Misuse of ACE assessment

I agree, assessing resiliency is a strengths base approach that is embedded in relationships which supports the one caring adult concept of attachment, regulation and competency....

Susan J Ciminelli posted:

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.

Susan, can I ask what your role in trainings is? I would love to be able to talk with you about how you train these teachers!

To Emma and anyone else - I have two websites - http://whitewaveseducation.com and http://traumasensitiveclassrooms.com

You can also find me on LinkedIn if you are curious about my experience and background.  I've listed some of my recent presentations at national conferences in the U.S. and Canada.

Prior to retiring as an elementary principal, I wanted specialized training in brain-research and addressing challenging student behaviors.  I went right to the sources.  I received first-hand training with Dr. Eric Jensen for the past four years.  And last year received first-hand training from Dr. Ross Greene, author of "Lost at School"  on his method called Collaborative and Proactive Solutions.  If you are interested in these, you can find out more at http://jensenlearning.com  and Dr. Ross Greene's work on his website,  http://livesinthebalance.org

Margo Buchanan posted:

Hello everyone! I am a social worker, coordinating a program in a local school system to help increase trauma-informed practices. A part of my job is to give trainings to staff on topics like ACES. A question that continues to come up is, "Why aren't we screening all students for ACES using the ACE calculator from the study?" My answers have varied, depending on who I am speaking to, however mainly I stick with the moral dilemma, which is: What are we going to do with the information once we know? We don't have supports in place at this time to meet the need in the school system I am working in. Another point is that the ACE calculator is a research tool, not meant to be used as a universal assessment. It also does not cover all ACEs, such as generation poverty, intuitional racism, death of a parent or sibling, etc. 

What I am curious about from you all is- Are there any resources out there that can help me to understand more about why we wouldn't necessarily use the ACE calculator in all human service or educational organizations and what other ways people are tackling this issue.

Thank you so much!

Margo

 

Hi Margo,

I'm new to this community so I hope I am replying appropriately.  It is my belief that the ACE calculator should not be administered if the administering person or agency is not equipped to treat the trauma.  Mental health providers who specialize in trauma would ultimately be the best equipped. Any other service provider or educational facility is not equipped to "deal with" the results and would be using them for purposes for which the information may not be appropriate.  I would assume that all schools have the ability to refer a student or student's family to or recommend mental health services, whether that be through the use of insurance benefits or cash pay.  When I worked in various high school settings often the students would tell teachers or school counselors about family situations that would alert those staff members to a need, even without the use of the ACE specifically.

If you think about the impact of asking a child if they were abused or their parent is mentally ill or chemically dependent.  Those can be very difficult questions for a child regardless of their A.C.E. score.  First realize the ACE questions were designed for adults to report on their childhood experiences.

Depending on the age of the child they may not know how to understand the question.  If the questions are directed towards resiliency deficits then it is easier for a child to understand, It has less stigma and it gives the means to identify children who would benefit from adult supportive relationships even if they do not have current ACEs experience.

William reminded me that schools are restricted by law on surveying children and the ACE questions being for adults.  The laws regarding surveying children and limits and liability are here:   https://www.law.cornell.edu/uscode/text/20/1232h

Susan J Ciminelli posted:

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

Susan, Thank you so much for this information. Do you have a link to this article? I cannot seem to find. Thanks!

I assume you mean the Cornell Law page - I did post earlier, but will do so again, no problem.  The laws regarding surveying children and limits and liability are here:   https://www.law.cornell.edu/uscode/text/20/1232h

I agree with William. From our organization's standpoint for the last 30 years, we have educated the professionals to be on the ready when they see kids and teens who are experiencing ACEs or when a child comes forward.  Demanding a child come forward through something like a screening can be extremely abrasive.  "Outing" a family, when you live by the "Don't feel, Don't trust, Don't talk" rules, is expecting a lot out of a kid.  The stress of being in such an awkward position could be suffocating for a child. 

And further - I think we need to be careful how we frame ACEs when we are talking to kids.  I am reading a lot of references recently that blur the distinction between trauma as it relates to an actual traumatic event vs the unresolvable stress.  Sometimes they are one and the same.  But if you portray trauma as only a traumatic event, a pool of children who are experiencing ACEs will never reveal themselves convinced that their situation "isn't really 'that bad.' "  I think it is very important to emphasize the unresolvable stress as the culprit of the ACE, and that the level of danger or violence is not the differentiator.  It is a very lonely place to be when you are overlooked by the very people who are advocating to provide services.

MaryBeth,

What do you mean by "unresolvable stress"?  My belief is that nothing is unresolvable if the client is willing to do the work, look at the painful or traumatic adverse childhood experiences (or any experiences), and they have the right (for them) clinician/therapist with the right tools.

