1 / 41

Adverse Childhood Experiences Screening Questions

This screening tool helps assess past trauma. Answer key questions to determine your ACE Score. Then, engage with the Devereux Adult Resilience Survey to reflect on your relationships, initiative, internal beliefs, and self-control.

marcum
Download Presentation

Adverse Childhood Experiences Screening Questions

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Adverse Childhood Experiences Screening Questions While you were growing up, during your first 18 years of life:

  2. 1) Did a parent or other adult in the house household often or very often: Swear at you, insult you, put you down, or humiliate you? or, act in a way that made you afraid that you might be physically hurt? • Yes • No

  3. 2) Did a parent or other adult in the household often or very often: Push, grab, slap or throw something at you? • Yes • No

  4. 3) Did an adult or person at least 5 years older than you ever: Touch or fondle you or have you touch their body in a sexual way? or, Attempt or actually have oral, anal, or vaginal intercourse with you? • Yes • No

  5. 4) Did you often or very often feel that: No one in your family loved you or thought you were important or special? or, Your family didn’t look out for each other, feel close to each other, or support each other? • Yes • No

  6. 5) Did you often or very often feel that: You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? or, Your parents were too drunk or high to take care of you or take you to the doctor if you needed it? • Yes • No

  7. 6) Was a biological parent ever lost to you through divorce, abandonment or other reason? • Yes • No

  8. 7) Was your mother or stepmother: Often or very often pushed, grabbed, slapped, or had something thrown at her? or, Sometimes, often, or very often was kicked, bitten, hit with a fist, or hit with something hard? or, Ever repeatedly was hit over at least a few minutes or threatened with a gun or knife? • Yes • No

  9. 8) Did you live with anyone who was a problem drinker or alcoholic or who used street drugs? • Yes • No

  10. 9) Was a household member depressed or mentally ill or did a household member attempt suicide? • Yes • No

  11. 10) Did a household member go to prison? • Yes • No

  12. Please add up your “Yes” answers.This is your ACE Score. • Zero “Yes” answers • One “Yes” answer • Two “Yes” answers • Three “Yes” answers • Four or more

  13. Devereux Adult Resilience Surveyby Mary Mackrain

  14. Relationships

  15. 1) I have good friends who support me. • Yes • Sometimes • Not yet

  16. 2) I have a mentor or someone who shows me the way. • Yes • Sometimes • Not yet

  17. 3) I provide support to others. • Yes • Sometimes • Not yet

  18. 4) I am empathetic to others. • Yes • Sometimes • Not yet

  19. 5) I trust my close friends. • Yes • Sometimes • Not yet

  20. Initiative

  21. 1) I communicate effectively with those around me. • Yes • Sometimes • Not yet

  22. 2) I try many different ways to solve a problem. • Yes • Sometimes • Not yet

  23. 3) I have a hobby I engage in. • Yes • Sometimes • Not yet

  24. 4) I seek out new knowledge. • Yes • Sometimes • Not yet

  25. 5) I am open to new ideas. • Yes • Sometimes • Not yet

  26. 6) I laugh often. • Yes • Sometimes • Not yet

  27. 7) I am able to say no. • Yes • Sometimes • Not yet

  28. 8) I can ask for help. • Yes • Sometimes • Not yet

  29. Internal Beliefs

  30. 1) My role as a caregiver is important. • Yes • Sometimes • Not yet

  31. 2) I have personal strengths. • Yes • Sometimes • Not yet

  32. 3) I am creative. • Yes • Sometimes • Not yet

  33. 4) I have strong beliefs. • Yes • Sometimes • Not yet

  34. 5) I am hopeful about the future. • Yes • Sometimes • Not yet

  35. 6) I am lovable. • Yes • Sometimes • Not yet

  36. Self-Control

  37. 1) I express my emotions. • Yes • Sometimes • Not yet

  38. 2) I set limits for myself. • Yes • Sometimes • Not yet

  39. 3) I am flexible. • Yes • Sometimes • Not yet

  40. 4) I can calm myself down. • Yes • Sometimes • Not yet

  41. There are no right answers. Once you have finished, reflect on your strengths and then start small and plan for one or two things that you feel are important to improve.

More Related