Letting go of ACEs to support trauma-affected students

I would like to see the trauma-informed education community focus less on ACEs, and in particular to stop asking students and staff to take ACEs surveys. The ACEs checklist wasn’t designed for that, and I think it does more harm than good.

For those not familiar, ACE stands for Adverse Childhood Experiences, which were the focus of a CDC-Kaiser study originally conducted in the 1990s. ACEs seem to have become synonymous with childhood trauma, and are often invoked in writing about trauma-informed education practice. An example of this is the popular documentary Paper Tigers, which is about a school identifying as trauma-informed and relying heavily on the vocabulary of ACEs as they shift how their school supports trauma-affected students.

At a conference last fall, I facilitated a group discussion for those interested in trauma-informed education. Participants were sharing how they were making changes to their schools to incorporate trauma-informed strategies. One participant shared that as a part of the admissions process for her charter school, she was planning on asking students to fill out an ACEs questionnaire. I’ve heard of other schools and staff groups being asked to do the same: to fill out a survey created from the list of ACEs identified in the CDC study. Presumably, the information from these surveys help schools identify students in need of support, and perhaps help teachers better understand how their own experiences impact their work with trauma-affected students.

I would like to strongly caution school leaders from using an ACEs survey with students or staff in their settings.

Limitations of ACEs

The ACEs identified in the CDC study aren’t meant to be inclusive of every possible traumatic experience. As is the case with any study, they needed to narrow down their focus in order to measure and study. The adverse childhood experiences that were focused on in the study were:

• Physical abuse

• Sexual abuse

• Emotional abuse

• Physical neglect

• Emotional neglect

• Intimate partner violence

• Mother treated violently

• Substance misuse within household

• Household mental illness

• Parental separation or divorce

• Incarcerated household member

Each of these items were assessed based on responses to specific questions in a lengthy questionnaire. When you search online for quizzes to determine your own “ACE score,” you’ll find a boiled-down 10-question survey which asks one to answer “yes” or “no” to experiencing each of the above ten items during the first 18 years of life.

Taking a ten question survey about childhood adverse experiences has a few problems. First is the issue of what’s not on the list. Focusing only on the ACEs list excludes a huge range of experiences; for example, the traumatic impacts of racism – not an ACE. Traumatic natural disaster, such as a hurricane, flood or fire? Not on the ACEs survey. If your intention is to use the ACEs survey to find out what percentage of students or faculty have experienced trauma, your data will be incomplete at best.

In addition, trauma is widely viewed as subjective – an interplay between dangerous events and our capacity to cope – and one’s experience of a potentially traumatic event is impacted by risk factors and protective factors. Because of this subjectivity, we cannot immediately assume that an ACE score correlates to an experience of trauma. Divorced parents is on the ACEs survey – which may be an adverse experience, but might not be trauma. To conflate all ACEs with trauma is a false equivalency, which makes “ACE score” an incorrect shorthand for trauma.

More than a number

To ask kids to take ACEs survey is to distill all of the complexities of their lives into a number, and that number isn’t really going to help your practice, anyway. Trauma-informed work in a school setting is all about relationship – should knowing if a student has 0, 4 or 7 ACEs change or impact whether we build relationship with them?

Speaking of relationship: requiring students or their families to report on these adverse experiences is a risky proposition. Asking these questions may open the door to conversations that educators are not prepared to have, and without mental health training and structures, these conversations may do more harm than good.

Even as a mental health screening tool, “the current ACE inventory was also not chosen through a rigorous process of scientific review to establish the best predictors of health outcomes” (Finklehor, 2017). With this in mind, schools should critically question what screening information they hope to gain through an ACEs score and consult with mental health professionals about best-practices tools.

Trauma-informed strategies are best practices for all kids. Does knowing how many students have high ACE scores change that? You should assume that your community suffers the impacts of trauma. Use state-level data if it helps to build community understanding and buy-in for trauma-informed practices, while also pushing all stakeholders to recognize that it’s not about the number.

We do our best work when we directly listen to the needs of our community and the individuals within it. Resources spent on ACEs screening might better be spent investing in building relationships.

ACEs as a profesional development tool?

For all the same reasons – don’t ask all your staff to fill out an ACEs survey. Like kids, your staff/teachers have varied and complex histories – and while taking ACEs survey might be enlightening for some, it should be completely optional and presented as only one among many strategies that teachers can use to gain self-awareness. Remember that many of your teachers have indeed experienced adverse situations as a child, and being asked to reflect on and check “yes” or “no” to these experiences may be harmful to their ongoing process of recovery.

Teachers absolutely should have self-awareness of “their own stuff” they are bringing to working with trauma-impacted kids. ACE information could be one option. There are many others. We should trust educators to choose their own strategy for building self-awareness.

I worked at a school for 8 years with a mostly trauma-impacted population. I was never asked to do an ACEs survey, and students/families were only asked to share specific history w/clinical staff, at their own pace. Our clinical director also held the opinion that, while it was helpful to know about specific triggers or needs, you can do the work with any kid if you know how to use the general frames and strategies. You don’t need to be a trauma detective to be effective.

A grain of salt

With all of this in mind, how should we proceed? Use the ACEs for what they are: an interesting data set that helps inform our understanding of long term impacts of a specific set of adverse child experiences. There is a wealth of other research on trauma and its impacts on children, and it’s worth spending the time to investigate different frameworks and ways of understanding this issue.

In working with the humans in our schools, seek other ways to understand your students and raise self-awareness in staff. Respect individuals’ paths to recovery and use trauma-informed practices as a mindset that supports all students.

This post is an expansion of a Tweet thread I wrote that can be found here: https://twitter.com/AlexSVenet/status/948221926371221507. And here’s a more recent thread with some additional reading: https://twitter.com/AlexSVenet/status/1359521708634431488