Misuse of ACE assessment

I've commented on this issue previously. Having worked in health services, I have felt that ACEs screening as part of medical services are protected information under HIPPA. However, to what extent are school records or human service records protected? Can they be easily accessed for criminal, civil and child custody cases, for example? 

My concern is that using information from a minor for other purposes can be very damaging. Hearing "the family's in trouble 'cause you squealed," whether true or not, could make them more distrustful of adults and less willing to disclose personal information. Some circumstance should and must be reported by law, but I am concerned about third parties using the data, for example, to question the fitness of parents or guardians.  I would love to hear from others with experience in this area, and from legal experts on whether my concerns are reasonable or not.

I personally believe taking the ACE questionnaire initiates healing.  Not screening the kids keeps them from healing. I speak in schools about ACEs. This morning I passed out the questionnaire to a few classrooms in a highschool and asked them to fill it out anonymously and then shared with them what percentage of the classroom had atleast one ACE. The results were consistent with all other studies I've seen. 65%-75% of students had atleast one ACE.  The best thing about it is that I was able to show them that they are not alone in this journey. Their peers have ACEs too. Sometimes that is all we want to know.  I didn't have the names on any of the results so I don't know which ones were really high, but they all now know who they can turn to for help and they understand the impact of ACEs. 

I totally agree that realizing that you are not alone can be a powerful healing experience, and using it anonymously is very different than having in in your official record. My concern is not about giving people information about themselves, but about that information then being used by others for purposes for which the owner never imagined. (Gee, where have we heard about that before?)

I too have some reservations about screening for ACES.  First, we already know more than half of our students have at least one or more.  So it's not like we need to "see" if any of our students are affected.  You don't need an ACE score to tell students they are not alone in their difficulties.  The biggest message is where and how to get help. That's for the students.

My second concern is that we educators (I'm a retired elementary principal) need to take a deep and systemic look at our practices in the classroom, school-wide, and in our response to challenging behaviors.  Our standard (problem-solving) practice with everything in school is to screen, identify, label, and provide some ad hoc service to those "identified".  We educators even with the best intentions, separate, isolate kids and make them feel that they are different and inadequate. If we think screening needs to be done, it's because this is our usual practice.  Unfortunately, our usual practices are inadequate when it comes to helping kids with ACES better function at school.

ACES research strongly indicates strong positive relationships and fostering a feeling of belonging is essential to healing.  Yes, inform kids that they are not alone in their difficulties.  By all means have these conversations.  But beware of using the data gathered as yet another "screening" tool to provide an ad hoc service - and fail to make systemic changes within the classroom, the school and the policies around challenging behaviors.  Habits, beliefs, and practices of teachers & principals are difficult to break.  Let's not treat ACES as yet another way to sort and label.  That's why I discourage my workshop participants and school clients from using a screening tool - we have to retrain and rethink, not identify who has ACES.  Screening students it's not relevant to us educators since our task is make positive changes that affect every student.  And by the way - ACES can change - maybe you have none now, but when one is living in it, the experiences could change overnight.  A score last month means nothing - anyone at any time could go from zero ACES to have multiple ones due to changes in ones life circumstances.  So it's not even practical for educators to screen.  Leave the screening tool for what it was intended - medical and mental health use.  We educators need to instead change OUR game and change our practices.

I hope this helps you Margo!  Good luck.

http://whitewaveseducation.com

I think routine screening for ACEs and other traumatic experiences is potentially harmful and is not a trauma-informed practice. Discussion about traumatic experiences is best done within a trusting relationship, not by a stranger or through a written instrument. And Margo is right that it was developed as a research tool, and not intended as a screening instrument.

I think an important element to consider is how ACEs could be used as a reflective tool for the teachersand administrators themselves, though I'm not advocating for screening teachers. How do teachers' own adverse experiences (or lack thereof) affect their teaching practices, attitudes and responses to students' classroom behaviors? In the social services contexts I work in, the question I hear raised is "How do we do this work when we may have our own trauma to deal with?" If that's not coming up for teachers, perhaps the starting point is different, ie. How do you relate to and have empathy for children without problematizing or pathologizing them based on assumptions or implicit biases you may hold? How is it different to be affected by vicarious trauma vs. one's own lived adverse experiences? How do we balance the need to support the teachers' needs with the students' needs without making ACEs all about the adults? 

