Early prototype of the ACE Toolkit online!

Dear Friends,

In my opinion...

It's important to bear in mind that even the best ACEs questionnaire will always be a blunt instrument.  

In  an educational or clinical setting, staff should be taught to take a thorough ACEs history. Assessment of the cumulative load of childhood adversity must account for the age of onset, duration, and severity of adverse experiences, as well as the presence or absence of supportive relationships and other protective factors.  

To facilitate the history-taking process, multiple-choice questions should be paired with open-ended questions.  (See note below.) Some students/patients reveal more in a written survey than they disclose face-to-face; however, both should be part of the assessment process. 

Debbie
Deborah Bock, MSW, LCSW
Resilience Trainer
Anchorage, Alaska 

NOTE: At well-child visits, Dr. Nadine Burke-Harris routinely asks parents two questions, (1) Since you were last here, did anything scary happen to your child?  and (2) Since you were last here, did anyone hurt your child?  

James Gallant posted:

Hello, Thomas!

This app could be the one embraced by the helping professions worldwide to develop an internationally accepted format for accurately accessing and disseminating this huge amount of scientific information about various forms of trauma and preventing/addressing these issues effectively.

That's why it's so vitally important to "fact check" all the new and upcoming 'wanna-be trauma-informed products and programs' as they're being developed to ensure fidelity to the original ACE Study (1998) findings and to ensure the credibility of our future efforts.

I trust that when you finish loading the (10) ACE categories and questions into your new e-toolkit's <ACE Screening> function, they'll appear exactly (verbatim) as stated in the original ACE Study (1998).

If this app does end up working and it's later found to contain significant amounts of inaccurate/paraphrased or excluded information, that would not be helpful in the big picture.

---

 

I also must respectfully disagree with Jane Stevens' position on the subject of "taking an ACEs history" vs. "completing an ACEs screening".

 Jane said; "Also, I suggest using the words "taking an ACEs history" rather than screening. I made that transition because, in the medical community, "screening" means that you follow up with some type of recommended medication or procedure depending on the outcome of the screen (e.g., screen for cholesterol, comes up positive, prescribe medication)".

If we now transpose my example of requiring all ACE screenings to list the ACE Study (1998) categories verbatim, we come up with this scenario;

• Child screens <positive> for "Divorce" or "Separation from a [living] Biological Parent".
• Identify the legal rights of all family members and/or needs for establishing legal rights.
• Write that down in the treatment plan.
• Ensure all future services are scheduled at times that "will not" interfere with current legal rights to be somewhere else [with someone else].
• Assess compliance with all legal rights of the child being served.
• When legal rights violations are alleged or suspected, officially refer the case directly back to the court with "competent jurisdiction" for a review and enforcement services if necessary.
• If warranted, contact Child Protective Services. Especially if the child already has a diagnosis of a developmental disability.
• The "Developmental Disabilities Assistance and Bill of Rights Act of 2000" clearly states that people with a developmental disability have the legal right to live their life <free of violations> of their legal/human rights.
• Easy as that!

It appears the medical community may be actively resisting the screening label knowing that they can continue to believe they don't have to follow up on these types of issues the same way they would follow up on a cholesterol screening (prescribing a procedure) because they're only "taking an ACEs History", they're not "screening" for anything. It then becomes someone else's job to "follow up".

That's a mighty convenient loophole for the professional folks out there that we're trying to convince to change the way they address trauma (ACEs) in their professions.

I think the label should stay "screening" to specifically elicit those feelings and thoughts, on the part of the medical community, that these issues warrant a comprehensive response that's co-equal to following up on a positive cholesterol screening.

Lets do a <ACEs Connections - Community Survey> to assess the thoughts on this "history" vs. "screening" issue. 

Keep up the good work Thomas, This really is cool!!!

James Gallant

Hi James,

Thanks for your thoughtful and insightful comment, and thanks for the acknowledgement about the potential impact of technology like this. 

I am not a mental health professional myself, but that being said, it is also my personal impression that how we talk about something - the narrative and the discourse we apply - has great influence on how what expectations and responses it yields in people and systems.

I cannot personally validate the hypothesis about whether the use of the phrase "screening" instead of "history" is cardinal to which discourse is applied in the setting mentioned, but based on my own experiences - not with this specifically, however, but with the impact of parlance in various walks of business - I am personally biased to think that this is indeed the case; that the use of "screening" instead of another phrase in a tool like this probably has an impact on the what effect it has on the following process.

I also think that it would be very interesting and beneficial to have a survey and a discussion on the topic of discourse.

I agree with your opinion that backbone of questionnaires in the ACE Toolkit should be the ones that are scientifically vetted to ensure as much scientific validity as possible.

