School Counselors’ Experiences With Adverse Childhood Experiences

Abstract

Adverse childhood experiences (ACEs) are potentially traumatic events occurring in the household or community that hold painful or distressing outcomes for children immediately and in their future (Centers for Disease Control and Prevention, 2019). School counselors work with children and young adolescents suffering from negative mental health outcomes as a result of ACEs (Hunt et al., 2017; Jimenez et al., 2016; Kaess et al., 2013; Kerker et al., 2015; Koball et al., 2021; Zhang & Mersky, 2020). Further, school counselors often work with minoritized populations, who are at a greater risk for racialized trauma (Cronholm et al., 2015; Merrick et al., 2018; Thurston et al., 2018). Research has not identified the extent to which school counselors are aware of ACEs and use that knowledge to inform their practice. This study fills a gap in the literature by investigating how school counselors understand and address ACEs, using a descriptive phenomenological approach. We identified three themes and various subthemes from the data and offer discussion and implications of the research for school counselors and counselor educators.

Adverse childhood experiences (ACEs) are potentially traumatic events occurring in the household or community that hold painful or distressing outcomes for children immediately and in their future (Centers for Disease Control and Prevention, 2019). Three original domains (i.e., abuse, neglect, and household dysfunction) of ACEs have been identified (Felitti et al., 1998), with social determinants of health recently added as a fourth domain (Koita et al., 2018). These potentially traumatic events include psychological abuse, physical abuse, sexual abuse, emotional neglect, physical neglect, parental divorce, domestic violence, substance abuse, mental illness, and incarceration (Applewhite et al., 2016), and food insecurity, housing instability, violence outside the home, and experiences of discrimination (Koita et al., 2018). Potential traumas can be understood in two broad categories: those occurring within the family context and those that occur within the social context (Kalmakis & Chandler, 2014). For this article, we use the definition for ACEs offered by Kalmakis and Chandler (2014): “Adverse childhood experiences are childhood events, varying in severity and often chronic, occurring within a child’s family or social environment that cause harm or distress, thereby disrupting the child’s physical or psychological health and development” (p. 1495).

The negative outcomes associated with ACEs are experienced in both childhood and adulthood (Hughes et al., 2017; Petruccelli et al., 2019). Due to the widespread prevalence and profound impact of ACEs in communities, families, and individuals, all school counselors are likely to interact with children and adolescents who are navigating the impacts of ACEs. For example, school counselors encounter students struggling with trauma from ACEs in both rural and urban environments (Crouch et al., 2020), and school counselors working in Title I schools likely see students that experience significantly more ACEs than children in non-Title-I schools (Blodgett & Lanigan, 2018).

School counselors are ideally situated in educational settings to support students struggling with trauma as a result of ACEs (Johnson & Brookover, 2021; Zyromski et al., 2022). School counselors are called to build equitable comprehensive school counseling programs that meet the unique developmental needs of all students (American School Counselor Association [ASCA], 2019b; Griffin & Steen, 2011). However, school counselors’ level of knowledge around ACEs and working with students who have experienced trauma as a result of ACEs is not clear. To date, only one qualitative study was found directly addressing school counselors’ experiences working with ACEs. Johnson and Brookover (2021) explored school counselors’ knowledge, actions, and recommendations for addressing social determinants of health, a subcategory of ACEs. In 2022, Wells conducted a study with a self-created and validated questionnaire to assess school counselor readiness to promote and lead culturally responsive trauma-informed practices. The study did not differentiate between trauma and ACEs. Other researchers, in particular Ray et al. (2021), have begun examining the impact of interventions on outcomes for students experiencing ACEs, but overall, scholarship in the field is lacking. In fact, Zyromski et al. (2020) found that only three of the 9120 articles published from 1998 to 2018 in American Counseling Association and American School Counselor Association journals and other journals related to counseling used the term adverse childhood experiences in their title or abstract. This lack of research includes the currently unknown degree of school counselors’ knowledge and perceptions about ACEs. The purpose of this article is to communicate the results of a phenomenological exploration of 10 school counselors’ understanding of ACEs and their professional experiences in the educational setting with ACEs, specifically how their understanding impacts their school counseling practices.

