Administering ACE questionnaire in a clinical setting

Hi, Keith: I'm sure you'll have some useful replies to your request, and you can check out the group Taking an ACEs History -- Who's Doing IT and How? for some short articles we've done on organizations that are integrating an ACE survey into their work.
Cheers, J.

Hello Keith,

i have much to share in this topic.  Could we have a call?  Maybe others would like to join as well.  You raise all the right questions.  One thing is to think of this as an assessment to open a healing and health promotion dialogue vs screening.  The frame is one of empowerment and self care and development- much more!  Christy 

I would like very much to join in on that call.

Yes, let's make a call happen. I'm wondering if we could use some kind of web-based teleconferencing tool. Can we have multiple callers on Skype? I've also used Zoom in the past, but am not sure if this is free.

I would also like to join the call.

We can use the chat function on ACEsConnection. It's a little different than audio conversation....there's a moderator, and it's a great way to package a lot of information into a short time. People type in their questions, the host answers, but so does everyone else, if they have information to contribute. It's archived in a way that you can quickly scroll through the text to retrieve useful information. And it's great way for two people to connect with each other without interrupting the flow of the conversation.

What do you think?

Hi all,

RegroupTherapy is a free, encrypted platform. (I use it for teletherapy sessions.) It's easy to sign up and, unlike Skype, is private and protected. I have it and could facilitate a call Friday morning sometime between 11 and 1 PST, if you would like. I would need your emails and names. You would get an email with instructions to download a simple plug-in and a code to sign in to the call. I use the ACE questionnaire frequently when working with a variety of clients in private practice. Please feel free to email me at cathyharris@traumainformedpro.com if this sounds good to you.

http://www.regrouptherapy.com

I would really like to participate as well. I can offer to host the meeting in a web conferencing tool as my company subscribes to such.

 

When would you guys like it to happen? I'm in the Central European timezone (PST+9, EST+6), but I have no problems staying up late to participate.

Keith Haas posted:

Yes, let's make a call happen. I'm wondering if we could use some kind of web-based teleconferencing tool. Can we have multiple callers on Skype? I've also used Zoom in the past, but am not sure if this is free.

Just realized that we use Zoom as well. :-)

I'm going to lobby again for having this chat on ACEsConnection, so that we can alert other members who aren't going to be able to join but want to, so that they can benefit from the information provided by those that participate.

A reminder: since the chat will take place in the Taking an ACE History group, the content would be available only to people who are members of ACEsConnection.

This is getting exciting! I like being able to see people's faces, and I've had positive experiences with teleconferencing in the past. Fridays typically don't work well for me, but anytime during the day Monday through Friday, 8am to 5pm would work. I am on Eastern Standard Time.

I am fine to use the ACEsConnection chat function, in order to benefit the community as a whole.

Yeah, using the site chat would be fine as well.

As a free (as in beer) alternative, Google Hangouts has a free group feature with up to 10 video participants (or 150 chat participants) for free: https://support.google.com/han...answer/3111943?hl=en.

And if people wanted to do a teleconference at some point, we could simply record it and publish it here (via YouTube), so that the rest of the community could enjoy it as well.

Sounds good, Thomas. I expect that this will be pretty popular, as our one about trauma-informed schools was. So having 20-30 people in a text chat might be more manageable than 20 people in a video chat or a conference call. I expect that we'll have quite a few ideas to follow up on, and some of those may be smaller, which lend themselves to better participation in a video chat.

I could do a chat tomorrow at 11 or 1 PST

Ack. I'm booked tomorrow. Can we do this next week so that we can let a few more people know about it? I can announce it in the Monday's daily digest. If that works, are you available on Tuesday at 9 am PT or 2 pm PT, or Wednesday 9 am PT, or Thursday 9 am PT, 10 am PT, or 1:30 pm PT?

I'll want to connect prior to show you how the chat works, too, so that it goes smoothly. It's easy.

I could do Thursday 9am PT.

I coordinate a jail based substance abuse program and we use ACE for both our substance use disorder program and our trauma, addiction and mental health program.   We use the ACE in the individual assessment for people entering our SUD program and in a group orientation for our TAMAR Project.

We discuss the research finding with the group as a whole, without asking individual members to disclose their score. Very useful tool in looking at who may need a more in-depth assessment for trauma.  Individuals are surprised to see some of the correlations between behavioral health issues and their scores- in a way, normalizing (not the best word) their reactions/behaviors.   

Great way to get the conversation started as well. 