When I write "questionnaire" in plural it is because I have a vision that the ACE Toolkit could - and probably should - offer a wide range of questionnaires, tools, and screening methodologies: from the scientifically vetted, like the original ACE questionnaire, over WHO's, to experimental ones under development, e.g. for children and youth, or for other marginal groups, etc. 

This would leave room for the tool to be used for various purposes, and for the ideas and hypotheses permeating from new experimental methods to potentially propagate to the rest of the community quickly.

Also, the ACE Toolkit could serve as an instrument of collecting and analyzing the data relevant to vet such hypotheses about new instruments, tools and screening methodologies.

What are your thoughts on this?

Best,
Thomas

Kim Ander posted:

Thank you for creating such a visionary tool for screening for ACEs. I work in a primary care setting and can see this being used easily.  Works/looks great on my I-Phone as well. 

Hi Kim,

Thank you very much. I'm glad that you find it useful already, and that it works for you. :-)

Feel free to PM me here or add me on Skype (translucent-tpb), in case you would like to share some of your thoughts on how it would be useful - even if they're just casual thoughts - as I'm sure that they would be very useful for the ACE Toolkit project.

Best,
Thomas

Bridget Lambert posted:

Looks good on galaxy core! I can visualize this being helpful in a lot of social service settings.  Thanks for your efforts!

Hi Bridget,

Thanks for your feedback and for your effort as well. I'm glad to hear that you tested it and that it worked for you. :-)

Would you care to tell more about your thoughts on which settings this could be useful in? The development of the ACE Toolkit is really dependent on the thoughts and idea of the community, and any thoughts, ideas, perspectives, and criticism is much welcomed.

Best,
Thomas

Hi all,

Thanks for all your comments! Very much appreciated.

I've been working my way through a very busy day today, and I'll reply to the comments tomorrow when my brain is yet again out of the fog of writing (a rather abysmal number of documents, e-mails, and what have you). :-D

Releasing v0.1.1

I managed to release v0.1.1 (up from v0.1) with all the 10 ACE Study questions included, and also containing minor graphical improvements and with some "mock" elements present.

The presence of the mock elements is to give you guys an idea of some of the design elements that could be present in different contexts in the app.

For example, I envision that one use of the ACE Toolkit would be by a professional, who would administer the screening tool to a number of clients, e.g. in a group/batch or spread across the day.

I presume that the professional would like to be able to get an aggregate overview of the data, including a graphical representation of the structure of the underlying data.

The spiderweb/radar diagram type could be useful for conveying such structure, and that is what I have implemented in the following screenshot (note the note about the mock functionality):

In this example, the radar diagram would show the aggregate ACE score per question/answer of the cohort. Using this approach, we can identify that many respondents have ticked Question 4 and 7, while a lot less have ticked Question 9. 

Visualizing data like this could make it easy to identify which ACEs are the most prevalent among the cohort.

 What do you think?
 Do you think that data visualization could be a useful tool for you? 

Mock Functionality & Canary Versions

In general, introducing mock functionality at this stage is all very fine, but who wants functionality lying around that is not really usable (and mode and median represented as percent), anyway? No-one, really, and that is why the mock functionality is only that present in the current early versions.

Later on, I expect to make the switch to instead releasing "canary" editions of the app (alongside the vetted production edition) with such sketched/sketchy functionality, which in software parlance means: Being the user of a canary edition, you're the canary in the coal mine. :-)

Empty Thou Browser Cache

Every time you want to check http://resixorg.github.io/ace-toolkit/ for new versions of the ACE Toolkit, be sure to clear the browser cache (or reload multiple times) to force your browser to download the newest version of the app.

The reason for this is that your browser is very good at caching stuff it thinks it might need later, which in most cases is what we want, but not necessarily during this part of the software development process where changes occur often.

You know that you're seeing the newest version of the app, when the version number of the app (located in the top bar) has incremented and matches the most actual version number. In this case v0.1.1.

Need help in clearing the cache on your mobile unit? Take a look at: http://pch.custhelp.com/app/an...t-phone-or-tablet%3F

Have fun - and happy testing!

Best,
Thomas

Hello, Thomas!

This app could be the one embraced by the helping professions worldwide to develop an internationally accepted format for accurately accessing and disseminating this huge amount of scientific information about various forms of trauma and preventing/addressing these issues effectively.

That's why it's so vitally important to "fact check" all the new and upcoming 'wanna-be trauma-informed products and programs' as they're being developed to ensure fidelity to the original ACE Study (1998) findings and to ensure the credibility of our future efforts.

I trust that when you finish loading the (10) ACE categories and questions into your new e-toolkit's <ACE Screening> function, they'll appear exactly (verbatim) as stated in the original ACE Study (1998).

If this app does end up working and it's later found to contain significant amounts of inaccurate/paraphrased or excluded information, that would not be helpful in the big picture.

I also must respectfully disagree with Jane Stevens' position on the subject of "taking an ACEs history" vs. "completing an ACEs screening".