Adverse Childhood Experiences and School Counselors

ACEs affect a large percentage of the U.S. population directly or indirectly, with 60.9% of the population reporting at least one ACE and 15.6% of the population reporting four or more (Merrick et al., 2019). Due to the high prevalence of ACEs in the general population, school counselors in educational settings are likely to engage with students that have experienced trauma as a result of ACEs (Merrick et al., 2019; Zyromski et al., 2022). Further, school counselors must realize that not all ACEs lead to trauma and that the trauma-focused literature often conflates trauma and ACEs by using multiple terms to reflect similar, not identical, constructs related to trauma, such as adverse childhood experiences, complex trauma, toxic stress, or maltreatment, among others (Hays-Grudo & Morris, 2020; Petruccelli et al., 2019; Waite & Ryan, 2020). The confusion around trauma and the origins of various types of trauma may hinder school counselors’ ability to directly address certain ACEs that may impact their populations, such as social determinants of health (Johnson & Brookover, 2021).

Adverse Childhood Experiences

A dose-response relationship exists between ACEs and harmful health outcomes: the higher the number of ACEs reported for children or adults, the greater the risk for negative mental, emotional, and physical health outcomes (Anda et al., 2006; Merrick et al., 2019; Stillerman, 2018). As children experience greater numbers of ACEs, they are more likely to experience negative health outcomes, such as ADHD, anxiety, depression, mood disorders, or nonsuicidal self-injury (Kaess et al., 2013; Kerker et al., 2015; Koball et al., 2021; Zhang & Mersky, 2020). Kerker et al. (2015) suggested that a 32% increase in likelihood of behavior issues, a 21% increase in likelihood of medical issues, and a 77% increase in likelihood of social issues occur with each subsequent ACE experienced.

Marginalized groups are at higher risk for ACEs (Cronholm et al., 2015; Merrick et al., 2018; Thurston et al., 2018). Black, Hispanic, multiracial, gay, lesbian, and bisexual individuals, and those with less than a high school education who earned less than $15,000 annually or were unemployed were more likely to report ACEs and more likely to experience racial prejudices, neighborhood violence, bullying, overrepresentation in foster care and adoption, and more likely to suffer from the impact of natural disasters (Merrick et al., 2018). Health disparities are predictable outcomes for minoritized populations disproportionately exposed to ACEs (Narayan et al., 2018; Warne et al., 2017).

Although research on ACEs has contributed to a national awakening around the deleterious impacts of trauma, the research base is not without limitations. For example, much of the research related to ACEs has occurred with middle class, predominantly White populations, with more recent research highlighting the impact of community-level adversities on health outcomes (Pachter et al., 2017; Wade et al., 2016). Further, the ACEs score is not precise in its ability to measure assets, such as protective factors or positive childhood experiences (Zyromski et al., 2022). The use of screeners to assess ACEs has been widely discussed in the greater literature, with critics suggesting that widespread screening for ACEs may be premature (Finkelhor, 2018) due to potential ethical issues and the failure to consider a set of criteria necessary to meet before implementing any routine health screening program (Dobrow et al., 2018; McLennan, McTavish, & MacMillan, 2020). Items on an instrument treat all exposures to categories of ACEs equally when some may be more traumatic or have greater impacts on outcomes than others (Dube, 2020; McLennan, MacMillan, & Afifi, 2020; Ports et al., 2016). Instruments also fail to capture the variability in responses to ACEs, yet people with ACEs do not all exhibit the same symptoms or experience similar negative health outcomes (Finkelhor, 2018). Finally, an ethical concern is raised if a screener identifies a group of students as high risk but school staff cannot provide effective interventions to that group (McLennan, McTavish, & MacMillan, 2020).

School Counselors

The ASCA National Model (ASCA, 2019b) provides a framework with which school counselors can close opportunity and equity gaps. Holcomb-McCoy (2022) pointed out, however, that many well-meaning school counselors believe they are doing the best they can in this work but are lacking the additional context or insights to identify the root causes of students’ challenges. Johnson and Brookover (2021) called on school counselors to expand how they respond to student needs, specifically around social determinants of health that often reflect external systemic oppressors that limit student success (Griffin & Steen, 2011). In particular, ACEs represent myriad ecological oppressors that reflect systemic and structural injustices that directly impact students in educational settings.

