PERC uses ACE Scores to keep ex-offenders out of prison

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?

Hughes-Conlon first thought it might be useful for her staff. “We get a lot of abuse,” she explains. “I thought it might be helpful to understand where they (the ex-offenders) were coming from. I saw it was another thing to give us understanding, a way for us to say: ‘We need to have a little more patience with this person because….’”

Her logic: Anything that helps her clients become more successful keeps them from getting into trouble and going back to prison.

But that small piece – that short survey — is having a bigger impact than she imagined.

A little background might be useful here: Hughes-Conlon is outpatient clinical director for the Pinellas Ex-offender Re-entry Coalition in Pinellas County, FL, home of Tarpon Springs (and Tampa to the south end of the county). PERC staff work hard at helping people released from prison restart their lives and at keeping them on a stable path. Every year, PERC provides about 2,200 ex-offenders with services, including haircuts, resume writing, housing and job referrals.

Denise Hughes-Conlon in conference at PERC's group meeting room.

Hughes-Conlon’s passion for the last 10 years has been working with the types of people that most of us would rather avoid, or would even pretend did not exist: batterers and sex offenders. Why? “Because I used to work with victims and I thought I needed to do something to stop the continuous cycle of victims coming through the door,” she notes. “My original goal was to save at least one victim. I think I have accomplished that. Now my goal is to continue.”

She was sitting at a table with a couple dozen other members of the Peace for Tarpon steering committee when Saenger issued her challenge. They’d all listened to a presentation about the Adverse Childhood Experience Study (ACE Study), a research project of Kaiser Permanente in San Diego and the U.S. Centers for Disease Control and Prevention, which shows a link between early childhood trauma and adult onset of chronic disease. The study also showed that childhood trauma increases the risk of people engaging in violence or becoming victims of violence.

The CDC’s ACE Study measured 10 childhood traumas – physical, emotional and sexual abuse; emotional and physical neglect; living with a parent who’s an alcoholic or addicted to other drugs; witnessing the abuse of a mother; a family member in prison or diagnosed with mental illness; and a loss of a parent through divorce or abandonment – in 17,000 people in San Diego. (Of course, there are other possible traumatic events a child can experience – such as severe illness, homelessness or surviving a catastrophic tornado or flood – but those were not measured.)

From this list, researchers determined each person’s ACE Score. Each type of trauma counts as one. To their surprise, they found that childhood trauma in this middle-class, college-educated, mostly white population was very common – 70 percent had an ACE Score of at least 1. And the odds were very high that if someone had 1 trauma, there were more. In other words, if your dad was an alcoholic, it’s likely that there was also emotional abuse in your background.

The study showed that the higher the ACE Score, the higher the risk of disease, suicide, violent behavior, or being a victim of violence. People with an ACE Score of 4 or more had significantly higher rates of heart disease and diabetes than those with ACE Scores of zero. The likelihood of chronic pulmonary lung disease increased 390 percent; hepatitis, 240 percent; depression 460 percent; suicide, 1,220 percent. The percentages climbed to grim and astounding levels as the ACE Score increased – people with an ACE Score of 6, for example, had a 4,600 percent increase in the likelihood of becoming an IV drug user.

The reason for this – which neurobiologists such as Martin Teicher, Jack Shonkoff and Bruce McEwen figured out — is because the toxic stress of chronic and severe trauma damages a child’s developing brain. It essentially stunts the growth of some parts of the brain, and fries the circuits with overdoses of stress hormones in others.

Children with toxic stress live their lives in fight, flight or fright (freeze) mode. Unable to concentrate, they are incapable of learning and they fall behind in school. They respond to the world as a place of constant danger, not trusting adults and unable to develop healthy relationships with peers. Failure, despair, shame and frustration follow. As they transition into adulthood, they find comfort by overindulging in food, alcohol, tobacco (nicotine is an anti-depressant), drugs (methamphetamines are anti-depressants), work, high-risk sports, violence, a plethora of sexual partners….anything that pumps up feel-good moments so that they can escape – even briefly – the sharp, tenacious claws of agonizing memories and despair.

Each year at PERC, about 200 ex-offenders participate in four types of support groups: substance abuse, anger management, batterers intervention and sex offenders. Most of the groups’ members are men; there’s a separate trauma group for women only.

Sex offenders attend group meetings for three years. Other ex-offenders attend meetings for a few months. The conditions of their probation determine the length of time they participate. (According to the U.S. Bureau of Justice Statistics, nearly 4.9 million people were on probation or parole in 2010. In Florida, about 115,000 people are on probation or parole.)

When Hughes handed the ACE test out to the sex-offender group members, she wasn’t prepared for the results: The average ACE Score for the 15 men was 9. “That was shocking to me,” she says. “I knew they were high, but not that high.”

Some had experienced all 10 childhood traumas measured in the ACE Study, and more. “One guy who had a 10, his father shot his brother in front of the whole family,” she says.

