ACES screening debate article

I recently had this conversation with a group of folks. One point that was brought up is that without screening, you don't necessarily know what types of resources are needed. I live and work in a very rural, under-resourced community. If and when our medical community (or someone else) starts doing routine screening of ACEs, there definitely will be many cases in which there aren't options for referral. But if we don't start screening because we know there will be barriers for follow-up, we won't know what kind of follow-up we need to develop.

We are also so small that we don't have good data from the state about % of children or adults with high exposure to ACEs in our county. Our data is lumped in with 7 other counties, some of which are hundreds of miles away. We believe we are probably higher than most of the rest of the state based on related data, but we don't have the ACEs-specific data to back that up. It makes it harder to go after funding if we're up against counties that can say, "XX% of adults have ACEs score of 3 or more."

When we start screening, we will have better data for planning and seeking funding for the services that will most support people in our community. 

Ms. Godbold makes an excellent point about "survivor empowerment." The ACE score is a tool best used by the individual for the ways in which it can lead them to their own power/choice to enter a healing process. Knowing "the score" gives a starting point; information about how to engage healing should come next...and then it is up to the individual to select from a number of modalities that they feel comfortable with and will use for relief. The resiliency score helps build in empowerment for acceptance of healing. And, I'm no expert, but I believe healing also includes how to feel free from the cloak of hurt--how to enter the "what you don't know" as opposed to going back to "the hurt that is still hurt-y but comfortable in its familiarity."

In the end, it's about survivor empowerment. That is the goal of trauma-informed care. Cooperation, collaboration, choice - power-with rather than power-over so that the survivor is not retraumatized by once again having power and control taken away.

We had a debate about parents taking the ACES test in our parenting classes. In the end, we decided to ask the parents themselves. They unanimously wanted to do it. (And were anyway going home and looking it up online to take the test.) If we offer the ACES test in class, we are able to provide a resiliency questionnaire first, so parents do not just see themselves as having 'deficits'. People are given the choice to opt-out of taking the test or to take it at home. (No one ever does.) In the subsequent classes, we provide knowledge, skills and tools for overcoming the impact of trauma - especially as it relates to parenting. 

The score remains with the parents. It is their information and we have no business knowing unless they choose to share (which many do - with the group). We collect the tests (anonymously) from those who wish to submit them, tally the scores, and then reflect back the percentage of people in the room scoring for each item. This normalizes the often high scores our parents have. 

What bothers me about screening is the presumption that any service provider has the right to know people's ACES scores. (If someone wants to share, great. But it is their life and their information.) But what bothers me more, is that we 'professionals' should have the information about ACES and not share it. When we asked parents if they wanted to take the test they said, "Hell yes! We need to know this information. Why would you keep it to yourselves?"

Greg, perhaps one of the reasons "the notion that people knowing information without knowing exactly how to deal with it is worse than not knowing" bothers you is its paternalistic application to healthcare or in the provision of other human services. By paternalistic I mean a provider who presumes to know what's best for end-users of services who are capable of making that decision for themselves. I understand the quandary discussed by William Heisel in the article you refer to. However, I believe the ethical approach is to obtain an informed consent from individuals prior to responding to ACEs inventories. The process of informed consent would ensure that "the right not to know" is respected. 

I agree.  ACEs test data can be dangerous without identified resources.  It can also be misused.