Johnson and Brookover’s (2021) is the only published study to date of which we are aware that specifically speaks to school counselors’ knowledge and experience with ACEs. However, Johnson and Brookover framed their study not as one exploring ACEs, but rather a study of the more specific subcategory of social determinants of health (SDOH). Still, their results were encouraging in that they illustrate how school counselors have been engaging with SDOH in six domains: awareness, help seeking, self-reflection, involvement and role, addressing SDOH, and social justice. Johnson and Brookover found that school counselors struggled with awareness of the term SDOH and were unable to provide a definition or examples of indicators. The ability of school counselors to address the symptoms of SDOH without having clarity around its specific definition may reflect multiple factors, in that SDOH is not widely discussed in the literature or in preparation programs’ curriculum. Researchers have not investigated whether similar issues exist around the broader term ACEs.

School counselors will encounter students in the school setting struggling with the negative impacts of ACEs. For example, learning and behavioral problems are much more likely to be experienced by children with four or more ACEs than those with none (Burke et al., 2011). Young children who experience ACEs are more likely to have poor academic and behavioral outcomes in kindergarten (Jimenez et al., 2016). Further, the odds of preschoolers being suspended increased by 80% for every ACE they have experienced (Zeng et al., 2019). Increases in ACEs correlate with academic failure, behavior problems, and a lack of attendance in school, and exposure to ACEs by the age of 5 is a predictor of internalizing and externalizing behaviors of students in middle school (Blodgett & Lanigan, 2018; Hunt et al., 2017). In fact, Hunt et al. (2017) suggested children as young as 9 years old may start to show behavior problems due to exposure to ACEs and that ACE exposure can also be correlated to diagnosis of ADHD in middle school students.

Other high-risk problem behaviors may emerge later in early adolescence. Having intercourse by the age of 15, experiencing early pregnancy as a teenager, experiencing unintended pregnancy, and having sex with more partners than those who have not experienced ACEs are related to ACEs exposure (Hillis et al., 2000). Other behaviors, such as misuse of alcohol and other drugs (Pilowsky et al., 2009), are additional implications for counselors to consider as they engage with their child and adolescent clients across various settings. Considering the types of mental health and behavioral issues that might need to be assessed in clients is important for counselors in all settings. However, no studies to date have assessed school counselors’ awareness or knowledge of ACEs.

Rationale

School counselors work with children and young adolescents suffering from negative mental health outcomes as a result of ACEs (Hunt et al., 2017; Jimenez et al., 2016; Kaess et al., 2013; Kerker et al., 2015; Koball et al., 2021; Zhang & Mersky, 2020). Further, school counselors, who are most often White women (ASCA, 2020), will often work with minoritized populations, who are at a greater risk for racialized trauma (Cronholm et al., 2015; Merrick et al., 2018; Thurston et al., 2018). The extent to which school counselors are aware of ACEs and use that knowledge to inform their practice is not known. However, in a position statement on the role of school counselors in trauma-informed practices, ASCA (2022) calls school counselors to “understand the impact adverse childhood experiences have on students’ academic achievement and social/emotional development” (para. 1). Practitioners, including school counselors, who are addressing trauma within a system and addressing ACEs among their student population must (a) realize what trauma is and how it affects students and families, (b) recognize the signs and symptoms of trauma, (c) respond with interventions based in fully integrated knowledge, and (d) seek to actively resist retraumatization (Menschner & Maul, 2016). Thus, any trauma-informed practices developed by school counselors must first begin with understanding. We do not yet know the level of school counselors’ understanding about ACEs.

This study fills a gap in the literature around how school counselors understand and address ACEs. The impact of ACEs on student school success is well documented in the greater literature. However, very few articles in the counseling literature speak to ACEs specifically (Zyromski et al., 2020). Fewer still speak to school counselors, with a single study exploring school counselors’ knowledge, experience, and skills related to a subcategory of ACEs (Johnson & Brookover, 2021). Other school counseling scholars have explored ACEs in relation to social/emotional competencies and problem behaviors (Ray et al., 2021) and have offered child-centered play therapy as an effective intervention to increase social/emotional competencies among children that have suffered from ACEs (Ray et al., 2021), but neither of these articles specifically frames the work in school counseling settings or explores school counselors’ awareness or experiences with ACEs.

