What’s Your Client’s ACE Score?

child

The topic of childhood trauma has been in the news a lot in the past 15 years. From the Sandy Hook shooting to Hurricane Katrina to the Wold Trade Center terrorist attack, it seems more and more children are experiencing tragedy. On a smaller scale, every day children across the United States experience domestic violence, drug abuse in the home, a family member’s mental illness, divorce and a number of other significant life events. All of these experiences are adverse and are potentially and likely harmful to the development of the child. In fact, if you experienced toxic stress in childhood, you likely are more prone to health consequences, both physical and emotional.

toxic stress

As our understanding of the effects of Adverse Childhood Experiences (ACEs) has come into light, so have advances in Trauma-Informed Practices in the mental health field. But how can one quantify Adverse Childhood Experiences and their effect on one’s quality of life and their life span? This article seeks to inform the reader about one tool that can be used to assess a client’s childhood adversity, the ACE score.

In 1997 the largest study to date on the effects of childhood trauma was conducted as a collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente’s Health Appraisal Clinic in San Diego. More than 17,000 insurance members provided detailed information about their experiences with abuse, neglect and family dysfunction before the age of 18. Participants also underwent a comprehensive physical examination. A link to these questionnaires can be found here http://www.cdc.gov/violenceprevention/acestudy/questionnaires.html

The results were astounding. Certain childhood experiences showed a strong correlation to some of the leading causes of illness, death and social problems. Listed below are the correlates.

  • Alcoholism and alcohol abuse
  • Chronic obstructive pulmonary disease (COPD)
  • Depression
  • Fetal death
  • Health-related quality of life
  • Illicit drug use
  • Ischemic heart disease (IHD)
  • Liver disease
  • Risk for intimate partner violence
  • Multiple sexual partners
  • Sexually transmitted diseases (STDs)
  • Smoking
  • Suicide attempts
  • Unintended pregnancies
  • Early initiation of smoking
  • Early initiation of sexual activity
  • Adolescent pregnancy

(Data taken from http://www.cdc.gov/violenceprevention/acestudy/findings.html)

Looking at the data from ACEs alone only gives us half a picture. Therapists understand that trauma impacts everyone differently and that what is traumatic for one person may not be traumatic for another. So how do we measure the impact of trauma? We need to also look at a clients resilience. Although there is not yet a standardized measure for resilience, the one found here Resilience Questionnaire  is a good start to furthering your understanding. Resilience encompasses certain protective factors, including external factors such as positive relationships and internal factors such as mental attributions.

Armed with these new data points, how can you use your client’s ACE score and resilience score to develop a more effective and comprehensive treatment plan? Can you help your client develop an understanding of how these childhood traumas impact their functioning today? How can you foster resilience in your client?  Using a client’s ACE score and resilience factors can help you provide high quality treatment to a wide client base.

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More detailed information about ACEs can be found here http://www.acesconnection.com/home and here http://acestoohigh.com/

 

 

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