Find Your ACE Score and/or Know Your Students ACE Score

The form below is used to determine a ACES score.  Knowing your student and understanding his or her trauma from childhood, just might change how children are disciplined or “handled” in schools.  It is time for the pendulum to swing from punitive to restorative intervention, maybe this tool is just what school districts might to change the paradigm models of detention, suspension, expulsions.  It also creates an opportunity for teachable moments for all adults to self-access and heal as well.

 

092406GRCR                                                                           Gender:  _____  Age:  ____

Finding Your ACE Score (Available in other languages, if needed)

While you were growing up, during the first 18 years of life:

  1. Did a parent or other adult in the 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  or No                                        If yes, enter 1   ______

  1. Did a parent or other adult in the household often or very often. . .

      Push, grab, slap, or throw something at you?

                                     or

      Ever hit you so hard that you had marks or were injured?

                                            Yes  or No                                              If yes, enter 1   _____

  1. 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

                                            Yes  or No                                            If yes, enter 1   _____

  1. 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  or No                                          If yes, enter 1   _______

  1. 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

needed it?

                                                        Yes  or No                              If yes, enter 1   ________

  1. Were your parents ever separated or divorced?

                                                      Yes or No                                  If yes, enter 1   _______

  1. Was your mother or stepmother

Often or very often pushed, grabbed slapped, or had something thrown at her?

or

Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard?

or

Ever repeatedly hit at least a few minutes or threatened with a gun or knife?

                                                   Yes  or No                                                                                        If yes, enter 1   _______

  1. Did you live with anyone who was a problem drinker or alcoholic or who used street drugs? Yes or No                                                                    If yes, enter 1 _______
  2. Was a household member depressed or mentally ill, or did a household member attempt suicide? Yes  or No                                                   If yes, enter 1   _______
  3. Did a household member go to prison? Yes or No                If yes, enter 1   _______

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