Adverse Childhood Experiences
Using ACE Screenings to Mitigate Long-Term Adverse Outcomes
By: Tanikka Price, Education Director of the Central Ohio Pathways HUB, Health Impact Ohio
Growing up as a little Black girl in the Linden area of Columbus, Ohio, I got good grades and did well in school. However, I was constantly in trouble for disruptive behavior, such as fighting. Teachers and caregivers would continually ask me, “What is wrong with you?” Perhaps the better question would have been, “What happened to you?” My behavior was directly related to my Adverse Childhood Experiences (ACEs), but I would not learn about that framework until my later years.
I was introduced to the ACEs framework while working as a Community Health Worker (CHW) in 2011 at Moms2B, a prenatal support program at The Ohio State University. ACEs are potentially traumatic events that occur during childhood. The ACEs framework is a ten-item questionnaire designed to assess exposure to specific trauma in childhood (between the ages of 0 and 18). The ACE questionnaire allocates points for each trauma category experienced. Categories include physical and emotional abuse, neglect, and household dysfunction. An ACE score of four or more can have a detrimental impact in adulthood, with a higher propensity for dysfunctional relationships, future violence victimization, morbidity rates, and lifelong health outcomes. ACEs are linked to toxic stress, mental illness, substance misuse, promiscuity, domestic violence, and chronic health problems in adulthood.
Minority groups have long been encouraged to pursue higher education to escape toxic environments. I grew up believing that higher education was necessary to achieve success. I found, though, that as I amassed degrees and certifications, including a law degree, I still struggled in other areas of my life. I questioned if ACEs were the cause of discrepancy between my educational success and my quality of life. I speculated that I was not alone, that there might be other Black women with high ACE scores who felt this same pressure to succeed, fear of failure, and worse, the fear that they would never be good enough.
After working as an attorney and a Supervisor of CHWs, I saw firsthand the myriad of ways ACEs impacted Black women and contributed to health disparities. I was surrounded by intelligent women who had been impacted by ACEs, and were now in domestic violent situations, or using unhealthy coping mechanisms to survive. I saw myself in these women and wanted to assist them in overcoming their childhood trauma.
The desire to further understand and help women overcome the negative impact that childhood trauma was having in adulthood influenced my Doctoral. Candidate dissertation topic. In 2014, I enrolled in Northcentral University, and focused my dissertation on exploring how ACEs impacted educational attainment in the lives of other African American women. My dissertation, “A Phenomenological Study of the Impact of Adverse Childhood Experiences on Educational Attainment in the Lives of African American Women” highlighted the experiences of 18 women with ACEs, and their perceptions of how it impacted their lives and educational pursuits.
My hypothesis was that women who had completed their educational pursuits would be more successful and have a higher sense of self-efficacy than those who had less education. However, the research I conducted demonstrated that rather than education dictating success, it was their ACEs. My research indicated that the most prevalent negative outcomes for adults with high ACE scores were attempted suicide, teen pregnancy, and mental illnesses. Knowing a client’s ACE score can help CHWs to better understand their clients’ lived experiences, which can then help to direct their clients to the appropriate services and resources through the Central Ohio Pathways HUB. Despite the negative outcomes the women experienced, themes of grit, motivation, resilience, and self-efficacy emerged from their stories. Self-efficacy, the belief that one can do what they set their mind to, proved to be more important than educational attainment in predicting success in the participants’ lives.
My research uncovered interventions that could mitigate ACEs, including integrating trauma-informed behavioral therapy at schools, for children like me who frequently get asked, “What is wrong with you?” when acting out. Being screened for ACEs as a child can help mitigate the long-term negative effects of ACES. Mentors, teachers, and coaches to be educated in trauma-informed care so they can refer adolescents to be screened for ACEs and ensure that they receive appropriate interventions. Parents and guardians of these children also benefit from an ACES screening to identify the intergenerational effects of ACEs. Evaluating these scores can help to ensure that people are getting the help they need.
Learning about ACEs changed the trajectory of my life. My life’s work began when I committed myself to educating others on ACEs and started implementing strategies to assist in working through trauma. While ACEs are traumatic, they no longer have to result in adverse outcomes.
To learn more about the Central Ohio Pathways HUB, please email HUB CEO, Jenelle Hoseus, at jenelle@hcgc.org.
