Hello All,

Do we have any military service providers in the community who use an ACE screening as part of their practice - be it in primary care, behavioral health, pediatrics, etc.? If so, can you share with me how you use it and for how long you have been doing so? I'm also interested in anyone with knowledge of any efforts to raise awareness about ACEs in the military community. I'm coming from the perspective of working in military family policy for the Department of Defense and being a social worker and Army veteran. I'm also currently a fellow with Zero to Three and am focusing on ACEs in the military community. Any information is greatly appreciated, thank you!

Lee

 

Original Post

Certainly, in the past it was "well known"(written about in the research journals) that ACEs could set the stage for later service-related PTSD, but I thought recruiters had begun to take that into account and screening those people out. So, my question back to you is: "have you checked the clinical literature?" using things like PubMed / Google Scholar?

Benjamin Telsey posted:

Hi 

I am active duty US Army Pediatrician working in Seoul, South Korea and I have recently started a project implementing ACEs questionnaires for all of our annual wellness exams ages1-18, its been very worthwhile so far... allowing us to provide much more holistic care 

please feel free to reach out to me directly to discuss more 

my email: skipro36@gmail.com

Benjamin, thank you very much I will be reaching out shortly.

Russell Wilson posted:

Certainly, in the past it was "well known"(written about in the research journals) that ACEs could set the stage for later service-related PTSD, but I thought recruiters had begun to take that into account and screening those people out. So, my question back to you is: "have you checked the clinical literature?" using things like PubMed / Google Scholar?

Russell, thanks for your comment/question. Yes, I'm familiar with the literature. I've seen the research you mention regarding ACEs setting the stage for later service-related PTSD. I've also seen some research that discusses a higher prevalence of ACEs among the enlisted force. To my knowledge, recruiters do not use an ACE screening. I served in the Army after 9/11 and can say for sure there was no such screening at that point, and I'm fairly certainly there still is not. My interest is centered on those using ACE screenings in their practice.

Jane Stevens posted:

Russell: I don't think the military uses ACEs to screen recruits, but will look into that. They screen for past criminal records.

the research I'm referring to goes back more than 20 years, when it was found that a very large percentage of men serving overseas later developed PTSD (up to a 1/3rd ?) and that a significant predictor of this was prior/childhood trauma --  before the ACEsQ came in probably -- I tend to lump all such statistics into "adverse childhood experiences" and not just those picked up by the Q'airre

Lee McMahon posted:
Russell Wilson posted:

Certainly, in the past it was "well known"(written about in the research journals) that ACEs could set the stage for later service-related PTSD, but I thought recruiters had begun to take that into account and screening those people out. So, my question back to you is: "have you checked the clinical literature?" using things like PubMed / Google Scholar?

Russell, thanks for your comment/question. Yes, I'm familiar with the literature. I've seen the research you mention regarding ACEs setting the stage for later service-related PTSD. I've also seen some research that discusses a higher prevalence of ACEs among the enlisted force. To my knowledge, recruiters do not use an ACE screening. I served in the Army after 9/11 and can say for sure there was no such screening at that point, and I'm fairly certainly there still is not. My interest is centered on those using ACE screenings in their practice.

I thought a subsequent study had found a reduced incidence of PTSD symptoms amongst vets -- perhaps that was just a "naive hope".

imho it almost seems a bit negligent NOT to screen for possible risk factors, such as childhood adversity, but I'm not entitled to say -- that's for the US people. NZ/Australian troop numbers serving in those conflicts is very much less, and they tend to be more of the highly selected special forces types, who hopefully have been screened / tested for such phenomena -- as you know the research shows that some people are more likely to respond more adversely to further stress in their lives, not all do but ....

don't know how many psychologists you know, but you might try to find someone on the PsyLaw-L discussion list for forensic psychologists -- not all are in the "helping field", but some are involved in assessment for  compensation field, they should know more of what you're after -- one such psych you could track down is Tyler Carpenter, and he could put a question to the list on your behalf -- he used to be in the Boston area

Here's some other interesting research: 

Adverse childhood experiences in relation to mood and anxiety disorders in a population-based sample of active military personnel.

Relation between traumatic events and suicide attempts in Canadian military personnel.

