of the many areas that is important to explore among our helping professionals and then providing support as needed.  Thanks too, for the observation about the more common presentation of Wave I and Wave II sample data in the Felitti study--I'll definitely note and plan to use those data!

Fascinating!  We didn't collect demographic data on our small sample since it would have been identifiable, but typically those who attend represent a broad array of helping professionals, so it might be difficult to tease out the impact.  Anecdotally, in social work (I'm a social work professor), many of our BSW and MSW students "find" social work based on their own trauma experiences, and want to make a positive difference for someone else.  A study by Gilin & Kauffman (2015), Strategies for Teaching About Trauma to Graduate Social Work Students, found that 80% of the students who participated in their study reported at least one ACE and 27.3% reported 4 or more.  These findings support what I've observed anecdotally.  The researchers then discuss various teaching strategies to reduce vicarious trauma given the findings.  I think that this is just one of the many areas that is important to explore among our helping professionals and then providing support as needed.  Thanks too, for the observation about the more common presentation of Wave I and Wave II sample data in the Felitti study--I'll definitely note and plan to use those data!

Did anyone see this:

Adverse Childhood Experiences: Concept Mapping in the Bachelor of Science in Nursing Curriculum

Marie E. Gill, PhD, MS, RN; Lin Zhan, PhD, RN, FAAN; Judith Rosenberg, PhD, MS, MPH, C-PNP-PC; Leigh Ann Breckenridge, DNP, FNP-C


To see the full abstract, click HERE

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Daun KauffmanCarey S. Sipp (ACEs Connection Staff)Robin M CoganKaren Clemmer (ACEs Connection Staff)
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