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  • Autumn Quiles, LCSW

ACEs Screening in California

A huuuuuuge research study (like 17,000 participants) was conducted in the mid-nineties in California. The researchers were trying to understand the long-term effects of childhood abuse, neglect and household challenges. They identified factors that they started calling Adverse Childhood Experiences (ACES). They learned that if a child scored high on an ACES screening (meaning they had a lot of ACES) they were at high risk for significant problems with health and well being, as adults.

This was the first time that researchers connected very specific adverse life events in childhood to a person's well-being in adulthood. It was the first time that childhood abuse and neglect, or exposure to domestic violence or a parent's substance abuse, were scientifically connected to the possibility of that child growing up to have an unwanted pregnancy, have depression, becoming an alcoholic or- and this was huge for the medical community- die early.

Doctors and physicians suddenly became very interested in a person's exposure to ACEs in childhood, because addressing those ACEs could quite possibly prolong a person's life.

So, more and more research has emerged about ACEs- defining them, measuring them and understanding their direct connections to specific negative outcomes. These information is sort-of Old News to those of us in the mental health community. Therapists who work with adults know, from experience, that the most unsafe and unhappy adults had traumatic childhoods and those of us who work with kids who have been exposed to trauma see the psychological damage first-hand. It has been very validating to see research confirm what therapists have intuitively known for years.

Some organizations have really latched onto the idea that identifying ACEs is a panacea for almost all negative well-being in adulthood. They figure that if we can identify individuals with high ACEs, we can mitigate the effects of that childhood experience so they can live happier and healthier, longer. This, I believe, was the vision of the Surgeon General of California.

California's new surgeon general, Dr. Nadine Burke Harris, announced that California would start implementing universal ACES screenings. She feels strongly about addressing childhood trauma and, as a therapist, I do too! I was excited about the new initiative, but I had some reservations... and now that I am seeing how they are rolling out the new initiative, those reservations are growing.

This article reflects many of the concerns I have about how California is conducting the screenings and what kind of response they can offer families who report a high score. I firmly believe that when a question is asked, the person who is asking must be prepared for the answer they receive. California will be asking families very sensitive questions (and I have concerns about the When, Who and the How of the asking), but I don't know that they are prepared for the answers they will receive. Simply knowing a person's ACE score is not sufficient; we must also be prepared to therapeutically address those experiences. I don't think California has a therapeutic infrastructure in place to respond. Furthermore, mental health clinicians know that simply asking about trauma (the screening itself) can re-open old wounds and re-traumatize a person. I don't think it's clinically responsible to open those wounds, if there is not a plan for helping an individual to heal those wounds. I suspect that California will have a lot more high-ACE screening results than they anticipate. I worry that, as a state who is under a lot of scrutiny for this avant-garde commitment to addressing trauma, they will be heavily criticized for an inadequate response.

I want California's new initiative to be successful because it could help adults to live happier and healthier for longer. I would like other states to make this kind of commitment to identifying childhood trauma. But I would also like California, and other states, to make the subsequent commitment to treating/addressing childhood trauma. If we, as a society, are going to ask the questions, we must be prepared to offer viable solutions for the answers we uncover.

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