I'll bring in the pragmatics, because believe it or not we have already observed it happening.  When dollars are squeezed, we can't allow ACEs to be misunderstood to be predictors and triage out patients. I was at an ACE summit two years ago where we actually heard  accounts in two separate workshops about a hospital system who was doing this.  The higher number of ACEs actually demoted quality of care and receiving certain scarce medicines.  This is why we organizationally do not advocate yet for mandatory screenings.  We need to be clear that the people who gather the data are using it properly, and it is never to be used in a derogatory fashion.

To Angela's question, in my trainings, I teach teachers how to incorporate coping strategies and imbed them in their daily instruction and routines.  By doing this, teachers learn that those same strategies - breathing, mindful activities, etc. are just a beneficial for them.  In fact, once they start doing these with their students, the teachers find themselves in a better place - because they are getting a double benefit.  The teacher benefits from doing the coping skills daily, and benefits from her students' improvement in emotional well-being.  My training goes deeper than the coping skills - so when they apply the other strategies I share, they improve students social interactions, relationships with the teacher and see academic success.  Which leads to a huge improvement in both students and teacher's anxiety.  It all goes together.

Should read  "Just as beneficial for them (the teachers) as for their students."

My biggest concern is when ACEs are discussed without including the topic of resiliency factors. On their own, ACEs operate from a deficit perspective. We run the risk of pathologizing our students/clients if we don't also talk about personal strengths.

Being no expert in this arena - I'll simply rely on one. Dr. Felitti has commented about the power of acknowledging and responding to ACEs in a non-judgemental and empathetic way itself being a powerful intervention. When screening is done so infrequently on an issue that is seen as an epidemic possibly for our systems and health particularly later in life - not doing so out of "fear" feels quite overblown. In the same writing - Chapter 10 of "The lifelong effects of adverse childhood experiences" where Felitti says this about it being an intervention, it is related to asking simple follow up in a medical evaluation - and in seeing reductions in ER and office visits from those patients after follow up. I realize that is in a sense a relationship and it involves follow up - but we are not talking therapy in that context. Being careful is appropriate. Not moving out of fear - and without strong data to support the status quo - is baffling.

Susan J Ciminelli posted:

I too have some reservations about screening for ACES.  First, we already know more than half of our students have at least one or more.  So it's not like we need to "see" if any of our students are affected.  You don't need an ACE score to tell students they are not alone in their difficulties.  The biggest message is where and how to get help. That's for the students.

My second concern is that we educators (I'm a retired elementary principal) need to take a deep and systemic look at our practices in the classroom, school-wide, and in our response to challenging behaviors.  Our standard (problem-solving) practice with everything in school is to screen, identify, label, and provide some ad hoc service to those "identified".  We educators even with the best intentions, separate, isolate kids and make them feel that they are different and inadequate. If we think screening needs to be done, it's because this is our usual practice.  Unfortunately, our usual practices are inadequate when it comes to helping kids with ACES better function at school.

ACES research strongly indicates strong positive relationships and fostering a feeling of belonging is essential to healing.  Yes, inform kids that they are not alone in their difficulties.  By all means have these conversations.  But beware of using the data gathered as yet another "screening" tool to provide an ad hoc service - and fail to make systemic changes within the classroom, the school and the policies around challenging behaviors.  Habits, beliefs, and practices of teachers & principals are difficult to break.  Let's not treat ACES as yet another way to sort and label.  That's why I discourage my workshop participants and school clients from using a screening tool - we have to retrain and rethink, not identify who has ACES.  Screening students it's not relevant to us educators since our task is make positive changes that affect every student.  And by the way - ACES can change - maybe you have none now, but when one is living in it, the experiences could change overnight.  A score last month means nothing - anyone at any time could go from zero ACES to have multiple ones due to changes in ones life circumstances.  So it's not even practical for educators to screen.  Leave the screening tool for what it was intended - medical and mental health use.  We educators need to instead change OUR game and change our practices.

I hope this helps you Margo!  Good luck.

http://whitewaveseducation.com

Hi, I am a retired school social worker and currently an instructor for a University Social Work department. I teach Trauma Informed Systems - Resiliency and Sustainability; Social Work In Schools Design and Practice. Both of these courses emphasize how systems can become trauma informed/trauma sensitive. I wholeheartedly agree with your response. We need to ethically use any screening tool for its intended purpose.

