Can an ACE screening interview in court programs be therapeutic?

This is the second blog in our three part series on how the Adverse Childhood Experiences Study and trauma informed practice can deepen TJ practice in courts.

Therapeutic Jurisprudence Founder David Wexler writes…

There has been an explosion of important trauma-informed work relating to Adverse Childhood Experiences (ACE). Regretfully, I have played absolutely no part in that explosion, and in fact have learned almost all I currently know about ACE from a TED talk and from a wonderful journalistic account of causes and solutions to depression and related matters. The book, by Johann Hari, is entitled Lost Connections, and came to my attention on a Facebook post recommendation  by Prof David Yamada, the Chair of the Board of Trustees of the International Society for Therapeutic Jurisprudence.

I immediately bought a digital copy of the book, and when, on my Kindle, I saw it garnered blurbs from Hillary Rodham Clinton and Elton John, I was pretty much hooked. And I was constantly exposed to fascinating facts and insights.

For example, one study  examined the medical records of prisoners in a Michigan facility. By coincidence, half the cells looked out onto bare brick walls while the others overlooked rolling farmland and trees. The group facing the countryside was 24% less likely to suffer physical or mental illness. Such a finding, if produced by medication (as opposed to exposure to the soothing effect of nature), would have  likely caused quite a stir in the medical journals.

More closely related to the ACE area is a discussion in the book about serious obesity in some women. It turns out that obesity often first occurred shortly after individual girls were sexually abused or assaulted. In other words, obesity in women is often a protective factor, developing after they have been sexually assaulted; the weight gain may lead to their desired result of others paying little attention to them—so, as a treatment,  a serious weight-loss regimen alone may often prove transitory.

But the heart of the ACE material that motivated this Blog was found in  chapter 21 on “acknowledging and overcoming childhood trauma.” It is a TJ truism that we are always alert to findings in psychology, criminology, and social work that may have implications in the legal arena. This particular chapter presents some intriguing findings regarding the acknowledgment and management of childhood trauma.

The study of significance here derives from a questionnaire sent to all who received health care from Kaiser Permanente. The survey asked about ten traumatic events that can happen to a child—physical abuse, emotional abuse, sexual abuse, and more. The study matched these answers against current health.

Then, Dr. Vincent Felitti  decided to follow up in the following way:  The next time a patient/respondent came for health care of any kind, the treating doctor would check the patient’s file and responses to the older survey about childhood trauma. If the earlier survey results indicated one or more traumatic events, the treating doctor was instructed to say something like “I see you had to survive X; I’m sorry that happened; it shouldn’t have. Would you like to talk about it?”  If so, the doctor would express sympathy, would ask if it had negative long-term effects, and would inquire whether the patient thought it relevant to current health.

It turns out that many patients had never acknowledged these events before. In any case, the doctor would offer real compassion.

Here, interpretation gets a bit tricky. The patients so treated were 35% less likely, over the study’s given time-frame,  to return for medical help for any condition. Does this signify a significant reduction in their illnesses? Or might the patients not have returned because they had felt shamed by the process?

The study authors took the first position—that the compassionate interview reduced the shame and humiliation. It was likened to a secular version of confession in the Catholic Church. The researchers came to this conclusion because there were no complaints and because many later expressed their thanks for being able to recount these early painful events.  In an interview with the Lost Connections author, Dr. Felitti stated, “Now, is that all that needs to be done? No. But it’s a hell of a big step forward.”

So, where might we go from here?  In an older essay entitled Therapeutic Jurisprudence and the Culture of Critique, I was taken with the position of linguist Deborah Tannen that we are too attached to an instinctive “argument culture”, a culture that often leads us to play a “doubting game” and to trash some new ideas and studies.  Instead, Tannen urges us—at least initially—to play the “believing game”—to assume a tentative conclusion to be true, and to see where it takes us. The traditional “doubting game”, on the other hand,  can prematurely terminate a potentially promising solution.  With the “believing game”, we can always go back and reexamine our position, and perhaps then reject it. But many conclusions seem most worthy of an initial “believing game” treatment.

So too here. Imagine if a confidential , respectful, empathetic interview with a respected professional can actually, in itself, significantly reduce a person’s shame and humiliation, reducing depression, anxiety, and more.

And if it might do so, how might the law facilitate that very shame-reducing process?

There might be many ways, but one obvious one might be for some problem-solving courts—drug courts, mental health courts, domestic violence courts, veterans courts, community courts— and court support programs in mainstream courts to think through how a compassionate ACEs interview can be a standard part of an eligibility/assessment process.  A compassionate ACEs interview would involve administering the ACEs questionnaire followed by a compassionate discussion about the participant’s ACEs score and what this may mean for them and their recovery plan.

One of the best uses of a Blog, it seems to me, is to throw out some new findings, to play the “believing game”, and to see where it may lead us. In the ACE area, the notion of diagnosis as a hell of a big step forward in treatment seems a really worthwhile idea to ponder.

Read more about the ACE study in our first blog of this series and stay tuned for next weeks blog where Judge (Retired) Peggy Hora talks about trauma informed judging.

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5 Responses to Can an ACE screening interview in court programs be therapeutic?

  1. Jennifer Brobst says:

    The ACES assessment and other research-based psychological assessments are not meant for use by non-clinicians. They form part of a cohesive evidence-based practice in a well-designed structured format that is dangerous when misapplied. Disclosure of traumatic history, particularly if not previously disclosed or if previously disclosed with negative impacts, should not be taken lightly or asked loosely, even with the best of intentions. While compassion may seem like it is always helpful, it is not necessarily the case with regard to serious mental health conditions such as PTSD.
    Routine questions about trauma history and use of the ACES could not only open up wounds without the expertise to address them, but it could also create liability for the professional when used in an unintended setting if followed by suicide or violent acts.

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    • mainstreamtj says:

      Thanks for this contribution Jennifer. You raise a very important ethical issue that needs to be thought through. Many court programs do involve clinicians and many have safety and referral protocols when issues are raised through screening. Any other thoughts from others who maybe use these tools already in say specialist court settings?

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  2. Pingback: ACES: Deepening Therapeutic Jurisprudence Practice in Courts | Therapeutic Jurisprudence in the Mainstream BLOG

  3. Laura Greenlee says:

    As a psychologist, I agree that the ACE should be used by clinicians who are trained to understand the depth of trauma. However, the ACE is available online, and there are many non-clinicians who use it as a screening tool, as well as individuals who assess themselves. I suggest that to avoid further trauma, when individuals score four or above, they should be encouraged to seek the professional services of a trained mental health professional who can offer assistance in mitigating the impact of adverse childhood experiences. There are ways to treat trauma; it is not always a life sentence. But without proper evidence-based intervention delivered by compassionate and hopeful professional, seeing the results of a high ACE score can be devastating.

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  4. mainstreamtj says:

    Interest points Laura. What I am taking from the comments to this post so far is that the screening should not be done in isolation but part of a supportive response that is buttressed by good follow up and supports by clinical professionals. The structure around the screening could be part of a trauma informed court response that is therapeutic and not anti therapeutic

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