ACE-ing the Test

WHEELING – An area agency is taking a vital role in advocating for early assessment of traumatic childhood experiences and for evaluation to deal with subsequent challenges.

Crittenton Services Inc., based in Wheeling, is now using a 10-question survey as a trauma screening tool to assess clients’ experiences. The form asks for simple “yes” or “no” answers to the series of questions. Results of the Adverse Childhood Experiences survey are used to formulate and evaluate appropriate treatment options.

The local organization participated in an ACE survey pilot conducted by Crittenton agencies nationwide. Kathy Szafran, president and chief executive officer of Crittenton Services Inc., spoke at a briefing held by the National Crittenton Foundation at the Capitol in Washington, D.C., in October. She and other speakers discussed the results of the ACE pilot study and the impact those results can have on the assessment and treatment of children and families.

In addition, as a member of the West Virginia Child Care Association, Crittenton Services is supporting legislation pending in the state Senate and House of Delegates to establish a system for outcome evaluation of West Virginia children. The House and Senate bills also seek to establish a standardized measuring tool, known as the West Virginia Child and Adolescent Needs and Strengths, to be used for the evaluation.

The bills, which have the support of legislators from Ohio County, call for the use of the WVCANS tool as the accepted system for outcomes evaluation in juvenile justice, child protective services, youth services and court systems. “We would use the same assessment tool for at-risk children coming into the system regardless of point of entry,” Szafran explained.

She represents the West Virginia Child Care Association as an advisory board member for the West Virginia Comprehensive Behavioral Health Commission. She serves on a task team that has prepared a report for the commission on the use of CANS for trauma assessment.

Szafran explained the main goal of the legislation is “quickly and appropriately assess children and get them where they need to be as quickly as possible.” Using this tool, agency representatives can assess a child’s needs and the family’s ability to meet those needs, she said.

Citing another goal, she said that “West Virginia University will be our data source.” Agencies will channel basic information about children (without names) to WVU, and officials there “will be able to take this data and map West Virginia-specific services and what type of professionals we need in these communities,” she said.

Such data could be used to secure federal grants for professional workforce development in the state, she added.

Observing an “extremely high” poverty level in the Mountain State, she noted that growing up in poverty leads to stress and trauma. By providing services to children at an early age, agencies may be able to “prevent many long-term, high-end services, not only for mental health but also for physical health,” she commented.

In material advocating adoption of the proposed legislation, the West Virginia Child Care Association cited the example of a teen girl, now 19, who was treated successfully at Crittenton Services in Wheeling after being deemed a juvenile delinquent. At age 14, the girl – high on drugs – attacked an adult woman at a county fair. She was arrested and placed in a juvenile detention center, but received no drug or alcohol treatment or counseling. Two months later, she was referred to Crittenton Services and she found out she was five months pregnant. At Crittenton, officials learned that the girl’s father, a drug trafficker, had forced her to make and sell crystal meth.

“She needed to be quickly assessed and pulled into the system,” Szafran said, referring to the girl, who is now rearing a 4-year-old daughter. “She’s a lovely young woman. I think that quick assessment could have gotten her where she needed quickly.”

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The National Crittenton Foundation’s ACE pilot study resulted from observations by doctors and a study they conducted in San Diego in the late 1990s.

The physicians in San Diego could not understand why only some patients were able to lose, and keep off, a lot of weight. They found that individuals who had bad childhood experiences were apt to have difficulty with health-related matters, Szafran related.

To study this issue, researchers embedded 10 questions about abuse into a health survey for Kaiser Permanente, one of the largest health care providers in the nation, she said. Between 1995 and 1997, more than 17,000 people who received physical exams through Kaiser Permanente in San Diego completed the confidential ACE survey.

The groundbreaking study linked childhood trauma with adult onset of chronic disease and social and emotional problems. Szafran said the study found that people with a higher level of traumatic childhood experiences had a higher risk of a shortened lifespan (by almost 20 years).

Two decades later, in May 2012, the National Crittenton Foundation called representatives of its member agencies to meet with Dr. Vincent Felitti, one of the principal investigators of the orginal ACE study. It was decided that the 28 Crittenton agencies operating in 33 states would conduct an ACE pilot study, Szafran said.

In the pilot, Crittenton agencies in 18 states completed 1,350 surveys from current and former clients. Crittenton Services of Wheeling gathered more than 300 surveys from clients – men, women, boys and girls – served in its residential and community-based programs in West Virginia, Szafran said.

“Our scores were really higher than the study in San Diego,” she said. “People who are coming into services have higher risks.”

The nationwide survey found the majority of clients served by Crittenton agencies across the country have suffered severe trauma at a young age, which, according to the original ACE study, could have a significant impact on their long-term health.

“The surveys show us the true severity of the trauma and violence many of our clients have experienced in their young lives. Utilizing the ACE surveys will allow us to better define the population we serve and offer the best trauma-informed treatment possible to help them heal and prevent future long-term illnesses,” Szafran said.

Now, Crittenton Services is using the ACE survey for every client to determine “the type and intensity of services this client is going to need.” With ACE results, youth served by Crittenton “get into the right treatment faster,” she said.

The relationship between early childhood trauma and long-term life may have implications on health care expenditures over a lifetime, Szafran indicated. “If you minimize the risk of childhood trauma or have intervention, you can greatly impact the long-term cost of health care,” she suggested.

Through the ACE study, “now it’s scientifically proven that kids who have bad childhoods have problems as adults,” she commented.