ACEs Score (Nursing)

00:00 So how do we determine whether a child is experiencing adverse childhood experiences? Well, there is a scale for that and we call it the ACEs score. And the higher the number on the ACEs score, that indicates the more difficulties this child has in their household.

00:24 So, like the first question would be "Did a parent or other adult in your household very often or often swear at you, insult you, put you down, or humiliate you, or act in a way that made you afraid that you might be physically hurt?" Each one of these questions comes with "If it's yes, it's a one. If it's no, then it gets no score." The second question "Did a parent or other adult in the household often or very often push, grab, slap, or throw something at you, or ever hit you so hard that you had marks or you were injured?" Oftentimes people ask me "You're asking these questions to children?" And the answer is yes. If you can imagine a child who is caught in a situation where they're not able to say anything to anyone and then they're asked on a score "So did this ever happen? Did this ever happen?" It is a safe place for them to be able to say "Yes, but." And oftentimes what we hear is "Well yeah my mom used to throw things at me but it was only because I was bad." So we listen carefully to what the answers are. "Did an adult or person at least 5 years older than you ever touched or fondle you in a way that it'd be sexual or attempt to actually have oral, anal, or vaginal intercourse with you?" Again, the answer usually is yes or no. Or it's not really like that, you listen to the child's answer. "Did you often or very often feel that no one in your family loved you or thought that you were important or special? Or your family didn't look out for each other, feel close to each other, or support each other?" "Did you often or very often feel that you don't have enough to eat, had to wear dirty clothes, or had no one to protect you or that your parents were too drunk or high to take care of you or take you to the doctor if you needed it?" This question here is a really interesting one because a child who is living in a house where there is substance use and substance abuse often does not have enough to eat, often doesn't have anyone cleaning up after them, making sure that they have clean clothes.

02:58 These are the children that when you see them, they have dirty teeth, their hair is mudded, their clothes are dirty. Being able to say to yourself "Oh, maybe this child is having some adverse childhood experiences, maybe this child needs to have an ACEs score done " would be very helpful to you. "Were your parents ever separated or divorced?" "Was your mother or stepmother often or very often pushed, grabbed, slapped, or had something thrown at her? Or sometimes often or very often kicked, beaten, hit with a fist, or hit with something hard." On this question I will share with you that whenever I am working with a family and I have the opportunity to sit down with the kids, the question that I ask them is "Is there anyone in your house you are afraid of?" And the second question is "Is there anyone in your house you are afraid for?" Basically, the child will say "Oh, well I'm not afraid but I'm really worried about my sister because." And then they will tell you the story. This is that question. "Are you seeing someone else become abused and are you worried for them? Do you feel like you have to protect them?" These children are much older in their young years than we give them credit for. We also ask them "Was your mother or stepmother ever repeatedly hit over a least few minutes or threaten with a gun or a knife?" "Did you live with anyone who is a problem drinker or alcoholic or used street drugs?" "Was a household member depressed, mentally ill, or did a household member attempt suicide?" This is really important. Children who are exposed to death by suicide have a much higher problem emotionally because at that young age to be able to come to terms with someone killing themselves is really difficult.

05:19 And the last question is "Did a household member go to prison?" Each yes answer gets 1 point and we're not worried that much at a 3 or a 2 or a 1 because there are many people who may be living in a house that has a parent who has alcoholism or has a parent who has a mental illness, but there is enough support in the house that they are not being in any way injured and their emotional well-being is being taken care of. But if the score is 4 or over, we start looking more seriously at this child for protective services.

06:02 And as the number goes higher, we really have to make sure that we are getting somebody in there to help them. So, what we know is that as the number goes up, so do the physical diseases this child will have over a lifetime. So, again, I'm repeating it I know but as the score goes up, that risk of mental, physical, and emotional problems also goes up. Now, this test, this scoring is really a guideline and it's used to be able to help this child or this youth get resources so that the earlier we get in there, the earlier we can start reversing the trends, just like anything else. Early treatment and prevention is really really going to be the trick to help this child have a good life.