Understanding the ACE score and What to Do When You Know
As an educator with a background in healthcare, to say that I’m fluid in acronyms is as funny as it is accurate.
However, I also love that in my writing and coaching, I get to have conversations with people who feel comfortable to ask me questions that they may not be comfortable asking others. Recently I shared a post about the impact of positive childhood experiences on people who have a high ACE score and I got a simple question in my email.
What is ACE?
So simple, but I wondered how many educators have not heard of this study or why it provides critical information for us to consider as we care for/educate/love children who may have had less than ideal childhoods. So here are the top 7 things you need to know about the ACE study and some additional places you can get more information if you want to deepen your knowledge.
ACE stands for adverse childhood experiences. This was coined during the 1995-97 CDC-Kaiser Permanente study of over 17,000 adults who responded to their health care plan provider request to reflect on experiences they had during their childhood. During this study a link was discovered between 10 common experiences and the leading causes of death in the country.
There are 10 categories of ACEs.
Parental separation
Parental substance abuse
Household mental illness
Domestic violence
Physical abuse
Emotional abuse
Sexual abuse
Physical neglect
Emotional neglect
Parental incarceration
The ACEs effect is believed to be not only on behavior but also development. This is currently being studied more, but what we know is that while experiencing these ACEs does predispose a person to making choices that may be less healthy, thereby contributing to poor outcomes later in life, there is also an indication that even when choices are positive, there can still be negative outcomes that are not otherwise explained.
Nearly 2/3 of all people are suspected to have at least 1 ACE. But 10% have an ACE score of 4 or more, which is the category where we would expect to see the most pronounced negative outcomes. While we know there will be some communities where the average number is consistently higher, even lower scores are cause for concern.
The higher the ACE score the more likely the risk factor. This is maybe the most important key for educators to consider because rarely do we have a crystal ball to foresee the future for our students. But with the ACE data, we can tell that higher scores make children more likely to experience depressive symptoms, smoke or do drugs. This means we can target our program efforts to the needs we can see and those we expect to come in the future.
ACEs are one indicator of potentially traumatic experiences, but not the only one. This data has not been without it’s controversy as some are quick to point out some traumatic events that could be missing or the concept that there is little consideration for cultural and systemic indicators of adverse experiences. But this is a great starter tool.
ACE data is only as good as your administration process. The original ACE study was done with middle and upper middle class working professionals with a reasonable level of understanding and some anonymity. Within the context of the school setting, this would be much more difficult and as such your use of this as a screening tool may be more challenging. Families must be able to trust the administerer of the assessment and schools must be ready to handle the information they receive. This is a good way to work toward making your program more trauma-informed, but it cannot happen without training and support.
There are some indicators that positive childhood experiences that increase protective factors for children are a good way to help shield children from the impact that the ACEs may have, but obviously part of our goal is to stop these experiences from happening. Including community advocacy through education and social reform are part of where we go from here. We also know that children with a high ACE score often have parents with an equally high, if not higher score. Supporting parents is part of the job we must do.
Dr. Nadine Burke-Harris has blazed a modern day trail for implementing an effective and holistic approach to caring for children who have experienced ACEs. She founded the Center for Youth Wellness where great trauma-informed practices have been establish, before becoming the surgeon general for California. Her TEDTalk has been viewed millions of times in the 5 years since it was released and it still rings true today.
Are you using the ACE study in your work? Sound off in the comments and let us know how you are making a difference.