Very interested in participating. Amy Bryant and I have developed a flyer we are distributing to local pediatricians that offers a resiliency questionnaire and also offers a free online webinar, free closed parenting Facebook groups, and an online parenting class that they may want to sign up for. The idea is to help prevent ACEs by teaching parents about their own resiliency and how to parent using co-regulation which helps regulate both the parent and child.

Many parents' lives are too hectic to find a sitter and drive somewhere once a week, so we are offering it online. I'm attaching our flyers.

Hi Christy,

I'm going to set up a 'group' via regrouptherapy.com I'm waiting to hear
back from others as to the time that would work between 11 and 1 PST. I'll
let you know as soon as I know.

On Thu, Feb 11, 2016 at 10:36 AM, ACEsConnection <
communitymanager@acesconnection.com> wrote:

Hi guys,

I'm planning on participating, but I'm a bit confused about the time slot.

We could perhaps do a Doodle (http://doodle.com/) to help us coordinate more explicitly?

Also, as you probably know by now from my posts, I am working on online open source, privacy-first ACE screening and reporting tools (delivered through smartphones, apps, PCs, websites (also embedded) and on paper), and I should be able to demonstrate a prototype next week as well.

I don't want to hijack the agenda for this particular meeting, but one of the most important factors to me in being able to deliver value to the ACE community with my project is that it addresses the actual needs and supports the real-life processes that you guys engage in with your clients, users, students, etc. It's also a huge personal motivation to me.

If you would like it, I could do a short live demo via a YouTube stream, and engage with the community via the ACEsConnection chat either during the meeting or at some other time next week?

Best,
Thomas

Robbyn Peters Bennett posted:

Very interested in participating. Amy Bryant and I have developed a flyer we are distributing to local pediatricians that offers a resiliency questionnaire and also offers a free online webinar, free closed parenting Facebook groups, and an online parenting class that they may want to sign up for. The idea is to help prevent ACEs by teaching parents about their own resiliency and how to parent using co-regulation which helps regulate both the parent and child.

Many parents' lives are too hectic to find a sitter and drive somewhere once a week, so we are offering it online. I'm attaching our flyers.

thanks for sharing the flier!

I'm also a bit confused. I thought there was a need to host this conversation on the ACE chat function? I guess we need to make two decisions: first, the format and second, day and time. I can make time available Monday through Friday between 9am and 5pm EST as long as I have a week or two notice.

We're going with a chat on ACEsConnection first, Keith. And we'll continue doing chats about this as long as people are interested, probably featuring people from different types of organizations that are implementing taking ACEs history, and in some cases, using it as a screening tool. Stay tuned for day/time....I hope to figure that out today. It'll be no sooner than next Thursday.

This is very exciting and I would love to be part of the chat - this is also a topic of great interest among the MARC communities and others.  I just participated in a webinar conducted by a FQHC (Community Based Health Center) in Colorado that has integrated ACE screening into their process.  I am still interested in creating a directory on ACEs Connection of everyone who is using the ACE questionnaire - or a modified version of it - in practice.

We are working with Family Voices on ways they can communicate with their families.  This is so helpful.  

Might there be interest in framing ACEs screening in a broader positive health and healing frame?  I am worried about what seem to me to be artificial debates about screening for ACEs vs. promoting healing and positive health and resilience.  I can chat Thursday morning but 11am-9pm booked that day!!

Hello Christy,  As my organization does not use the tool I ask the questions but put them in to the three catetories physical, mental, and Family dysfunction. Ad B. Vander Kolk points out in his book, may people in dysfunctional families don't realize they are. One of the SW I works with argues that the question should be asking people if there were any experiences they Perceived as traumatic, the emphesis being on the perception of the patient. That however would mean that the patient consciously recognized it and many times they do not.

 

I agree that it is trauma perceived that engages the bodies reaction and chronic stress.  As such, I have wondered about using a consequences-based vs event based assessment.  Yet, seems the ACEs items cover the range of likely sources of more extreme trauma.  For me, the unique aspect is trauma associated with loss of safety and nurturing from primary caregivers and those we needed to trust, etc.  much to discuss

I've also heard people, when educated about ACEs, say that they didn't understand that being verbally abused or experiencing neglect or divorce, or living with an alcoholic parent, could do damage. They just thought they themselves were "bad" people (or even bad children or born bad) and it took that education about ACEs to open the door for them. If people experience neglect, for example, as normal, then often they think they're responsible for the  consequences of neglect. Over and over, people when hearing about ACEs, say: "This explains my life." i.e.....if you don't know what safety feels like, then "loss of safety" feels normal.

Keith Haas posted:

Hello all,

Also, I am considering administering the resilience questionnaire as well. Any thoughts on this would be appreciated as well.

