The Wisconsin Child Abuse and Neglect Prevention Board is committed to mobilizing research and practices that prevent the occurrence of child maltreatment. The Prevention Board partners with organizations throughout the state, providing support for proven programming so that children across Wisconsin grow up in safe, stable and nurturing families and communities.
Limitations on ACE Screening
In the 1990s epidemiologists Drs. Robert Anda and Vincent Felitti conducted a ground-breaking study that definitively linked adverse experiences in childhood to poor outcomes in adulthood. Adverse Childhood Experiences (ACEs) are potentially traumatic events or circumstances that occur prior to age 18. The original ten ACEs encompass forms of child maltreatment and household dysfunction. These ACEs have been shown to increase the risk of poor mental, behavioral and physical health and negatively influence life outcomes in adulthood. Ten years ago, the Child Abuse and Neglect Prevention Board, along with numerous partners, began the process of collecting ACE data in Wisconsin. The Wisconsin findings mirrored the original study.
In the intervening years, much national attention has been directed toward identifying and preventing ACEs. Use of the questionnaire from the ACE study as a screening or assessment tool has gained widespread interest. Dr. Anda, as well as a number of other researchers, have declared this increasing practice to be troublesome, pointing out that the tool was not designed nor has it been validated for this purpose. In contrast, practitioners argue that the ACE assessment has great value for families when it is used, not as an evaluative or predictive tool, but as a resource for relationship and empathy building.
Determination needs to be made as to whether ACE screening practices are the most appropriate way of understanding adversity or if there may be more effective tools or methods. Ultimately the prevention and reduction of ACEs requires grounding within a larger public health framework that consists of a comprehensive, coordinated system offering primary care universally with referral to more intense levels of care as needed.
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