Shortened ACE questionnaire

Thanks so much- I like the shortness and it opens a dialogue on the issue. Gabor Mate also helpful

Appreciate your help

Bill, Gabor Mate, M.D., who recently presented in Montreal, and practices in B.C., may have some options you'd find helpful. A Pediatrician/Legislator in Vermont sponsored Vt. House bill 762 in 2013 requiring all health care providers (in Vt.) to screen All patients-regardless of age, for ACEs. Some Vermont ACEsConnection members may also be of help regarding your specific question (shortened version).

This may or may not be relevant to Craig's Chiropractic query: "A Validation of the Adverse Childhood Experiences Scale in Nigeria" by Olalekan Taoreed Kazeem-Dep't of Psychology/Univ. of Ibadan (using the World Health Organization's ACE International Questionaire) in the "Research on Humanities and Social Sciences" journal-Vol. 5, No. 11, 2015 -- comparing the ACE International questionaire to the two [Short version and 'longer version'] CTQ (Childhood Trauma Questionaire) developed by Bernstein and Fink in 1998.

That's EXACTLY the word Tina, that came to me after I posted:  Bandaid!

We seemed to have lost William in this discussion?!

William Watson posted:

Mem Lang posted:

Like this, Gail.  Adding on to this: if patient wants to know more, but it's not going to be possible due to time constraints, that they're given written information to peruse in their own time with support phone nos.  And to plug over and over again: a resilience test score to go hand in hand that is TRULY  trauma friendly and incongruously/simultaneously brief? That's the next challenge.

Great that you're doing this, William! Thinking you'll tell other Drs if you find it benefits patients.  And it can be an initial tool in which to give them enormous insight, life changing to a degree, into their health concerns.  The best  therapeutic practices is but another topic! 

Yes-that is the plan-to spread the ACE story amongst my colleagues. Problem is, we're all so damned busy, dealing with the day-to day issues in a busy family practice!! Needs something short and sweet or it won't fly!.

And then the questions  (from my colleagues) will be: what do I do with this information? Am I opening a Pandora's box, creating a problem list that can't be fixed or helped? Will my patients be triggered by asking these questions about their abuse history?

Certainly the problems your patients present with cannot be solved w/o addressing ACEs and toxic stress. 

Anything else is is a bandage.  Good Luck

Suggestion for a shorter version:

1. Have you heard about Adverse Childhood Experiences (ACEs) and the lifelong impact? 

2. Do you want to learn more for yourself, your work or for others in your life? 

Maybe having a longer, more discussion based meeting, 2 or 3 hours, once a month where people can learn about ACEs and the health impacts and be connected to resources if it's too heavy or time consuming for practitioners to go into in more depth. 

Clearly, you're a caring doctor, or you wouldn't even be asking or thinking about ACEs, etc. 

Clearly, you also ask wise questions: am I opening up a Pandora's Box?

Well, honestly: yes you are! But what flies out of the box, rather than death and destruction, may be renewal of hope, etc! 

Is it wise or valuable to do so?  Hmm, it's really a rather complex question with a rather complex answer.  Sorry, if I wasn't honest I'd say, yes, go full steam ahead, what are you waiting for!

Am I glad I have ACEs, etc information? That's a resounding yes. 

Is it frustrating that this is such a good platform to commence any therapy and most are not in the know?  That too would be a resounding yes!

Would (and should) it inform how you treat patients once such information is gleaned?  Well, you get the pattern!

Are there some websites (and don't get me wrong I believe they mean the very best for their readers) that say they believe in trauma informed care, yet refuse to put the information out there about ACES etc for fear of further traumatisation, yet put the finer details of personal accounts of sexual abuse on the same website?

Or possibly worse, are a 'positive thinking' organisation, or university (teaching psychology, don't get me started!!) or whathaveyou,  who refuse to even LOOK/DISCUSS at taking on board the concept of trauma (using ACEs etc) as needing to be a precursor to more resilient health? ... 

The only success I've personally encountered with promoting the understanding of ACEs was with a nurse who was screening at a GP's practice, and I said after the dismal questions she asked me, have you heard about ACEs, emailed her information; bumped into her months later and asked how it was going and she said something along the lines of, "I choose who I give the ACEs test to very carefully -  if I think they can handle it.  Those who I have given it to have been most grateful and found it extremely helpful in understanding their situation. One of our nurses is going interstate to a conference for further training".

