Feature by Ron Means, MD, Assistant Medical Director, Baltimore Child and Adolescent Response System (BCARS)

Behavioral health clinicians are tasked with providing traditional services such as medications, therapy, counseling, and rehabilitative services.  Often we have to make other, non-traditional interventions for those we treat. Those interventions are usually less defined, but they have significant impacts.

In recent years, the need for a comprehensive approach to treating children and families has been made more evident with research involving adverse childhood experiences, or ACE. ACE is the term used to describe all types of abuse, neglect, and other potentially traumatic experiences that occur to people under the age of 18. Keep in mind, ACEs are not synonymous with trauma. They have the potential to be traumatic, and they certainly can have major impacts on the lives of those we treat. These impacts can manifest immediately or, as research has shown, much later in life.  ACEs have been linked to risky health behaviors, chronic health conditions, low achievement, and early death.

It is important to identify ACEs when they exist. The goal of this identification is to treat immediate sources of trauma and adverse experiences that might affect those we serve at various stages of their lives. Behavioral health clinicians are well-versed in identifying and treating abuse. Emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect are all ACEs that we seek to identify and respond to immediately. Other ACEs that are harder to tackle should also be on our radar. These include:

  • -domestic violence
  • -substance use in the household
  • -mental illness in the household
  • -parental separation or divorce
  • -an incarcerated household member

Mobilizing resources to address these problems is critical. As the number of ACEs increase, the risk for a poor outcome also increases. Unfortunately, in large part due the difficulty addressing these issues, we often fail to intervene in and sometimes miss the presence of these problems. Considering what we know about the impact of all ACEs, we should work to eliminate or minimize the impact of them.

ACEs have been linked to risky health behaviors, chronic health conditions, low achievement, and early death

Interventions might include offering resources to the parents of children we are working with to pursue their own substance use or mental health treatment.  For adults that we work with, we can reinforce compliance with their own care by educating them on impacts to their children.  Interventions might even include addressing domestic violence or discord related to separation/divorce in family meetings.  Offering resources to parents such as case management, job training programs, or information to acquire their own health insurance can be critical in helping them avoid illness or incarceration.

In order to provide the most comprehensive and effective help for today and the future, we must address all ACEs to the best of our abilities.

For more info, go to cdc.gov and enter ACE in the search field.


A major factor in health and achievement for us and the individuals we serve

As much as we might want to believe that we leave our childhood experiences behind us as we progress into adulthood, research has shown that these early experiences can affect us throughout or lives. Both we and the individuals we serve tend to see our childhoods as normal, but determining the ACE score can change lives for the better.