# Trends in Adverse Childhood Experiences (ACEs) Among Clients of The Exchange Center for Child Abuse Prevention in Alabama's Wiregrass Region

## TL;DR

This study examines ACEs in Alabama's Wiregrass region, finding high ACE scores overall with no significant difference between urban and rural areas.

## Contribution

This is the first known research to demonstrate high ACE scores across Alabama's Wiregrass counties.

## Key findings

- An overall mean ACE score of 5.897 was found across seven Wiregrass counties.
- Clients with the in-patient code Adult Sexually Abused as Children had the highest ACE scores (6.74).
- No significant differences in ACE scores were found between urban and rural counties.

## Abstract

Adverse childhood experiences (ACEs) are stressful or traumatic events like physical or sexual abuse experienced before the age of 18. ACEs are a national health crisis, with many children in the United States (US) experiencing at least one adverse childhood event. High ACE scores (3+ of 11 categories) are correlated with poor preventable physical and mental health outcomes. Given the unique challenges faced by rural communities, understanding how ACEs uniquely impact rural populations and their health outcomes is imperative to population-specific interventions. The Exchange Center for Child Abuse Prevention (ECCAP), a free non-profit center serving both urban counties (Coffee, Dale, Henry, Covington, Geneva, and Pike) and rural counties (Houston) in Alabama's Wiregrass region, is uniquely poised to serve clients with a history of ACEs. It was hypothesized that ACE scores from ECCAP clients living in rural Wiregrass counties would be higher than those from urban Wiregrass counties. Client data were obtained as a retrospective study using the 10-item ACE survey administered at ECCAP. Participants received trauma-informed therapeutic services through ECCAP from 2019 to 2021 (N=1643). Data collection was done independently by the ECCAP prior to the formation of the hypothesis, which was formed after data collection. Outcome measures were presenting victimization code and ACE scores correlated with the client's county of origin. An overall mean ACE score of 5.897 across seven Wiregrass counties was found, with no significant differences between ACE scores between counties (p>0.05). Exploratory findings indicated that clients who came to the clinic with the in-patient code Adult Sexually Abused as Children (ASAC) had the highest ACE scores of all clients (6.74). This is the first known research to demonstrate high ACE scores across Alabama's Wiregrass counties, where no significant difference was found between scores of clients from urban versus rural counties. This work can benefit the Wiregrass region of Alabama by quantifying the community’s needs, thus demonstrating the importance of trauma-informed centers like ECCAP. Since the population served by the ECCAP is not representative of the population at large, future surveys should sample a broader patient population and delineate urban versus rural trends using zip code rather than county of origin. Future clinical work could integrate ACE surveys into in-patient questionnaire data so clients with high ACE scores can be referred in real-time to evidence-based, trauma-informed services like those provided by ECCAP.