"The child is the father of the man."

William Wordsworth

Go back to the time before you turned 18, and consider how you related to the adults in your family. With that perspective, answer the following questions*:

• ___ Were you physically abused as a child (hit so hard it left marks)?
• ___ Were you sexually abused (did an adult molest you)? 
• ___ Was your mother physically abused? 
• ___ Were you emotionally neglected (did you often feel as though your family did not love you)? 
• ___ Were you physically neglected (did you have to wear dirty clothes or have no food to eat)? 
  
• ___ Did you have an immediate family member go to prison? 
• ___ Did you have an immediate family member with a mental illness? 
• ___ Did you have an immediate family member who was an alcoholic or addicted to drugs? 
• ___ Were you separated from one of your parents by divorce or death?
• ___ Were you verbally abused (told that you were an idiot or stupid)? 

Now tally up the times you answered “yes.” The number of times you answered “yes” is something like your ACE score. It ranges from 0-10, with 0 being the least traumatic childhood and 10 being the most traumatic. If you’re like most people, you probably answered “yes” at least once. And if you answered “yes” at least once, chances are you answered “yes” twice--only 23% of people with at least one have an ACE score of just one. 

* Note: These questions are only meant to prompt reflection and are not for “diagnosing” someone’s ACE score. View the actual ACE research questions here.

What’s concerning is when you answer “yes” four times or more. Not surprisingly, a person with an ACE score of four or more has a greater than average risk for suicide and alcoholism. But what you may not know is that an ACE score of four or higher also makes heart disease, cancer, and diabetes more likely. And a score of six or more could take twenty years off your life. (If you skipped the survey in the beginning, you just went back and answered it again, didn’t you?)

What happens in childhood - and how one views those events - deeply influences one’s adult life. How deeply is a matter of investigation. Available information about ACEs, or Adverse Childhood Experiences, has a direct bearing on the work we do in pregnancy centers. In this article, I will explore what researchers have learned about ACEs in the past 20 years. 

A little background: in 1995-97, The Centers for Disease Control (CDC) joined forces with Kaiser Permanente to conduct the Adverse Childhood Experiences (ACE) Study. At first, seven categories were considered: psychological abuse, physical abuse, sexual abuse, witnessing domestic violence, and living with household members who were mentally ill, suicidal, or had been imprisoned. In later studies, three other factors were added, bringing the total to ten: loss of a parent through divorce or abandonment, emotional neglect, and physical neglect. These statistics were then compared to adult risk behavior, health status, and disease. This ACE study is one of largest investigations of childhoodabuse and neglect and the impact they have on later-life health and wellbeing. 17,421 people participated. All were employed by Kaiser Permanente and had good health benefits. They represented a cross-section of various ethnic groups. Most were middle-class and well-educated.

The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that ACEs are common, that they occur in clusters, and that they have what is known as a “dose response.” This means that the higher the cumulative score of ACEs, the greater the likelihood of an adverse impact on a person: physically, socially, and behaviorally. Of particular concern to pregnancy centers is the sub-study “Early Childhood Adversity and Pregnancy Outcomes.” The research indicates that ACEs have a strong relationship to poor pregnancy outcomes, may be a factor in fetal death, are predictive of males being involved in teen pregnancies, and lead to risky health behaviors, such as depression, suicidal ideation, and terminations (abortion). Check out the extensive list of references for further study. 

ACEs are strongly connected to trauma-informed care. Although awareness of trauma-informed care concepts has increased in recent years, application of ACE concepts is less available and has, perhaps, been ignored -- even by the CDC. Some states, such as California, are incorporating this research into their services, but many others are not. Researchers point to the need to do more preventive work to minimize the occurrence of ACEs.

Likely, many of your clients have high ACE scores. And without intervention, they may cope with their pain in unhealthy ways and parent in ways that increase the ACE scores of their own children. What is your role? Likely your center already offers services that support life decisions. Awareness of ACEs may increase the effectiveness of these services. Consider reviewing this article and related studies with your team. As they learn about ACEs, your client services team members can better help clients access the healing and skills they need to avoid passing down generational hurts on to their children. Think you’re not equipped? Think again. Studies show that people who demonstrate true care and concern make an impact, even if they are not professional counselors. (Of course, if a person is dealing with a mental health problem, it is always good to encourage them to see a counselor or therapist. However, that does not mean that you have to step out of their life.) We cannot undo the past, but we can point our clients to a brighter future by listening to their concerns, providing practical assistance, and offering compassion, hope, and help through Jesus Christ. Healing is always possible in Christ, and resilience can be cultivated. You’ve had difficult clients before, and you’ll have them again. Demonstrate care and concern. You can be part of the changing the future for their children.

Learn more from this brief summary of the research:

In closing, won't you join the conversation? Have you reviewed the research into Adverse Childhood Experiences before? How do you think these factors impact your clients?

Joan Boydell is a Center Service Specialist who started as a center director in 1989.  She is delighted to see how the Care Net ministry has grown and matured over the years, consistently adding resources and setting high standards for centers throughout North America.  She lives with her husband in Lancaster County, PA and works as a Licensed Professional Counselor.

Alana Varley, Center Services Assistant at Care Net, also contributed to this article.