Prevalence of Childhood Physical and Sexual Abuse in Veterans With Psychiatric Diagnoses

Hi Folks, 

I attended a forum today on PTSD and was told by a presenter that there is no evidence based link between ACEs and PTSD. I'll check the resources above Jane, and in addition if anyone knows of any other research that makes this connection I'd appreciate the referral. 

I work with a lot of vets who struggle with PTSD and I recall a conversation I had with one about ACEs and the coping mechanisms we use to survive them. He told me the ability to dissociate is assessed during recruitment because it's advantageous for military personnel to already have that practice established. I know that's an anecdotal reference, but it is telling and rings true to me, although I was shocked that it was so calculated. 

If we screened for ACEs to identify risk factors for developing PTSD so we wouldn't hire people with this experience, we wouldn't have any military, 1st responders, nurses or emergency room personnel. 

I'm really working on helping the general public to even get ACEs on their radar. Out of 400 people in the room today, even the presenter didn't know what I was talking about. I've got a wide open lane ahead of me, but it's lonely so nice to be in a community of the informed. 

Thanks for listening and sharing.

Elizabeth Perry

Thanks for the honesty, comprehensive, and courage of your response. It raises many, many, many, many questions, but just off the cuff 

HOW is the ability to dissociate assessed as a positive skill for military personnel?  When providing treatment for patients with histories of trauma, mindfulness skills training is often part of the standard treatment package BUT special precautions need to be taken to make sure negative reactions do not occur (not no reaction -- but a reaction that is counter-therapeutic); so for SOME people, with the skills to control their responses, in SOME situations, at SOME times, the ability to dissociate is a positive coping strategy --- BUT there's a lot of precautions that need to be taken in case uncontrolled dissociation occurs -- there're VOLUMES  of research articles about the possible risks of dissociation -- New Zealand based researcher Martin Dorahy has produced some good research, for example -- he'd probably respond with some EXPERT opinion if you contacted him

The term ACEs might not have been used but was there any discussion of the risks of further traumatization if one has been previously traumatized -- again SOME people become more resilient if they've been traumatized before, but certainly not everyone; which brings up the next question

What measures of resilience are used --  I well remember a presentation, to a group of social workers, by one of "The Two" -- Bob or Vincent -- where the frequency of ACEs in the audience was much higher than the Kaiser results and so far as we knew the modal performance of those present was in the professionally acceptable range, at least -- as Jane would be the first to say -- ACEs are only one side of the coin, resilience factors must also be considered -- the ACEsTooHigh website is an essential companion to this one

https://acestoohigh.com/

etc etc etc -- many questions raised

but wishing you all the best, thanks for raising those questions

Best,

Russell (retired psychologist -- went into it, for decades, because of my own ACEs history --- score 9 or 10)

Hi, Elizabeth: I don't think there's much doubt that there's a link between ACEs and PTSD. Many people actually prefer to call it CTSD (chronic traumatic stress disorder). And I prefer to call it a normal reaction to toxic stress caused by ACEs, and not a disorder at all. The toxic stress (allostatic load) research that Dr. Bruce McEwen and others have done are pretty clear on how the physiology works. And the links to the research listed in my previous comment show how military personnel and veterans with high ACE scores have higher incidence of PTSD than those with lower scores. Bessel  van der Kolk's book, The Body Keeps the Score might be a useful resource, too.

With most of that room not knowing about ACEs, you have great opportunities ahead of you to do some useful education!

Cheers, Jane

Jane Stevens posted:

Hi, Elizabeth: I don't think there's much doubt that there's a link between ACEs and PTSD. Many people actually prefer to call it CTSD (chronic traumatic stress disorder). And I prefer to call it a normal reaction to toxic stress caused by ACEs, and not a disorder at all. The toxic stress (allostatic load) research that Dr. Bruce McEwen and others have done are pretty clear on how the physiology works. And the links to the research listed in my previous comment show how military personnel and veterans with high ACE scores have higher incidence of PTSD than those with lower scores. Bessel  van der Kolk's book, The Body Keeps the Score might be a useful resource, too.

With most of that room not knowing about ACEs, you have great opportunities ahead of you to do some useful education!