In the substance abuse, anger management and batterer interventions groups, she found that 60 percent have ACE Scores higher than 4.

“Now that I know people are traumatized, I seek different information to help them,” says Hughes-Conlon.

She changed the curriculum for the women’s groups to Seeking Safety, which specifically addresses trauma. Developed in 1992 by Dr. Lisa Najavits, a professor of psychiatry at Boston University Medical School, it’s described as a “present-focused therapy to help people attain safety from trauma/PTSD and substance abuse.” The women learn information that they can use daily, such as how to say no, and how to create every-day boundaries. They’re asked to make commitments and describe how they’re working on them.

“It’s been very useful. I actually had one lady ask to stay on probation longer,” Hughes-Conlon laughs. “She told me ‘I want to be here. This is helpful.’ I told her that she could come anyway.”

Since the curriculum for the batterers-intervention group is controlled by the state, it wasn’t changed. Hughes-Conlon doesn’t think it needs to change. “Batterers would take this information and use it as an excuse,” she explains. She uses the ACE survey as information for the PERC staff. “It gives us a different insight. It changes how you look at a person – whether you look at them as just a criminal or someone who had trauma in their background.”

She thinks the ACE survey has “solidified things” for the members of the sex-offenders group, which uses a relapse-prevention curriculum developed by the Association for the Treatment of Sex Abusers. “It might motivate them to do better – perhaps result in fewer victims.”

Even though the recidivism rate for sex offenders is very low – 5 to 17 percent – says Hughes-Conlon, “Once a sex offender, always a sex offender.” And just as diabetics or alcoholics must pay attention to their triggers to stay healthy, whether a man chooses to act out is the main challenge a sex offender deals with. She tells the men in the group “you have to watch your stressors differently, because the way you have acted out is more horrendous than if a diabetic eats a chocolate bar or an alcoholic drinks a beer.”

Hughes-Conlon began using the ACE survey in April 2011, a couple months after Tarpon Springs declared itself a trauma-informed community. She’s seeing a lot more information about child brain development, the ACE Study and trauma-informed care in the conferences she attends. At a behavioral health and addictions conference she attended in 2011, “the whole conference was about trauma,” she says.

“People are getting it now,” she says. “It’s always nice, especially when working with sex offenders, when a scientific study comes along and underlines everything you’ve seen.”


  1. The information PERC gathered from offenders is just the first step in preventing re-offenses. PERC’s response to this information is incredibly disappointing and inadequate. The agency changed the curriculum of their women’s trauma treatment group? That’s it? At the very least, adding a trauma treatment group for men with ACE scores of 4 or higher would be a reasonable response.

    What faulty logic PERC uses when saying that batterers will use their ACE scores as an excuse for their offenses! There is no research basis to support this claim. And with average scores of 9 in the sex offender group, PERC still provides no treatment for trauma? This is bordering on malpractice, in my opinion.

    We know that trauma is resolved through a step by step process of education about the disorder, skills building in managing symptoms through trauma focused cognitive behavioral treatment, repairing attachment disorders through teaching, modeling and providing a healthy relationship in therapy, and revising the narrative of the trauma to create a cohesive, clear and strengths/resiliency based storyline and theme.

    My sincere hope is that PERC now offers comprehensive treatment for ACEs to all their clients since the 2012 publication of this article. I would love to read a follow up piece to this article!


  2. Jane: What a wonderful article. I have been making the ACEs presentation around Michigan for a couple of years now. Last year, I took it upon myself (and with the support of our Children’s Trust Fund of Michigan) to give the presentation to a randomized draw of half of the members of the state legislature. I deliberately avoided giving them any policy recommendations, as I didn’t want to get embroiled in the kind of debates that often accompany “lobbying visits.” I just wanted to share the facts. That said, I was frequently asked the question about what can be done about it. It turns out that there are very few tangible examples of people putting the ACEs studies into practical, street-level action. This Tarpon Springs story is one example, and its a great one. With all the horrible stories that come out of Florida (and everywhere) regarding child neglect and abuse, its really exciting to see a community addressing ACEs in such a direct, and I hope, meaningful way. All the best.
    Richard Cole, Michigan State University, East Lansing, MI


    • Thanks for your kind words, Richard. This week, I’ll be posting more examples of how individuals, schools and public health centers are using ACEs. It’s been a fascinating journey so far, and very inspiring to see so many people working on solutions.


  3. “Once a sex offender, always a sex offender.”

    Congratulations, in one single sentence you invalidated your entire article. I take personal offense to that statement. Getting drunk once in life does not make one an alcoholic, and many sex offenders have offended only once and don’t re-offend. That was a very irresponsible statement coming from a professional.


  4. Great article, Jane. It’s amazing how changing our understanding of the reasons for people’s behavior can lead to greater empathy for them–and with greater empathy, more opportunities for growth.


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