 

 

Keith,

What resilience questionnaire are you talking about? I'm interested in the topic and have some reservations about it, as well. One of them is the limitations in the field of instruments to measure resilience. To wit: 

concepthttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3042897/ 

Best of luck with the call, I won't be able to attend but look forward to the "proceedings" on such important issue.

Andres

Hello Andres,

I am referring to the attached questionnaire. It is my understanding that some programs administer this alongside the ACE questionnaire as a way to capture the presence/absence of known protective factors and contributors to resilience. I am not aware of the statistical validity of this measure.

Keith

Keith—

There was no attachment. Please resend.

Thank you,

Andres

Andrés F. Sciolla, MD
Associate Professor of Clinical Psychiatry
Medical Director, Northgate Point RST
University of California, Davis
Department of Psychiatry & Behavioral Sciences
2230 Stockton Bvld.
Sacramento, CA 95817
Tel 916-567-4222
Fax 916-567-4220

So Jane, and all those experienced in ACE understanding and possibly administration of to clientele, would you use or advocate the use of the Resilience history score?

I don't think I'll get the definitive answer I am looking for...!

All the best with the call.

Hi, Mem -- These pediatricians do, and it helps them understand their families, and it seems to help the parents understand their life course.

Hello Mem,  Yes, I would definately use it. To me the is no point digging up problems if you can't help supply solutions. Resiliency history helps you identify this and direct patients to resources. I just found out about this place yesterday and have sent an inquiry asking directory of practitioners with these unique skills that I can refer patients to. http://www.lisaferentz.com/workshops/     Based on the recent seminar I went to taught by Dr. B. Vander Kolk I have a new preference for referring people to those practitioners who use therapies that appeal to the visceral senses rather than just talk therapy. 

 

Keith, now I see the attachment and the questionnaire. Do you (or Jane) know who is the author, and whether it has been validated?

Diane Iverson posted:

Hello Mem,  Yes, I would definately use it. To me the is no point digging up problems if you can't help supply solutions. 

 

Dear Diane,

From a provider-centered perspective, I understand your point. None of us likes to feel helpless. From a client- or patient-centered perspective, however, research shows that clients want their providers to ask about exposure to traumatic experiences and respond with empathy to their disclosure.  For clients, disclosure in the context of empathy can be therapeutic in itself. In addition, the disclosure and the response they receive may deepen the trust and feelings of safety with their provider. In order to bring about behavioral change towards recovery and reduce health risks, mental and physical healthcare relationships require that foundation of trust and safety. There's a beautiful piece on a recent issue of JAMA, "Responding To Suffering" by Ron Epstein and Anthony Back that I think conveys this point.

Best,

Andres

PS: The article is attached, but please do not post it in the public domain, as I believe it would be an infringement of copyright. 

Andres,

I am not aware of the author, or whether or not it has been validated. Anyone else on the list know these things?

Hello Jane Stevens & Keith Haas, It appears some folks may be drifting a bit off topic here. While discussing the ACE Study (1998) in the Chadwick Manual, Dr. Felitti and Dr. Anda stated that "Surprisingly, the ten categories turned out to be essentially co-equal in terms of long-term effects".

If this is true, our efforts to respond to ACEs should be pursued co-equally.

We should start the helping process by;

1. Clearly identifying any specific court ordered legal rights (PPOs, Custody/Parenting Time) associated with any identified ACE.
2. Assess that person's needs to establish, change, or enforce any of these types of legal rights.
3. Link them directly to "Court Services" to establish, change, or enforce their legal rights.
4. And then, we can move on to 'coping skills' for the rest of the ACEs.

Think about when a child starts any treatment program and then their parents get divorced. How should we address this new "ACE" to prevent additional ACEs and the possible sources of ongoing toxic stress?

I think we should address the Divorce ACE co-equally, as if it were Domestic Violence or Sexual Abuse. Right?   

In my opinion, any other interpretation of the ACE Study (1998) should be discouraged and not allowed in this conversation. Its counterproductive and may very well be an attempt by some to justify why they don't want to following-up on [all] of the ACEs identified, especially Divorce.

---

Divorce = Divorce Court = Legal Rights = System of Care running to Hide. 

---

 

Some helping professionals seem to be willing to move on so fast, they sometimes overlook the most important thing in the life of the person being served;

• "To participate in the regular, consistent, and nurturing family  relationships they already have according to a current court ordered standard of care".

I believe the single most beneficial use for an ACE Questionnaire/Survey is prevention, both for the children and for the parents who may be repeating the 'relational abuse' that their own parents perpetrated against them.  