I can only speak of my experience really, as a consumer.  But I like to think I'm a rather discerning one!  I'm still in my infancy as an advocate.  I'm very low on the pecking order of what should be disseminated as relevant(!) information, but it very much seems to me, all these people have certainly not experienced the depths of despair/trauma, turned it around, lived to tell the tale, and CHANGED such an irrelevant system.  My belief in this platform only grows stronger. My relatively newly minted bullsh** radar goes off constantly now I've pieced so many more loose puzzles together. THAT is empowering (and giving empowerment is/should be the aim).   It has assisted me so many times in so many different ways. It has made more sense than most theories (fits like a glove with attachment theory) I've encountered in my rather long lifetime and lifetime of searching/researching. 

So, William, good luck with your decision!!!  Oh, and I didn't even mention good luck with the 15 minute time slot you'd have.  You'd have to ask some patients to prebook an extended consult to see you.  

I believe your role would be to give the info about ACEs, etc., let them take away the tests to fill in in their own time, ensuring a return visit with you is made in the very near future to ensure patient safety, view and discuss their results , incorporate it into further consultations, as a backdrop if you will, but not for you to have to administer therapy of any kind.  Too hard, too long.  Your job, I believe, would be to 'kick start' this important process.  To whom, hmm...?!  And to finesse whom you would be sending them to - which therapist and ensuring they have the best skills in that particular area.  As I said before: good luck (again!) with that one, giving all that I written above!  And oh dear, some say they're up to date, trauma informed, etc etc but their practise... If one is half intelligent, wise and intuitive, your therapist needs to be doubly so.  Big ask. To some degree then, with some people,  it's just not going to work with 'conventional' therapies, hence some people now look at 'alternative' therapies such as EMDR, biofeedback, etc., with what seems like varying rates of success. 

But it's STILL worth it, I believe, as more and more people know about ACEs etc. Therapy practise will/must get sharper...  

In summary, I believe: being left fending for oneself WITH ACEs etc knowledge is far more conducive to one's physical and mental health, than having no knowledge or a therapist with little knowledge or skills!!! And finally, most of the time, antidepressants are given as a cop out really. We are but in our infancy of understanding MANY areas that are complex. And people need to humbly acknowledge this. How often do you hear, "Well, I really don't know.  We're such a complex organism.  But let's try this..." No singular line of adjustment/fixing here. No one size fits all. Is it mental or physical or both??

Just hope you get the broken leg to deal with. Relatively straightforward, well...

Phew!

William, good afternoon again.

If you were to pose the same question from your colleagues to Dr.Felitti, he would respond that it was the major barrier he had to overcome with Kaiser administration in issuing the extensive 6 page questionnaire to the 25,000 kaiser patients.  His response i believe would be there was no crisis generated.

In my multiple presentations On this subject to multiple audiences comprised of professionals and laypersons,  I have only experienced one person meltdown.  It was a young man who seemed to be more concerned that his younger sister was currently experiencing the same adversity he experienced. He was quickly given group support and linked to a therapist.   Many folks would come up to me and share their stories and be grateful to know they were not alone. I always provided them with positive feedback in terms of their resilence.

I'll need an address to send you the charts.

Tom

You can also find handouts for parents in the 'Parenting with ACEs Group' which has a list of parent handouts found here: https://www.pacesconnection.com/...th-ACEs/set/handouts

Mem Lang posted:

Like this, Gail.  Adding on to this: if patient wants to know more, but it's not going to be possible due to time constraints, that they're given written information to peruse in their own time with support phone nos.  And to plug over and over again: a resilience test score to go hand in hand that is TRULY  trauma friendly and incongruously/simultaneously brief? That's the next challenge.

Great that you're doing this, William! Thinking you'll tell other Drs if you find it benefits patients.  And it can be an initial tool in which to give them enormous insight, life changing to a degree, into their health concerns.  The best  therapeutic practices is but another topic! 

Yes-that is the plan-to spread the ACE story amongst my colleagues. Problem is, we're all so damned busy, dealing with the day-to day issues in a busy family practice!! Needs something short and sweet or it won't fly!.

And then the questions  (from my colleagues) will be: what do I do with this information? Am I opening a Pandora's box, creating a problem list that can't be fixed or helped? Will my patients be triggered by asking these questions about their abuse history?

That would be very helpful-thanks!

William, good morning.

If you are thinking of written material to use as talking points or handouts to the patient(s) for later reflection, we have developed some that would be happy share with you.  We modeled the format on Dr. Chasnoff"s "I am concerned" handbook for health practitioners.  

