ACEs in Action

Starve the beast,’ say these cities, but don’t cut people off; reduce the need for services instead — 7/30/12

In a plain brick building on a tree-lined street in Albany, NY, a 67-year-old man brought to his knees from a lifetime struggle with alcohol addiction fills out a survey. Across town, on the bucolic campus of a residential treatment center for troubled teenage boys, a counselor asks a 13-year-old the same questions.

  • Did a parent often swear at you, insult you, put you down or humiliate you?
  • Did you see your mother being hit, pushed, slapped or kicked?
  • Did you live with anyone who was a problem drinker or alcoholic, or who used street drugs?

What’s the point of dredging up bad memories with these and seven other questions? Believe it or not, there’s a long-term payoff for the man, the boy and the city and county of Albany.

Strangely enough, it has to do with the short-term, beneficial effects of the drugs they’re using. Nicotine reduces anger, increases focus and relieves depression. Alcohol relieves stress.

States moving ahead on ACE surveys, meetings practices — 6/21/12

Last week, nearly 800 adults — human services professionals, educators, judges, business leaders, philanthropists, and policy makers — sitting in a room in Des Moines, Iowa, imagined they were 12 years old. At the request of the speaker, half stood up. These kids are regular smokers, the speaker, Dr. Robert Anda, told the audience. All of those of you who are seated do not smoke, he explained. The half that are standing also have high ACE scores (ACE = adverse childhood experiences). That means that they have experienced or are living with four or more of the following:

  • sexual, physical or verbal abuse;
  • physical or emotional neglect;
  • a parent who is diagnosed mentally ill or who is addicted to alcohol or another drug;
  • a mother who is regularly beaten or verbally abused;
  • a family member who is in prison;
  • the loss of a parent through abandonment or divorce.

So, at the very least, these kids, the smokers, are dealing with the effects of those adverse childhood experiences — anxiety, depression, and difficulty concentrating, he explained. Nicotine makes those effects disappear….for a little while. And when they come back, what makes them go away again? Another cigarette.

Anda asked the people who were sitting to give those who were standing a round of applause for “figuring out a biochemical coping strategy”.

Massachusetts, Washington State lead US trauma-sensitive school movement — 5/31/2012

SINCE AT LEAST 2005, A FEW DOZEN INDIVIDUAL schools across the U.S. have adopted some type of trauma-sensitive approach. But the centers of gravity for the action are in Massachusetts and Washington. These two states lead the way in taking a district-wide approach to integrating trauma-informed practices, with an eye to state-wide adoption.

With a school-wide strategy, trauma-sensitive approaches are woven into the school’s daily activities: the classroom, the cafeteria, the halls, buses, the playground. “This enables children to feel academically, socially, emotionally and physically safe wherever they go in the school. And when children feel safe, they can calm down and learn,”  says Susan Cole, director of the Trauma Learning Policy Initiative, a joint project of Harvard Law School and Massachusetts Advocates for Children. “The district needs to support the individual school to do this work. With the district on board, principals can have the latitude to put this issue on the front burner, where it belongs.”

Lincoln High School in Walla Walla, WA, tries new approach to school discipline, suspensions drop 85% — 4/23/2012

THE FIRST TIME THAT principal Jim Sporleder tried the New Approach to Student Discipline at Lincoln High School in Walla Walla, WA, he was blown away. Because it worked. In fact, it worked so well that he never went back to the Old Approach to Student Discipline. This is how it went down:

A student blows up at a teacher, drops the F-bomb. The usual approach at Lincoln – and, safe to say, at most high schools in this country – is automatic suspension. Instead, Sporleder sits the kid down and says quietly:

“Wow. Are you OK? This doesn’t sound like you. What’s going on?” He gets even more specific: “You really looked stressed. On a scale of 1-10, where are you with your anger?”

Port Townsend, WA, learns that to change health culture, it takes a community – 3/30/12

Last week, I posted a story about how a family services clinic in Port Townsend, WA, includes childhood trauma in regular health screenings for pregnant women and families. They’re doing this because the research is very clear: Toxic stress from adverse childhood experiences (ACEs) causes adult onset of chronic diseases, such as heart disease and diabetes. It causes suicide and depression. It also leads to committing violence or becoming victim of violence.

The purpose is to reduce toxic stress in children, so that they grow up to be healthier and happier.

As far as the staff at Jefferson County Public Health knows, they are the first in the country to figure out a way to integrate into their daily work the research about the consequences of adverse childhood experiences. If there are other clinics doing this, please let me know – this ACEsTooHigh community wants to hear about you.

What IS certain is that, of all the community systems in Jefferson County that support, intervene or interact with children and families, Quen Zorrah and the staff at the Family Services clinic were the first to jump in the pool. The pool, of course, is the metaphor for the place where everybody’s talking ACEs and integrating ACEs research into their everyday activities.

The big question that Jefferson County is grappling with now is: How do you get everyone else to jump into the pool?

Public health clinic adds child trauma to tobacco, alcohol, HIV screening — 3/23/12

When a pregnant woman visits the Jefferson County Public Health clinic in Port Townsend, WA, a town of about 9,000 people on the northeast tip of the Olympic Peninsula, she’s asked the typical questions about tobacco, alcohol and other drug use. She’s also screened for something that most public heath departments, ob-gyns or primary care providers don’t even consider asking: her childhood trauma.

