G.E.A.R. is a Parent-to-Parent Network of Information & Support For Parents of Children with Behavioral Health Concerns

The Following information will help the GEAR Parent Network better understand what are the ACE’s the families we work with have been exposed to, and that will help us to provide future educational workshops, awareness and prevention of adverse childhood experience (ACE’s).
The ACE Score attributes one point for each category of exposure to child abuse and/or neglect. Add up the points for a Score of 0 to 10. The higher the score the greater the exposure and the greater the risk of negative consequences.

* 1. While you were growing up, during your first 18 years of life:

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?

* 2. While you were growing up, during your first 18 years of life:

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?

* 3. While you were growing up, during your first 18 years of life:

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?

* 4. While you were growing up, during your first 18 years of life:

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?

* 5. While you were growing up, during your first 18 years of life:

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?

* 6. While you were growing up, during your first 18 years of life:

Were your parents ever separated or divorced?

* 7. While you were growing up, during your first 18 years of life:

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?

* 8. While you were growing up, during your first 18 years of life:

Did you live with anyone who was a problem drinker or alcoholic or who used street drugs?

* 9. While you were growing up, during your first 18 years of life:

Was a household member depressed or mentally ill, or did a household member attempt suicide?

* 10. While you were growing up, during your first 18 years of life:

Did a household member go to prison?

Now add up your “Yes” answers: _______ This is your ACE Score.

* 11. Which of the following below best describes your personal definition/situation as a caregiver? Check all that apply:

* 12. Age

* 13. Which if any of the ACE’s that you answered yes to above still bother you today?

* 14. Score

Thank you for taking this survey!
If after completing this survey you feel like you need immediate assistance, please call the Maine Crisis Line at 1-888-568-1112 Voice/TTY.
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