What Is the Adverse Childhood Experiences (ACE) Assessment and How Is It Used?

Topics: Overcoming Challenges

By Whayne Herriford, SCP, SPHR

The Adverse Childhood Experiences (ACE) Assessment is a ten-question assessment that was developed by the Centers for Disease Control and Prevention and Kaiser Permanente by collecting health information from more than 17,000 members in Southern California. Using data from the study they were able to predict health outcomes based on the frequency of answers to questions.

The ten areas of the ACE assessment look at abuse (emotional, physical and sexual), neglect (physical and emotional) and family dysfunction (family mental illness, physical abuse of mother, divorce, incarcerated parent and substance abuse in family).

Among the predictive results of ACE are:

Probability of Outcomes
Given 100 American Adults
33 with 0 ACEs 51 with 1-3 ACEs 16 with 4-8 ACEs
1 in 16 smokes 1 in 9 smokes 1 in 6 smokes
1 in 69 are alcoholic 1 in 9 are alcoholic 1 in 6 are alcoholics
1 in 48 uses IV drugs 1 in 43 uses IV drugs 1 in 30 uses IV drugs
1 in 14 has heart disease 1 in 7 has heart disease 1 in 6 has heart disease
1 in 96 attempts suicide 1 in 10 attempts suicide 1 in 5 attempts suicide
Chart from ACEs Iowa 360
Source: http://www.bfhd.wa.gov/ph/aces.php

An issue brief issued by Johns Hopkins Bloomberg School of Public Health in October 2017[i] looked at national and across-state data of ACE data among US children. Among the findings:

  • ACEs are common across all income groups and among children with both public and private insurance. Fifty-eight percent of U.S. children with ACES, however, live in homes with incomes less than 200 percent of the federal poverty level.
  • Black children are disproportionately represented among children with ACEs. Six in 10 have ACEs and they represent 17.4 percent of all children in the United States with ACEs.
  • Compared to those children with no ACEs, children three to five years old with two or more ACEs are four times more likely to have three or more of the six social and emotional challenges that can affect learning.
  • About two thirds of children six to 17 years old who bully, pick on, or exclude other children – or are themselves bullied, picked on or excluded – have ACEs.

Nationally, 21.7 percent children are estimated to have two or more adverse childhood experiences with individual states ranging from 15 percent to 30.6 percent. Eleven states have significantly higher numbers of children with two or more ACEs (.05) including Montana, Arizona, New Mexico, Oklahoma, Missouri, Arkansas, Louisiana, Mississippi, Alabama, Kentucky and Ohio.

Download a copy of the ACE assessment from the National Council of Juvenile and Family Court Judges (NCJFCJ).

Care should be exercised using the ACEs assessment in classroom or other environments for several reasons.  You may need permission from a child’s parent/guardian to administer it and there can be other legal constraints that should be adhered to. Additionally, if you are not prepared for or able to address the results of the assessment it’s probably not a good idea to uncover them.

In some situations, school counselors administer the assessment anonymously to get a sense of the situation within a population without specifically identifying individual status. This can help determine the level of trauma present and steps that can be taken to address it.

The Substance Abuse and Mental Health Services Administration has also created a set of guidelines that help define the best practices for trauma informed care at the organizational level. These can be applied to an organization based on the results of general ACEs data.

Learn more

Here is a YouTube video that talks about the ACES and some ways in which professionals can intervene to help children who are experiencing trauma in their home, school or community.