Gosh, I'm surprised by the comments about not using the ACE screener with kids and not believing that these scores should be noted. I agree with Courtney. Dr. Nadine Burke-Harris is considered one of the foremost experts in the country on the topic of Adverse Childhood Experiences, along, of course, with Drs. Felitti and Anda. Dr. Burke-Harris has developed free, teen-friendly screening instruments that can be downloaded from her site (see "Our ACE questionnaire" at the bottom of her website). One has to ask permission to use them, but they are free to use once permission is granted. Obviously, the parents of young children would fill it out for their children, but teens should be able to fill it out themselves. It is the multiplicity of ACEs that is important, rather than the individual ACE. School officials should advocate with pediatricians and other healthcare providers in their areas, including non-profit child-serving agencies, to perform screenings. Drs. Felitti and Anda indicate that universal screening is one of the two most important elements of gaining traction over the deleterious effects of ACEs on our society, including, I believe, the current alarm over the opioid crisis. This, after all, is the public health approach, which has far more successes than failures. Mr. Finklehor's opinion is worthwhile, of course, but, while caution is always advisable in so important an area of science, we cannot ignore the high stakes that it represents out of fear that someone somewhere will misuse it. That's why the HIPAA Act had to be passed in the first place. Rather than limit healthcare to victims of ACEs, they should, in my opinion, be given priority for services. ACEs can, after all, be transmitted multigenerationally, even if the premature mortality they often engender is not destiny. I work for an agency, along with sister agencies, that screens teens, and it has not resulted in reported iatrogenic effects. In my opinion, the reason why is precisely the one that Courtney referred to: a sense of freedom and a lifting of the veil as to the reasons why they have previously felt so awful.
There's a difference between screening and education. Screening is appropriate for pediatricians and other health professionals, including mental health professionals. Screening implies some type of intervention and follow-up with the person who's taken the ACE survey. In the case of pediatric offices, that might be how they follow up with the Healthy Steps program, which includes assessment for basic needs such as food, employment, transportation, housing, etc., as well as group therapy and therapy for individual families.
Screening should always be paired with resilience screening and ACEs science education. Quen Zorrah, a public health nurse who is a pioneer in ACEs science integration and education, says educating people, especially parents, about ACEs science is a social justice issue: Parents have a right to know about the No. 1 issue that affects their children's health and well being. She was one of the drivers behind the NEAR@Home toolkit for home visitors to integrate ACEs science in their work with families.
Education about ACEs science, which includes resilience, but not screening, is appropriate in non-medical environments, I believe. There's no reason for a school to know its students' individual ACE scores. However, it's really useful for a school to know the burden of ACEs, as well as existing resilience factors, for its student population. It's also useful â and just as important â for the school to know the burden of ACEs among its teachers and staff, so that they have the data to support the changes that this knowledge requires for students, teachers and staff to heal, and to create a healing and healthy environment, rather than one that traumatizes already traumatized people. Students, teachers and staff should take an ACE and resilience survey anonymously.
And, btw, the ACE survey should be expanded to include bullying, racism, sexism, witnessing violence outside the home, and if there is a significant refugee/immigrant population, questions about living in a war zone, fleeing country of origin, or fear of deportation. In other words, it's useful to assess the adverse experiences of the population you're assessing before determining the questions to be asked. And the resilience survey can be modified to include the kinds of supports students/teachers/staff should be receiving.
How this education manifests is different for different ages. The students at Lincoln High School in Walla Walla, WA, did their own anonymous ACE survey and added questions that they thought were pertinent for their lives. They said learning about ACEs science, and about the students' average ACEs score (5.5 out of the traditional 10) helped them understand more about their own lives as well as their peers' lives, and thus helped them understand that when a classmate was angry, surly or uncommunicative, it was because they were having a difficult time; they weren't intentionally "dissing" them. There are several high schools that are taking this approach.
It's incredibly empowering for students (and adults) to learn about their ACEs, because they understand that:
1.They werenât born bad.
2.They werenât responsible for the things that happened to them when they were children.
3.They coped appropriately, given that they were offered no other ways to cope; it kept them alive and sane.
4.They can change.
In Homer, AK, high school students were educated about ACEs science, and then developed their own ACEs presentation (in which they led with resilience) for other high school students and for middle school students.
At Cherokee Point Elementary school in San Diego, CA, they educated students about ACEs science without ever using those words. In the documentary, Resilience, children at an elementary school write letters to "Miss Kendra", as a way of helping them express and talk about their own ACEs, again, without ever using the words "ACEs science".
A pioneering way to address ACEs in elementary school children, which is being done in an elementary school in Washington State, is to educate their parents about ACEs. Research is pretty clear that if parents have ACEs, they'll pass them on to their children, if there's no intervention. As pediatricians and social service programs that teach parents about ACEs science have learned, once parents learn about ACEs science, they want to know how NOT to pass them on to their children.