Hi Anita,

I think you may have miss previous posts here and didn't realize we are talking about children in a school setting.  Your comment seems to be based on an adult client who has choices and who's traumatic experiences are in the past.  Mary Beth was speaking of children with trauma, who often live with the source of the trauma which is likely to be ongoing.  "Willing to do the work" doesn't apply to children because they have little to no control.  To quote Nadine Burke Harris, M.D., when you meet a bear in the woods, and you run away, your stress goes up, then returns to normal once the threat is gone.  But when you're a child and you come home to the bear that lives in your house, your amygdala is constantly on hyper-alert and the stress doesn't dissipate.  The problem becomes PTSD and often children not only lack the executive function to "do the work", they may be suffering from ongoing trauma.  The other condition you mention is "they have the right clinician/therapist with the right tools".  Again this discussion here has been concerning children in a school setting.  Clinicians/therapists aren't available in a school setting and thus MaryBeth was advising against educators from "screening" students and creating a situation where trauma is triggered and left unresolved.  I'm sure you'll agree that only trained therapists skilled in addressing trauma should be using the ACES questions with children and that schools should leave this to the professionals who can help the child.

As an observer of the ACE Study's usefulness and application, I think that this issue, posed by Margo Buchanan, is very relevant: "Are there any resources out there that can help me to understand more about why we wouldn't necessarily use the ACE calculator in all human service or educational organizations and what other ways people are tackling this issue[?]"

Here is my 'answer' from way out in left field: Everything is "energy." How do we use it, and witness the way it is used by others? The ACE evaluation is a tool by itself. When someone (of any age) answers it, the result is a snapshot of their status in the moment. It seems that giving the assessment to a child and using the result to build data, write a label, create a 'treatment' plan, or "do something with" is wrong. Adults should be able to access the evaluation, answer it for themselves and pursue some avenue of 'healing' that is a good fit for them.

Everyone is born as "gold." Everyone turns to "lead" in some way--just as any car starts depreciation the moment it is driven off the lot by a new owner.

Again, it is a matter of "energy."

If we start at this lowest common denominator and assume that everyone has some sort of ACE, some sort of inherent betrayal just because they became a human being in this wide, strange, beautiful, ugly, shades-of-light-and-dark-in-contrast world, then everyone should be taught to tap into their own ability to find compassion first for self, then for others.

Moving now from my post of observation, my personal belief is that traumatic events become the energy of "hurt." Hurt gets held in the body's overall memory ability as a quanta of energy. There are ways to locate and discharge this kind of energy, to neutralize it, and make it a fact that does not continue to radiate. I do not know how this happens, but I suspect that bringing a memory to consciousness and dealing with it gets it to a place where it can be neutralized.

This process is very personal! It is still quite mysterious. I've been working to figure it out since I first learned about the ACE Study in 2010, and I will stay with this mission for the rest of my life. Maybe even beyond my life if that is what it takes.

The human spirit is miraculous. The ACE Study is a gift to humanity. I wish "good energy" to all those who observe it, discern it, "use" it, and who--because of it--practice both the Golden Rule (treat others the way you want to be treated) and the Platinum Rule* (treat others the way you see that they want to be treated).

*Tony Alessandra, Ph.D.

I’ve been following this post and all responses with a pit in my stomach for the most part.  Several responses seem to point to “leave it to the professionals”. Unfortunately, if we do that the majority of people will never get help- that is why public awareness is vital.  There are a few posts that suggested we should just educate teachers to look for certain behaviors and letting that be our basis as to which students need help.  I agree, we do need to educate teachers but the problem with this strategy is that there are a lot of really resilient students that have learned survival tactics that prevent them from displaying the behaviors we are telling these teachers to look for and because it makes us rely on the teacher’s human judgment.

