David Finkelhor has a couple of publications about this in Child Abuse & Neglect: One is "A revised inventory of Adverse Childhood Experiences"; the other is "Screening for adverse childhood experiences (ACEs): Cautions and suggestions".
In the first (A revised inventory), Finkelhor suggests that other types of adverse childhood experiences (ACEs) be added to ACE surveys. In fact, over the last several years, many people and organizations have added other types of ACEs. Pediatricians at The Children’s Clinic in Portland, OR, at Bayview Child Health Center in San Francisco, and at Roseland Pediatrics in Santa Rosa, have added additional ACEs, including racism, bullying, involvement in the foster care system, witnessing violence outside the home, living in an unsafe neighborhood and losing a family member to deportation. The Philadelphia Urban ACE Study added five other ACEs to its survey. Dr. Martin Teicher at Harvard University uses emotional neglect, non-verbal emotional abuse, parental physical maltreatment, parental verbal abuse, peer emotional abuse, peer physical bullying, physical neglect, sexual abuse, witnessing interparental violence and witnessing violence to siblings to study effects during each year of childhood.
Wendy Ellis, who leads the Building Community Resilience initiative, developed the “pair of ACEs” concept to include adverse community environments — poverty, discrimination, lack of opportunity, poor housing quality and affordability, and violence — as well as maternal depression and homelessness. Prevention Institute in Oakland, CA, also adds adverse community experiences.
And we at ACEs Connection add ASEs — adverse system experiences — to include attending a zero-tolerance policy school, and involvement with the juvenile justice system, the healthcare system and social service systems if they have not integrated trauma-informed and resilient-building practices based on ACEs science (which, at the moment, includes most of the organizations in the U.S.).
btw, ACEs science includes the epidemiology of ACEs (original ACE Study plus subsequent ACE surveys); neurobiology of toxic stress from ACEs, especially the effect on a child’s developing brain; health consequences of toxic stress from ACEs; epigenetic effects of toxic stress from ACEs; and resilience research, which includes trauma-informed and resilience-building practices.
Regarding Finkelhors’ cautions and suggestions: Thousands of organizations across sectors — including healthcare, social services, behavioral health, home visitors, juvenile justice, education, business, faith-based community and even state agencies — are using ACE — and resilience —questionnaires to survey, screen, educate and empower staff and clients/patients/students/prisoners.
ACEs science is too powerful to wait years to begin developing evidence-based practices, and some of the early adopters already have substantive results to spur on adoption, and thus, refinement of practice.
There’s the 50% plus drop in births to teen mothers. The 98% drop in youth suicide and suicide attempts. A 90% drop in school suspensions, and the elimination of school expulsions. Over one year, zero violent incidents in a juvenile detention facility. After a year involvement in Safe Babies Courts, 99% of kids no longer suffer abuse. A 30% drop in emergency department visits. At an organization that implemented trauma-informed practices throughout its workforce, a 5% drop in health insurance rates. Radical cost savings for state and local governments.
If nothing else, encouraging people in healthcare and other sectors to educate their patients/clients/customers about ACEs science is imperative. The NEAR@Home toolkit was developed in Washington State for home visitors – people who work with new parents eligible for the program because they’re poor. They say that learning about ACEs is a social justice issue: ”Parents have the right to know the most powerful determinant of their children’s future health, safety and productivity.”
As people are developing practice-based evidence, early research shows that taking this approach is definitely on the right track. Robust research that continues to support this work will continue to refine and advance our understanding of the import of applying practices based on ACEs science now.