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Collaborative ACE Response at Senior Hope


Many of the advancements we see in ACE-informed programming and service delivery focus on early intervention and prevention with the purpose of altering potential long-term high-cost ACE trajectories. There seems to be less weight being placed on the development of ACE-informed programs specifically for older persons coping with the cumulative outcomes of a lifetime of adversity and trauma. Senior Hope Counseling, Inc. in Albany, New York, is one agency that has worked tirelessly to enhance ACE response for the aging population. As an active partner in the Healthy Environments And Relationships That Support (HEARTS) Initiative, Senior Hope reaches beyond its agency walls to the larger New York State (NYS) Capital Region and serves as a leading example of ACE- and trauma-informed senior care.

In NYS, Senior Hope stands alone as the only non-intensive, freestanding outpatient clinic certified by the NYS Office of Alcoholism and Substance Abuse Services (OASAS) that exclusively serves older adults 50 years and older with substance use challenges. In the words of Senior Hope’s Executive Director Nicole MacFarland, “Senior Hope is an ACE-informed outpatient treatment facility catering to older addicted adults. We believe that one size does not fit all and use ACE-informed strategies to promote a culture of resilience for clients and staff.”

The agency stands as an example of RISing leadership in aging (the “R-I-S” in “RISing” stands for “Restorative Integral Support,” a comprehensive model informed by Integral Theory, designed to help guide holistic response to client systems). As articulated by Larkin and MacFarland (2012), RISing leaders take the following steps to mobilize whole person/whole agency/whole community progress:

  • Raise awareness of client characteristics among staff, including the role of earlier adversity in current problems;
  • Provide education on adversity, trauma, resilience, and recovery to inform comprehensive response that brings together multiple services within healing social networks;
  • Create restorative cultures that provide self-care resources for staff, recognizing that leaders set an example and tone through role modeling and relationship-building;
  • Engage staff in identifying agency values and principles that will pervade the culture;
  • Create policies that facilitate social affiliations and support recovery activities;
  • Identify how each service within programs responds to client characteristics;
  • Build community partnerships to expand services and carry out research.

(Larkin, Beckos, & Shields, 2012; Larkin & MacFarland, 2012; Larkin & Park, 2012)

RISing leadership for ACE response started to develop at Senior Hope through an academic partnership led by Professor Heather Larkin at the University at Albany School of Social Welfare. It was through this partnership that many agency leaders and staff first became acquainted with the ACE Study and began thinking about the study’s implications for their aging client population. In 2012, as their first step in ACE-informed program development, agency staff decided to voluntarily administer the ACE questionnaire to newly admitted clients. Subsequent analysis revealed ACE scores of 4 or higher among 54% of the 50 clients who volunteered to take part in the survey. These results were a wake-up call, prompting Senior Hope leaders to mobilize ACE-informed action towards an agency culture supporting resilience and recovery.

Clinicians at Senior Hope continue to voluntarily administer the ACE questionnaire as part of the agency’s admissions process. ACE scores are regularly discussed at clinical meetings and are among the factors considered in treatment planning. Clients who are identified as having high ACE scores are recommended to join a trauma survivors’ group at Senior Hope where they have the opportunity to gain social support and build resilience among peers. The group was formed after analysis of the first wave of ACE scores in 2012 showed the need for additional services to address client adversity and trauma.

In addition, ACE scores are collected and used to inform continuing program development that maintains a restorative culture for both clients and staff.  Agency leaders recognize that the ability to provide optimal care is not a given and that burnout, when unchecked, can impact the workplace and ultimately affect client progress. Therefore, staff self-care is considered central to the maintenance of a resilience-promoting organizational culture.

At a community level, Senior Hope is a leading voice for the sectors of aging and addictions in the HEARTS Initiative cross-sector collaborative, which is one of 14 community networks involved in the national Mobilizing Action for Resilient Communities (MARC) project. Senior Hope has committed itself to activities advancing HEARTS’ MARC project goals. These activities include:

  1. Preparing staff for routine ACE questionnaire administration during assessment and treatment;
  2. Continuing to strengthen and share ACE-informed program developments, analyze data to identify individuals with 4 or more ACEs and cross-reference data from NYS OASAS to identify treatment outcomes of these clients; and
  3. Sharing findings with the HEARTS network, including trainings and web resources.

Senior Hope has grown over the years since the first wave of ACE questionnaires were administered back in 2012. This growth was set in motion through a partnership with the University at Albany--showing, perhaps most importantly, that change cannot be achieved in isolation. Rather, through the power of collaboration, Senior Hope has become a model of ACE-informed care for older adults struggling with addictions in the NYS Capital Region. RISing to the challenge of ACEs, agency leaders plan to share their findings locally, statewide, and nationally in advocacy efforts stressing both the importance of early life prevention and intervention and ACE-informed later life care.

Click on the following link to read a case study on Senior Hope by Heather Larkin, PhD, and Senior Hope Executive Director Nicole S. MacFarland, PhD:

Learn more about Senior Hope Counseling, Inc. by visiting their website at

Check out Senior Hope’s Facebook page:

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