Cheers, Jane

Although, to be honest, I'd personally be VERY careful about calling anything "chronic .... traumatic stress disorder" -- the Americans have been unable to find evidence in their DSM 5 field trials for chronic, or complex, "traumatic stress disorder" / PTSD -- and the two are likely to be easily confused, but they are not the "same". These criteria are scheduled for inclusion in ICD 11 in 2018, so are likely to influence American insurance practices then.

However, European researchers have repeatedly found convincing evidence for a Complex PTSD. Probably the best place, certainly the easiest, place to find "consensus guidelines for Complex PTSD  http://www.istss.org/treating-trauma.aspx

and the Society's Trauma Blog has some guidelines for treatment of vets.

The Europeans have developed treatment programs which have gone beyond the consensus guidelines (led by the American Cloitre) -- ask if you'd like some material there -- though some of their latest isn't yet in English.

The "ACEs -- PTSD" research literature is fairly "new", but the research linking early childhood stressors and PTSD has a much longer lineage -- same horse, just a different name.  The easiest way to check this is to do an advanced search on Google Scholar between 1980 (DSM III) and 1998, say.

Hi, all. I'm an active duty LCSW in the US Army. During my last assignment in an embedded behavioral health clinic at a large military installation in the US, I incorporated Felitti's 10-item ACE questionnaire in our intake packet to give us a quick assessment of the role that childhood adversity might be having on their functioning. It was a worthwhile addition, as it it provided a lot of information, rapidly. The data was often instrumental in assessment and treatment. I also conducted some education/training across the maneuver battalions of the prevalence and impact of ACE within our ranks. Both officer and enlisted could easily engage with the content, and found it to be helpful, especially in terms of understanding what factors might be influencing high risk/at risk/disengaged behavior within our ranks.

Hi Lee.

I would like to offer you 4 tools/exercises to test out and see if they help. ( ACEs IMMUNITY ) Is it taboo to talk about healing ACEs and trauma? It seems like a basic goal to me even if it is a placebo, knowing healing can happen is a good thing. Lots has been done with the polyvagal theory of unfinished fight or flight reaction to stress and abuse. My first exercise is for finishing this fight or flight or "play dead" reaction that is stuck in our autonomic nervous system.  I call it Finding Your Lion Heart. It is presented as an acting exercise to keep it one step away from your actual memories.  All CHM / Trauma is outer-directed and we are the victim.  This is inner-directed and we are always the victor.  As our wounding is a form of state-bound learning and imprinting we must get close to that original state to reverse and finish the F or F event with a different outcome. ( all imaginary like a video game ) But our body reacts as if it was real plus we are in control. This is the reverse of being out of control. The side effects of Finding your Lion Heart is the end of fear, the end of anger, and the end of pain. ( they have a limit and are not infinite) Also when you let loose of your control of these primal emotions in private then you gain control in public. Then it is with the end of pain that self-compassion is born and then available to others.

  The second exercise is a high quality powerful connected breathing meditation. How to walk your head and mind down to your heart and be in your heart.  At the end when your heart is open you put what you love in your heart. In the first process at the end you destroy worlds. The world of pain and the world of abuse and the world of neglect and so on.  These worlds give you a world view and move your life to be always ready for F or F. So stay stuck in the original adverse set of experiences. The third process is polarity flip flops.  This goes directly to your body and trains your mind to feel the effects of each poll.  Our trauma is held in our body subconsciously in the same place as how we walk.  Over time this exercise trains your body to recognize polarity and be able to move to the opposite with ease. Fear is a poll with an opposite. Stress is the same and on it goes with all subconscious unwanted behavior is really a single habit or reaching for only one poll.  And the last process is talking to the parts of self. This is also key and core to all our relationship outside and inside our skin. Parents kids lovers and business are all modeled on our inner relationships with the parts of self.  Think with this process you can increase your self-love 400% and intelligent decisions by 400% plus do all kinds of trust-building and conflict resolutions.  

The first 4 videos are the ACEs IMMUNITY process. The others are some few videos on why this works.

https://www.youtube.com/playli...gIhMEKCry7UgVofa0J-P

 

To be effective with Finding your Lion Heart then this video is good also. 

Forgive You and only YOU.

https://youtu.be/2cj3yuF8NYk

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