When children and their parents first visit Northeast Treatment Centers (NET) Children’s Behavior Health Services in Philadelphia, they fill out a 10-question survey about their adverse childhood experiences so that therapists can tailor treatment that may result in better outcomes.

The parents are asked about their own childhood adversity, and they also fill out the survey for their children under the age of 12. Teens answer the questions themselves. The survey came out of the CDC-Kaiser Adverse Childhood Experience (ACE) Study.

Harry Allen, director of Outpatient and Specialized Services at NET Children’s Behavioral Health says the 10-question ACE survey is the simplest tool for evaluating an outpatient’s needs. Other tools for informing a therapist about a child’s traumatic experiences are more complicated and require the therapist to first develop a rapport with the family. An ACEs assessment, on the other hand, can be used at the first visit with the child and parent because it’s simple to complete and helps to establish an immediate connection between the therapist and the family. Therapists began using the ACEs screening in mid-April.  

“Educating parents in this process is crucial,” says Allen. He adds that staff appreciates the value of the ACEs integration into the treatment process because “many of our referrals have a significant trauma at the core of their family system.”

At the second weekly visit, the child and parent will work out a treatment plan targeted toward a specific trauma. For example, for a child who has experienced domestic violence, treatment might be focused on coping skills to deal with associated triggers, such as a teacher yelling at the student. Coping skills could include learning deep breathing skills or squeezing a ball to control and re-channel the patient’s immediate reactions. In addition, the therapist might suggest a referral for the parent.

Sometimes, the child will request a visit without the parent, and then the therapist will see the child for a session or two. But then the family will be asked to return.

“We prefer to see the whole family, because working with the child alone, you really don’t know what’s happening with the rest of the family,” says Allen.

Every 120 days or four months, treatment is reviewed and updated, so it’s another opportunity for an ACEs screen.

Referrals to his clinic, says Allen, who also teaches at Philadelphia University’s master’s program in Trauma and Community Counseling, come from outside agencies and also from internal sources such as its intensive family therapy in-home program (Family Focused Behavioral Health), School Therapeutic Services, and the many drug and alcohol programs that NET operates throughout Philadelphia. All 140 new outpatients who enter the clinic every six months – treatment averages six months, with 280 outpatients total – qualify for medical assistance and are treated for free.

What happens if the parents are engaged in domestic violence, or there has been sex or physical abuse of the child? “If the child’s safety is compromised, we have to report that to the Department of Human Services, which will visit the family home within 24 hours,” says Allen. “DHS can provide support and it’s an opportunity for us to help minimize these behaviors. DHS decides whether the child is removed or not.”

Usually, says Allen, the parent or family member who brings a child to the clinic is not the one abusing the child.

Training 16 therapists to incorporate the ACEs tool for the clinic, which now treats 280 clients, took only two weeks. Therapists were trained on an individual basis and first went over the ACEs publications and related research. “This is such a rich tool,” says Allen. “It’s not just ten random questions.”

Since this system was just adopted, Allen says it will take a while to evaluate its effectiveness and develop specific treatment protocols correlated to ACEs scores and types of ACEs. Staff will collect data on how many outpatients have a high ACE score – more than a 3 – and will correlate that with a consumer satisfaction survey that asks outpatients after each visit to rate the therapist on a scale of 1 to 4 on four different questions. In this way, the clinic hopes to assess outcomes of the ACEs integration into its treatment and develop ACEs-based treatment protocols.