I have an ACE score of 9. My safe haven was school- it was also my coping strategy/survival tactic to keep myself busy and active, to overachieve and chase perfectionism.  I graduated highest honors, was the captain of the step team, the school news anchor, on prom court, etc I didn’t display any obvious signs of trauma or toxic stress, so it never crossed anyone’s mind that I needed help. I have met a great deal of people that have similar stories. As a result, we are well functioning average Americans with great jobs and healthcare (sound familiar? It should because that is the 17K+ people in the original ACE study) who fly under the radar until it is too late- our bodies (and our relationships) are breaking down from years of a dysregulated stress response system. We are having babies of our own, never knowing that we have developed self-sabotaging habits and behaviors that are going to cause ACEs in our new families. To make matters worse, based on this thread, it sounds like there are plenty of people that could have helped, but didn't because they didn't want to intrude or make us feel bad. That is heart breaking to me. There are hundreds of thousands of teenagers who are longing for this kind of information but don't know it exists until someone is brave enough to tell them. I really believe if someone had handed me an ACE questionnaire as a teenager I would have felt the same validation and freedom I felt when I finally stumbled on it while still desperately seeking answers at 25.  I still don't see an issue with giving them the option to anonymously take it for informative purposes, especially if you are also letting them know who to reach out to for help, giving them resources, and informing them that they are not alone. That would have been a gold mine for me. My heart breaks for these students, like me, who are flying under the radar because adults made the decision that either 1)they don’t display the behaviors so they don’t need help or 2) informing them was going to harm them more than their reckless or dysfunctional home life already has. I’m of the opinion we should do everything in our power to compassionately inform everyone, even the 0s- because they undoubtedly have friends with ACEs. One of the things I appreciate about the questionnaire is that it gives specific examples instead of broadly stating "Have you experienced abuse, neglect or dysfunction?" If you ask that question people mostly are going to say no because they don't consider their parent humiliating or criticizing them often or a parent with mental illness as one of those three categories.  That's why the questionnaire is so eye-opening in my opinion.  I also want to highlight the original question that Mary just reiterated- are there any resources that can help us understand why we wouldn’t use it? Not opinions, but scientifically proven data that suggests we shouldn’t? I'm fairly certain Nadine Burke Harris mentioned in her book that they encourage teenagers to self screen instead of having a parent complete the questionnaire on their behalf. I'm curious as to what age they start the self screening process. Has anyone seen that questionnaire? I assume it somewhat differs, but I am not sure how. 

Courtney,

Thanks for your post. While I know this is sensitive, I do think an expert trap has emerged a bit as well - indicating that only experts trained can do this sort of work. I believe there could be a danger in just "collecting" the information, and leaving it there without some explanation and follow up. I also believe that folks in general - and those who have experienced ACEs in particular, have a fierce resolve and have been coping with things that most adults - maybe even professionally licensed adults - have never had to deal with. Knowing their ACEs, alongside a caring adult who will be there to listen and support, will not derail them and may provide relief.

There have been some binary post - an either or position - that feels a little dangerous regardless of the subject (we all surely agree that, or we shouldn't do this), as if there is such a thing as undisputed fact - much less significant evidence. The version that Nadine Burke Harris uses - maybe the CYW - has a teen version. it is essentially the same 10 ACE questions combined with some other questions (maybe 6-8) around poverty and race, etc. that go beyond the scope of the initial 10 - and incorporates other things we have learned about what can be traumatic (witnessing community violence). I believe that she provides the screening tool to parents and teens - has them score it - and then only collects the overall number. She says she does not need to know the exact trauma that they have been dealing with to provide a framework about what it means to have experienced and now deal with the trauma.

Best,

Greg

Here is a link to an article cautioning the widespread use of ACEs screenings - giving some reasons and also indicating the kinds of resources you might want to have in place before doing so. It is one article - and I think you could find numerous others on both sides - but it provides some reasoning behind being cautious:

http://www.unh.edu/ccrc/pdf/CV350-InPress.pdf

Thanks Greg for joining the conversation and for the link to the article.  

Hi Courtney, I'm sorry to hear of your difficulties and thank you for sharing your own story with all of us.  Certainly your experience and perspective is an important reminder to all of us the importance of everyone being informed about ACES and understanding how prevalent it is and its life long impact.  I hope your circumstances are mitigated by having people in your life who love, support and care for you.

Thanks, Susan. It's a story of overcoming for which I am proud of and hope to help others have their own. Also, thanks for the article, Greg! 

William Bear posted:

If you think about the impact of asking a child if they were abused or their parent is mentally ill or chemically dependent.  Those can be very difficult questions for a child regardless of their A.C.E. score.  First realize the ACE questions were designed for adults to report on their childhood experiences.

Depending on the age of the child they may not know how to understand the question.  If the questions are directed towards resiliency deficits then it is easier for a child to understand, It has less stigma and it gives the means to identify children who would benefit from adult supportive relationships even if they do not have current ACEs experience.

 

Great points, William! As a teacher, I first thought students (high school) should be aware of their ACEs score.  Continuing on my learning journey about trauma, I have changed my mind.  I do NOT believe the score is as important as the students knowing their brain may have developed a little differently than some of their peer's brains (not in a negative way, just different) if they experienced or are experiencing trauma-related challenges.

Teaching at a 90-day residential drug and alcohol treatment facility for students ages 13-17 for the last 3 years has allowed me to explore even more.  I never give the ACE questionnaire to my students, but I do describe how trauma was indicated in the study originally used.  My main fear is that my students will turn on a family member or anyone else they may blame for the trauma and of course, this would cause even more trauma.  My students have already been through so much, I can't imagine causing more harm!

Currently, I share the study with my students and give VERY general definitions of how the study defined trauma.  I've had a few older/mature students research the study and find the questionnaire.  When this has happened, I discuss it with the student(s) one-on-one or small group (whoever was curious enough to look up the information and learn more).

I see both sides of this so I thought I would (very briefly) explain using some of my experiences.  My goal is to be a supportive adult to each and every one of my students and help them any way I can.