If you would like them, i would be happy to copy and send to ou.

Tom

Like this, Gail.  Adding on to this: if patient wants to know more, but it's not going to be possible due to time constraints, that they're given written information to peruse in their own time with support phone nos.  And to plug over and over again: a resilience test score to go hand in hand that is TRULY  trauma friendly and incongruously/simultaneously brief? That's the next challenge.

Great that you're doing this, William! Thinking you'll tell other Drs if you find it benefits patients.  And it can be an initial tool in which to give them enormous insight, life changing to a degree, into their health concerns.  The best  therapeutic practices is but another topic! 

HI Bill. Here are some suggestions from Dr. Andres Sciolla, a psychiatrist from University of CA, Davis and a big ACEs Science champion:

I suggest, "from 1 to 10, 10 being the most stressful you can imagine, how stressful was your childhood? ( Pt answers) thank you. We don't need to go into details right now, unless you want to (don't say the latter if you don't have time). Now, from 1 to 10, 10 being the most dysfunctional you can think of, how dysfunctional was the family or environment you grew up in?" Repeat the thanks and offer to talk, if appropriate.

Always, always introduce the questions with an explanation of why you are asking, how it might benefit the patient. You can add that "for some people these questions can bring up negative feelings that they don't want or can't deal with at the moment. If at any point you become too upset let me know so I can change the conversation."

Last, you can follow with "would it be OK with you if I ask you more specific questions or I give you a questionnaire to fill out?"

And of course don't forget to ask about resiliency factors, then and now to get a more nuanced understanding.  That too can be brief.  Without it, you only have half the information needed for effective intervention.

Our group has thought about utilizing the ACE in our clinic in a number of clinical situations: the annual physical, the well baby/new parent exam, the patient who presents with mental health issues. To have our study passed thru the REB, we would need somewhat narrow patient selection criteria.

Thanks everyone for your ideas. Yes, context is important when dealing with a diverse patient population with different health problems in the primary care setting. 

In the clinical context, it would useful to develop a brief version of the ACE as a screen, i.e.  2 questions, which, if positive can then be amplified to the full ACE. Does anyone know if that exists, and if so, has it been studied and validated? 

Dr. Watson, good afternoon. 

My experience is that without a prior explanation about ACES, completing the questionnaire lacks context. So you might want to try first assessing risky health behaviors, e.g., smoking and then ask the patient ,"when did you start smoking?" and then ask, "tell me about your childhood prior to that time."  hopefully, you can make the connection thru the dialogue.  

Alternatively, you might consider having for the patient a viewing of Dr. Nadine Harris Burke on Ted Talks, whichwill give the context for the questionnaire.  BTW we are now using one that asks for each question, "How did it affect you then?" and "How does it affect you now."

Tom

Hi, Bill: I don't know of a two-question screener, and think that would be difficult, because part of doing the 10 questions (and more, in some practices, as Stacy mentions), is to validate "normal" experiences that people tend to minimize, and to education people about what experiences are traumatic.  

We'll be providing a list of expanded ACE surveys in our resource center, which will go live next month. 

Have you seen this powerpoint? 

http://www.integration.samhsa...._TIC_Webinar_PDF.pdf

There are some good ideas plus about 2/3 through some abbreviated questions based on the original ACE questionnaire. In our practice we look beyond the 10 original questions at things such as bullying, racism, illness, traumatic birth, homelessness, intergenerational trauma, toxic relationships and financial insecurity. 

Quick comment:

One of the things i love about the ACEs is that one can share the number without needing to detail the specifics. 

What I mean, is like many forms, done before a patient is even in the room,  things can be answered and addressed without taking the time of the medical staff. An ACE score can be shared without even needing to "turn in" the responses and which questions are answered yes or no, because for health, it's not even that relevant and allows more privacy. 

I'm not sure people even want to go into the history but it might be super relevant to know how the present health issues are related to high ACE scores for both patient and medical staff.

Anyhow, I'm sure others can answer your question and share ideas, options and forms.

I just know, as someone with a high score, on the patient side of things, we already know what we lived. Answering yes/no to questions is not nearly as emotionally loaded as repressing, suppressing or avoiding topics because they are too uncomfortable for others. Even being asked the quesitons signals that the place understands, believes and acknowledged that adversity in childhood impacts adults. That right there can make for a big difference. 

Cissy

As a chiropractor I would love to see if tallied in one place are various levels of easy to integrate ACE questionaire forms that are available...thank you