Children cannot defend themselves alone. Some of them will spend their entire lives practicing the negative coping strategies because they now see their own parents thru a lens of 'Parental Betrayal' and 'Social Injustice'.

Rose-colored glasses will not help. We must at some point begin to eliminate/prevent the legal and human rights violations perpetrated against our children in real-time. 

Please forward the details and include me in the conference call that you are trying to schedule about  "Administering ACE questionnaire in a clinical setting". Thanks!

James Gallant, Marquette County Suicide Prevention Coalition (906) 360-3045 mqtsuicidepreventioncoalition@gmail.com

 

James, if you're referring to people being off topic asking about the Resilience/Child Protective Factors history 'score' I beg to differ and believe it has everything to do with the discussion.  Keith initially asked about the resilience score, so it is on topic.

Because it gives you the biggest picture of the client's childhood.  The question is how to administer sensitively as it can potentially traumatise people for a while when it sinks in if one has a really low score, yet is so pertinent I believe to understand that whole picture.  If you understand exactly what you went through, and you're young, you have your lifetime to try to heal, with a realistic grounding in what actually occurred and what you need to do, with help. So after such a score/history it needs to be followed up with something positive - empowering as well as the 'truth', to give hope.

At least that's my take on it!

Mem Lang posted:

So Jane, and all those experienced in ACE understanding and possibly administration of to clientele, would you use or advocate the use of the Resilience history score?

I don't think I'll get the definitive answer I am looking for...!

All the best with the call.

I haven't been around in awhile but I hate that scale. 

that scale has no validation.  a very good pediatrician looked at literature and came up with the questions. 

 

I think they are horrible for very high acers who have a High ACE and LOW, LOW, LOW on that.   The peds at the children's clinic are using CD risk.  You can get it for 50 dollars if you email the fellow.  I emailed and he was fine with using it in the clinic.

 

 

 

Mem Lang posted:

So Jane, and all those experienced in ACE understanding and possibly administration of to clientele, would you use or advocate the use of the Resilience history score?

I don't think I'll get the definitive answer I am looking for...!

All the best with the call.

Mem, I don't like the resiliency questionnaires that have been developed so far, because I don't think they are useful in understanding specific vulnerabilities. They don't educate what you need to focus upon. Resiliency is about community and relationships, but it is also about general cortical capability, sensory reactivity and physiological regulation. Resiliency is about the way the reward system has developed due to the quality of relational reward early on.

That said, I created my own resiliency questionnaire, based upon my understanding of the sequential development of the brain (leaning upon the work of the ChildTrauma Academy). So I asked questions that directly address relationship/community (relational reward), reliance on sensory soothing (somatosensory reward), level of physiological arousal (self regulation), and the capability of the higher mind to mitigate stress (cortical modulation).

Children have specific vulnerabilities in these areas, and so do parents. Parents need to know where their areas of strength and vulnerability are so that they can recognize where they may need support in order to better meet their children's needs and also their own.

Robbyn Peters Bennett posted:

Mem Lang posted:

So Jane, and all those experienced in ACE understanding and possibly administration of to clientele, would you use or advocate the use of the Resilience history score?

I don't think I'll get the definitive answer I am looking for...!

All the best with the call.

Mem, I don't like the resiliency questionnaires that have been developed so far, because I don't think they are useful in understanding specific vulnerabilities. They don't educate what you need to focus upon. Resiliency is about community and relationships, but it is also about general cortical capability, sensory reactivity and physiological regulation. Resiliency is about the way the reward system has developed due to the quality of relational reward early on.

That said, I created my own resiliency questionnaire, based upon my understanding of the sequential development of the brain (leaning upon the work of the ChildTrauma Academy). So I asked questions that directly address relationship/community (relational reward), reliance on sensory soothing (somatosensory reward), level of physiological arousal (self regulation), and the capability of the higher mind to mitigate stress (cortical modulation).

Children have specific vulnerabilities in these areas, and so do parents. Parents need to know where their areas of strength and vulnerability are so that they can recognize where they may need support in order to better meet their children's needs and also their own.

Hi Robyn, 

 

What questions do you ask? Curious.

 

Tina Marie Hahn, MD posted:

that scale has no validation.  a very good pediatrician looked at literature and came up with the questions. 

 

I think they are horrible for very high acers who have a High ACE and LOW, LOW, LOW on that.   The peds at the children's clinic are using CD risk.  You can get it for 50 dollars if you email the fellow.  I emailed and he was fine with using it in the clinic.

 

 

 

Hi Tina, Can you send me a link to the CD risk assessment? I'm not familiar with it, but am very interested. Thank you!