When the Youth Health Empowerment Project, a Philadelphia program for youth aged 13 to 24, did ACE surveys of those who visited their drop-in center over three weeks, it found that 81 percent had a score of 4 or more. That’s a significant result, because, based on the CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study, an ACE score of 4 greatly increases the risk of health and social problems, including heart disease, alcoholism, cancer, autoimmune diseases, becoming violent, and being a victim of violence.

The ACEs screening took place in spring 2014 and involved 41 youth, who each received a $5 gift certificate after completing the survey. The decision to try out the ACE survey was made after staff members spent a week in the summer of 2014 doing an orientation workshop about the Sanctuary model, which incorporates ACEs.

The Youth Health Empowerment Project (Y-HEP), which just celebrated its 20th anniversary, offers services and support to over 3,000 young people each year, many of whom are homeless or housing insecure, LGBTQ, and/or unemployed. They drop in during the weekday just to hang out in a safe place and on Monday evenings, when around 60 people show up. The center, which not only includes the drop-in space, but also therapy and a federally qualified health center, has 20 staff members.

Y-HEP is part of Philadelphia FIGHT, a comprehensive HIV/AIDS service organization that provides state-of-the-art, culturally competent primary care to all Philadelphians, regardless of their insurance status or ability to pay. The rate of HIV cases in Philadelphia, with a large segment of its population living in historically low-income neighborhoods, is four to five times the national average, which means that 1.2 million people are living with HIV infection and 1 in 8 (12.8%) is unaware of his or her infection.

Alex Ochs, a former intern who administered the survey at Y-HEP, said that the decision was made to ask the ACEs questions out loud rather than have the participants read them and check a box. He said that some of the participants couldn’t comfortably read the survey, and by reading the questions out loud in a calm voice, he and another intern could make the survey delivery consistent and also put the youth at ease.

“We wanted to give participants a little time between each question. If they had a physical reaction, such as heightened breathing or getting flushed, we would take some deep breaths with them and wait,” he explained.

Results were put into a spreadsheet without identifying individuals by name, but noting each person’s age and gender identification.

After the survey was completed, participants were invited to talk about their reactions and emotions in groups. “Everyone was very willing to do this,” said Ochs, who is now a licensed therapist. “People wanted to talk about it because it gave them a chance to voice their experiences out loud.

“Participants were thanking us because no one had ever asked them these questions before,” recalled Ochs, who added that he was surprised by the positive response.

The long-range plan, according to Alanna Butler, education coordinator for Y-HEP, is to implement ACEs screening for all participants who utilize the organization’s services and to integrate the results with other information they collect on each patient in the health center.

“In that way, we can have a better understanding of the degree of trauma here,” she says. “It would also allow us to quantify the level of trauma, and we would be in a better position to get funding for more therapeutic support.”