This week we return to the topic of Adverse Childhood Experiences. In our previous blog, we explored ACEs screening for children. What about ACEs screening for parents?
This is a question that I first heard when conducting an evaluation with a home visiting program for mothers and their children under 3 years old. The clinical staff had noted numerous traumatic childhood experiences reported during their conversations with participating mothers. Yet we had no group level information about how widespread these experiences were. The clinical staff decided to administer a structured screening inventory with each mother to describe the age and occurrence of traumatic experiences during childhood and adulthood. The results were astounding, and deeply troubled the clinical staff.
For example, mothers' reports regarding early family relationships showed:
- 82% were separated from their closest adult during childhood,
- 70% had a close family member or partner die unexpectedly,
- 74% felt shamed or humiliated by a close relation,
- 59% saw family fighting/ attacking each other.
The simple act of questioning about each of the 18 adverse events on the inventory triggered past trauma for both the mothers and the staff. After learning about their clients’ high prevalence of these and more graphic events, the clinical staff decided not to administer follow-up inventories. Instead, they screened mothers with a less intrusive tool when they entered the program, then referred those who were distressed to mental health practitioners specially trained to intervene with the long-lasting effects of trauma. The home visiting staff could then do what they were trained to do -- support the mothers’ in building strong, nurturing relationships with their children.
So is ACEs screening for parents helpful?
Barry Zuckerman, Professor of Pediatrics and Public Health, Boston University School of Medicine, Boston Medical Center, advises carefully weighing the benefits and consequences of ACEs screening for parents before adding it to your stack of assessments. Dr. Zuckerman is a leader in pediatric care and research who is an advocate for two generation pediatric care.
“Based on my experience that the best way to help children is to help their parents, and the best way to reach parents is through their children, I propose a new frame of a 2-generation approach that focuses not only on the child but also on the parents and their relationship to guide our innovation and target improvements.” [Zuckerman, Pediatrics 2016, Abstract ]
Because adverse childhood experiences touch on the relationships within families, it’s not surprising that Dr. Zuckerman has given some thought to ACEs screening for both children and parents. He co-authored an opinion article in JAMA Pediatrics this year commenting on ACEs screening of parents. The article cites several limitations, including the scope of the ACEs screening tool, its lack of consideration of coping skills and personal or community supports, and the lack of evidence of effective, meaningful intervention for parents with high ACE scores. Instead of delving into parents’ childhood histories through ACEs screening, the authors recommend keeping the focus of care on the child’s social environment. They suggest educating all parents about the negative effects of adverse childhood experiences and building protective factors (e.g., a strong parent-child relationship) to lessen theimpact of toxic stress and promote resilience in their children. For parent screening, the article suggests addressing current adverse issues, such as substance use, depression, or intimate partner violence, which typically disrupt the home environment and family relationships. Such screening keeps the focus on the current parent-child relationship and can be queried sensitively when gathering family information. If needed, parents can then be referred for appropriate evidence-based treatment offered by community partners.
After screening for current parental adverse experiences affecting the child, an observational assessment of parent-child interaction with a tool such as KIPS would offer information about what matters most to children – their parents’ behavior. A parenting assessment would offer insights into the parent-child relationship and the parent’s ability to support the child’s early learning. With this information in hand, you can tailor parenting intervention to each family’s specific strengths and needs. A strong, sensitive parent-child relationship will help each child build a healthy brain and body, and weather adverse experiences in their home, school and community.