A common tool used by an array of professionals to assess experiences of trauma in the first 18 years of life fails to adequately uncover and contextualize adverse experiences—and has the potential to re-traumatize an individual by the manner in which it is administered and the lack of responsiveness to disclosure, according to new research by a Daemen College professor.
The 10-item measure, known as the original ACE (Advertise Childhood Experiences) questionnaire, while widely used, is haphazardly administered, the study cites—and is often embedded in a battery of intake forms, the content of which is frequently left unacknowledged by providers.
What’s more, the researchers suggest that the poor construction of the items on the ACE questionnaire may lead to inaccurate information of the lived experiences of an individual.
“The questionnaire provides a crude measure of a far from exhaustive list of adverse experiences,” said Whitney Mendel, an assistant professor of public health at Daemen and co-author of the research. “We need to ensure that assessing for trauma is more helpful than harmful—and this will take a significant supportive work and changes in our systems of care.”
Childhood traumatic experiences often reverberate throughout a person’s life, research shows—often predictive of significant threats to health and wellbeing in adulthood, such as obesity, substance use disorders, cancer and other maladies.
“Although it has been useful in predicting health outcomes across the life course, the ACE questionnaire fails to help us understand how the individual emotionally or physically carries such experiences and therefore limits our ability to provide appropriate supports and treatment,” Mendel added.
Targeting trauma, encouraging compassion
The paper includes recommendations for revising the questionnaire, informed by “trauma-informed” (TI) tenets such as safety, collaboration, voice and choice, empowerment, resilience—and an acknowledgment of the prevalence of trauma and the capacity of individuals to heal, researchers noted.
Published in the Journal of Community Psychology, the paper identifies key areas of improvement to content and administration of the ACE questionnaire: identifying ambiguity in the questions asked of individuals, the limited breadth of traumatic events included, and failure to capture the gravity of an individual’s experience.
“There are better ways to ascertain more accurate information,” said Mendel. “For many people, this is a critical moment—few times in their lives are they ever asked about harmful experiences in a setting where they could be offered help for what they carry with them.”
“Applying trauma-informed values to the administration of the ACE questionnaire can help people feel seen and heard—while facilitating compassion and helping build safer, more trustworthy, and empowering relationships between clients and providers,” said Mendel.
Co-authors of the research “Is there anything else you would like me to know?”: Applying a trauma‐informed approach to the administration of the adverse childhood experiences questionnaire are Nicole M. Fava, an assistant professor in the Robert Stempel College of Public Health and Social Work at Florida International University; and Mickey Sperlich, an assistant professor in the School of Social Work at the University at Buffalo.