 Jane said; "Also, I suggest using the words "taking an ACEs history" rather than screening. I made that transition because, in the medical community, "screening" means that you follow up with some type of recommended medication or procedure depending on the outcome of the screen (e.g., screen for cholesterol, comes up positive, prescribe medication)".

If we now transpose my example of requiring all ACE screenings to list the ACE Study (1998) categories verbatim, we come up with this scenario;

• Child screens <positive> for "Divorce" or "Separation from a [living] Biological Parent".
• Identify the legal rights of all family members and/or needs for establishing legal rights.
• Write that down in the treatment plan.
• Ensure all future services are scheduled at times that "will not" interfere with current legal rights to be somewhere else [with someone else].
• Assess compliance with all legal rights of the child being served.
• When legal rights violations are alleged or suspected, officially refer the case directly back to the court with "competent jurisdiction" for a review and enforcement services if necessary.
• If warranted, contact Child Protective Services. Especially if the child already has a diagnosis of a developmental disability.
• The "Developmental Disabilities Assistance and Bill of Rights Act of 2000" clearly states that people with a developmental disability have the legal right to live their life <free of violations> of their legal/human rights.
• Easy as that!

It appears the medical community may be actively resisting the screening label knowing that they can continue to believe they don't have to follow up on these types of issues the same way they would follow up on a cholesterol screening (prescribing a procedure) because they're only "taking an ACEs History", they're not "screening" for anything. It then becomes someone else's job to "follow up".

That's a mighty convenient loophole for the professional folks out there that we're trying to convince to change the way they address trauma (ACEs) in their professions.

I think the label should stay "screening" to specifically elicit those feelings and thoughts, on the part of the medical community, that these issues warrant a comprehensive response that's co-equal to following up on a positive cholesterol screening.

Lets do a <ACEs Connections - Community Survey> to assess the thoughts on this "history" vs. "screening" issue. 

Keep up the good work Thomas, This really is cool!!!

James Gallant

Thank you for creating such a visionary tool for screening for ACEs. I work in a primary care setting and can see this being used easily.  Works/looks great on my I-Phone as well. 

Looks good on galaxy core! I can visualize this being helpful in a lot of social service settings.  Thanks for your efforts!

Keith Haas posted:

Thanks Thomas. This looks great. I'm going to take a closer look and see if this is something we can use here in our HIV clinic.

Keith

Hi Keith,

Thanks very much for taking the time. Very much appreciated.

I would love to learn more about the settings and interactions in which you would like to use an electronic ACE tool, as this would allow me to understand your needs and requirements into consideration, and design and develop the tool to support them as smoothly as possible.

At this point in time, the ACE Toolkit is like the first ink on a fresh canvas, so as a community we're able to paint pretty much what we wish, and in the style we wish. And we may branch and create specialized versions of the toolkit suitable for different contexts and interactions.

Therefore, any and every idea and suggestion is welcome, no matter how simple or complicated it might seem.

Best,
Thomas

Holly White-Wolfe posted:

Great start!  I can't wait to see this tool fleshed out even more. Thank you for sharing!

You're more than welcome. I'm glad that it piqued your interest, and thanks very much for the feedback!

I browsed your profile and noticed that your profession is described as "Program Planning Evaluation Analyst" (awesome title by the way). 

If you would be interested in sharing some more details about what you do, I would really like to chat/talk to you about how the ACE Toolkit could support your work in relation to e.g. gathering and analyzing ACE scores.

Best,
Thomas 

James Gallant posted:

Hello Thomas, I tried your e-toolkit on my HP Laptop and when I selected the 'new' button for an ACE Screening, only 4 questions came up and 2 of them were the same question. Then, I went thru several new screenings and the statistical parts seemed to be working to give me a Total ACEs and the average ACE Score across the group of screenings.

Impressive start and the possibilities are huge, Good Luck moving forward!

James Gallant

 

Hi James,

Thanks for trying it out!

Ah yes, I forgot to mention that I deliberately hadn't put in all the questions from the CDC 12-element questionnaire in the first prototype. I can certainly understand why you think this is an error. :-) Sorry about the inconvenience, and thanks for plowing through with the testing anyway.

I will make sure to include the rest of the questions and do a new release later today, and I'll notify you here when it's done.

Best,
Thomas

Hello Thomas, I tried your e-toolkit on my HP Laptop and when I selected the 'new' button for an ACE Screening, only 4 questions came up and 2 of them were the same question. Then, I went thru several new screenings and the statistical parts seemed to be working to give me a Total ACEs and the average ACE Score across the group of screenings.

Impressive start and the possibilities are huge, Good Luck moving forward!

James Gallant

Great start!  I can't wait to see this tool fleshed out even more. Thank you for sharing!

Thanks Thomas. This looks great. I'm going to take a closer look and see if this is something we can use here in our HIV clinic.

Keith