That’s because the public health nurses at Family Health Services know that a childhood full of toxic stress causes a lifetime of health problems, and, if not addressed, is usually passed on from parent to child.

But setting up a system to screen for child trauma, which seems so logical in hindsight, wasn’t an easy thing to do, says Quen Zorrah, a public health nurse who led the effort. Even after years of talking, reading research and preparation, the staff was still reluctant. But in the end, she and her co-workers concluded: If we can teach a client to put on a condom, we can ask a client about ACEs.

PERC uses ACE scores to keep ex-offenders out of prison — 3/6/12

It wasn’t a light-bulb moment that prompted Denise Hughes-Conlon to institute a few changes at the Pinellas Ex-offender Re-entry Coalition. It more like a nudge. Specifically, a nudge from Robin Saenger, then vice-mayor of Tarpon Springs, FL, who asked, “What small piece can you bring to Peace for Tarpon?

Hughes-Conlon’s piece? Have her clients – “not always the nicest, kindest people” she says — fill out the short 10-question version of the 200-question ACE survey.

How can answering a few questions on a survey possibly help ex-offenders or the people who help them?

Spokane, WA, students’ trauma prompts search for solutions — 2/28/2012

PROMPTED BY RESULTS from a large study of Spokane, WA, schoolchildren that showed how childhood trauma is taking more of a toll than many imagined, an innovative project is underway that will test three types of intervention in 900 families that participate in Spokane’s Head Start program. The study of 2,100 children was done in ten elementary schools in Spokane, WA, in late 2010. The study found not only that trauma is common in kids’ lives – trauma includes divorce, homelessness, witnessing family violence, involvement with child protective services, a family member abusing alcohol or other drugs, neglect, or mental illness in a family – but it’s also the main reason that children missed school or got into trouble. It’s the second-highest predictor of academic failure, after a child being in special education classes.

Tarpon Springs, FL, may be first trauma-informed city in U.S.  – 2/13/2012

TARPON SPRINGS, FL, ONCE KNOWN for harboring the nation’s largest sponge-harvesting industry, today boasts a new designation: it may be the first city in the country to declare itself a trauma-informed community. It isn’t that the 24,000 residents of the scenic Gulf Coast community know more than the rest of us about emergency room techniques, spend their time crunching spreadsheets of violence data, or watch more episodes of “America’s Most Wanted”. It means that the community has made a commitment to engage people in all walks of life – education, juvenile justice, welfare, housing, medical practices, businesses, etc. — in a common goal of less trauma…large and small, immediate and generational.

10 responses

  1. Pingback: Adverse childhood experiences | Free psychology

  2. I saw Dr. Anda speak at a training yesterday (May 1, 2013). As a social worker in Snohomish County, I’m wondering how I can make a difference. I need resources to help spread the word in this county. Help! I want to help!

    • Hi, Debbie — If you join ACEsConnection, the social network that accompanies ACEsTooHigh, you’ll be in a growing group of people (nearly 1,000) who are implementing or thinking about implementing trauma-informed practices. There’s also a good resources section.

    • Hi Debbie – I hope that you have found the Snohomish County folks who are actively involved in promoting ACEs information & resources. The SC Prevention Partners is a group of professionals spearheading a great deal of forward momentum. There is an ACEs Quarterly meeting that gathers at the Snohomish Health District where folks from many areas of the community come together to share info and hear about emerging issues and information. And, the Children’s Commission is focused on ACEs and focused on providing parent education and resources – just to name a few! Please be in touch with me if you want to get involved with any or all of these activities. ~Pam

    • Hi Debbie you can also connect with your Snohomish Community Network, Director Chris Jury at Community Networks are the local affiliate that initiated the foundational community works focused on ACE education and reduction. I am sure they would love to get you involved!

      Trish McNabb
      Eastside King County and Lewis County Community Networks

      • Hi Trish – there are a small number of SnoCo professionals doing ACEs work, including community presentations and training, many of us (including Chris) affiliated with the SC Prevention Partners. The County Children’s Commission is also focused on promoting ACEs information. We are in need of folks who are interested in doing public speaking to help with requests. Please contact me at if you are interested. Pam

  3. I am looking for information in regard to persons with disabilities and ACEs. If the person had a disabilty as a child and then reported higher ACES as an Adult? What is the relationship with having a disabilty and having a high ACE score.

    • Hi Peggy – Community Networks in Washington State have been working with Division of Vocational Rehabilitation and CDC to get out information regarding the impacts of ACES and disabling conditions. This presentation can be accessed by connecting with the Community Public Health and Safety Networks at and folks can connect with you about this particular focus of ACE work.


  4. Hi, Elizabeth – Great questions. ACEs is informing preventative and early intervention services in many areas, and many are just at the idea stage. This site and the ACEs Too High Network are facilitating getting at that information and sharing it. I’ll send you an invitation to the network so that you can ask your questions there.

    The Center for the Developing Child at Harvard recently posted a webinar featuring center director Jack Shonkoff and American Academy of Pediatrics president Bob Block. I haven’t listened to it yet, but I’m hoping there some information there. I’m very curious about how the AAP’s recent policy statement that encourages pediatricians to embrace ACE concepts will manifest itself.

    — Jane

  5. How does ACES inform health care reform, especially how the ACES Study can be used to establsih more preventative and early intervention services in primary care centers (health care homes)? What role can a behavioral health system of a large county play in integrating its services (and special knowledge of ACES) in public primary care centers and FQHCs?

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s