I don't believe anyone in this forum is saying not to acknowledge and respond to ACES.  Understand that screenings are not an intervention, just a tool for whoever is gathering data.  Screenings alone don't provide anything in way of an intervention.  Addressing the needs of children with ACES comes from actual programs, counseling, relationship building, improving teaching and disciplinary practices - all of which should be in place first because without these, there is no intervention.  As one other post alluded to, screenings in and of themselves without these programs does to help children build resilience and skills to deal with trauma.  In fact, those trained in trauma-informed practices, do not list "screening" for trauma because they may in fact trigger post traumatic episodes in the individual suffering adverse childhood experiences.  There's good reason to understand that while teachers and principals in our schools begin to become trained in trauma-informed practices, they should not assume that the model they use with reading, math and other learning difficulties can or should be applied to trauma.  I don't understand the comment "without strong data to support the status quo".  The objective is to get educators trained to understand appropriate responses and interventions because the "status quo" does not support or is insufficient to addressing their needs.  No one is "not moving out of fear" - the goal is to do what correctly meets the needs of trauma victims and caution against the actions that don't.

Thank you Corrine Anderson Ketchmark.  This is why it is important to have these communities where conversation and clarity can come through and help prevent misunderstandings and misinformation.  And we must be patient with those who are beginning the journey to understanding this work.  It is different and will take lots of explanation and thinking.  Thanks for your comment.

Susan - I agree with most of what you are saying. I will respectfully disagree with your statement that "screenings" done well, without judgment, with empathy, acknowledging that an individual is normal, worthy, and not alone  "are not an intervention". I'm saying that they can be with some modicum of skill. I probably wouldn't lean this far out on that ledge without knowing that Dr. Felitti seemed to believe so as well. 

Correction - From my earlier response - this -  "As one other post alluded to, screenings in and of themselves without these programs does to help children build resilience and skills to deal with trauma."    should read  "As one other post alluded to, screenings in and of themselves without these programs does nothing to help children build resilience and skills to deal with trauma."

The research Dr. Felitti has done is worthwhile and as you say Greg, done without judgment and with empathy.  But his research is not in question here. His research is not the same as what teachers and school personnel think of as "screenings".  When teachers talk about screenings, they mean basically "tests" used to gather things like ability and cognitive levels of incoming kindergarteners to determine if children have deficiencies.  I think Dr. Felitti would strongly agree that we do not want to have "screenings" of this type (called a deficit model) with children with trauma.  Having been an educator for many years, I know all too well that if educators without trauma training start "screening" for ACES, we are on a slippery slope because they are used to looking for "deficits" in a child's skills.  For me - I think you and I actually agree.  The screening isn't the problem. It's the question of those school personnel doing the screenings "are done well, without judgment, with empathy, acknowledging that an individual is normal, worthy, and not alone"  Unfortunately I have seen in my experience the lack of training, in less critical areas than trauma, have a detrimental effect on the effectiveness of an intervention.  This has happened where the district has not funded training to go with a screening product and so educators have to do the best they can with limited understanding. So before schools start screening any children, all should understand Dr. Felitti's work and be trained to understand that ACES data does not fit the standard practices model with "screenings".

And by the way - I thank you for your willingness to partake in this discussion.  Nothing wrong with disagreement - as long as we are still willing to be part of the discussion.  I also applaud what you do - tough work.  Thanks for contributing.

The results of an ACEs screening, by itself, tells you very little: two persons both can have a score of, say 4, but the impact on the individuals can vary widely. Which four and what was most significant? A person might have a score of 1, but that one factor might have been so traumatic as to affect them in a way comparable to someone with a score of say, 6.

If administered properly, an ACEs screening can provide the person completing the survey with valuable information, and the service provider with useful insights. What I think some of us are saying is that, if administered en masse, there is also potential for great harm, as sloppy or lazy staff start categorizing people as :sixes" or "seven plus." Your ACE score is not your destiny.

The ACE questions are very intrusive especially with children.  It is less intrusive to ask the resiliency questions. If a child has  some amount of ACE indicators but also has a high resiliency score they may be able to deal with the harms that are happening to them.   Just by observing students who are isolating  may help identify students at risk for traumatic situations in their lives.  Any community should be able to supply adult mentors to at risk students without having to use professionals.  If those mentors spend a little time each week valuing the student jut by showing up they can improve the  student's resiliency.