Thus, the level of knowledge school counselors have regarding ACEs is not clear, nor is how this knowledge influences their practice with students. This study helps fill the gap in the literature by providing insight into the knowledge, professional experience, and school counseling practices around ACEs of 10 school counselors who participated in a qualitative study related to these constructs. The research questions that guided this study were:

1. What are school counselors’ professional experiences with ACEs?

2. What is school counselors’ understanding of ACEs?

3. How, and to what extent, does school counselor understanding of ACEs influence their practice?

Methodology

The purpose of this study was to examine school counselors’ knowledge, professional experiences, and practices related to ACEs. Due to the nature of the research questions, we employed a phenomenological qualitative methodology to understand school counselors’ lived experiences working in schools with children who have experienced ACEs (Creswell & Poth, 2018; Moustakas, 1994). This study followed a descriptive phenomenological approach, which is a type of qualitative research in which the lived experience of each participant is described by the researcher rather than interpreted (Giorgi, 2012; Giorgi & Giorgi, 2003).

Reflexivity Statement

The first three authors have been counselor educators for several years, while the fourth author recently became a counselor educator. All four authors identify as White and have counseled primarily with children in the school setting, working with students who experienced ACEs. The first author, who identifies as a cisgender female, completed a master’s degree in school counseling and a doctorate in counselor education and supervision and worked as a high school counselor for 9 years. The second author identifies as a cisgender male and has published three previous peer-reviewed articles related to ACEs. He was an elementary school counselor for 2 years and also served at a middle school for the spring of one year. The third author completed master’s degrees in school counseling and educational psychology and a doctorate in educational psychology with a minor in counseling psychology. She was an elementary school counselor for 10 years. The fourth author identifies as a Southern, cisgender female who recently became a counselor educator. She completed a master’s degree in school counseling and a doctorate in counselor education. She worked as a high school counselor for almost 10 years. We believe that individuals’ reality is influenced by their values, and throughout the research process, we engaged in bracketing through reflexive journaling and extensive research team conversations, described in the trustworthiness section. As former school counselors, we all were impacted by our experiences in the field working with students and families. Specifically, we all have a bias that ACEs should be addressed within educational settings; thus, we started each meeting by bracketing our own values related to the research topic.

Participants

After receiving university institutional review board approval, we sent an email invitation to participate in this study to school counselors across the country through targeted announcements on social media and via email. We utilized criterion and purposeful sampling, which involves selecting participants due to the “amount of detail they can provide about a phenomenon” (Hays & Singh, 2012, p. 8). We chose social media and email outlets directed to practicing school counselors, including the ASCA Scene for school counselors, state-specific school counselor Facebook pages (e.g., Wisconsin, Ohio) and state school counseling organization email lists. Individuals interested in participating completed an online survey that included questions on availability, demographics, and inclusion criteria.

To participate, individuals had to be employed as school counselors at the time of data collection and: (a) have had at least one full academic year of professional school counseling experience, (b) be a certified or licensed school counselor, and (c) have graduated from a master’s-level school counseling program. Individuals were excluded from participation in the study if they did not meet the above criteria and/or if they participated in the qualitative dissertation on trauma-informed responses in schools (Hansen, 2020), because we hoped to gain differing perspectives about the phenomena of ACEs. Twenty-one individuals completed the screening questionnaire, 10 of whom met the inclusion criteria and were included in the study. We screened all interested participants to ensure they had adequate knowledge of ACEs with the item: “In your own words, define adverse childhood experiences (ACE) and provide a professional example.” We did not exclude any of the individuals due to this screening question.

Participants identified as women (n = 8) and men (n = 2) and as White (n = 9) and person of color (n = 1). Participants were elementary school counselors (n = 1), middle school counselors (n = 4), middle/high school counselors (n = 1), high school counselors (n = 3), and a director of school counselors (n = 1). Participants had a median of 10.5 years of experience in the field (range = 1–27 years, SD = 7.60) and were from nine states from across the United States: Kentucky, Massachusetts, New Mexico, Missouri, Wisconsin, Ohio, California, Idaho, and Virginia (n = 2).

Data Collection and Analysis

We conducted 10 semistructured interviews, each lasting around 60 minutes. Each interview included two researchers, with one designated as primary/lead and the other as a secondary researcher. The lead researcher followed the interview protocol, asking the primary questions, and the secondary researcher took field notes and asked follow-up questions as needed. We started each interview with the question, “How do you, in your professional role as a school counselor, understand adverse childhood experiences (ACEs)?” In keeping with the semistructured process, we included predetermined questions and follow-up questions for clarification (Hays & Singh, 2012; Merriam & Tisdell, 2016). The predetermined questions included:

• Please describe your professional experiences with adverse childhood experiences (ACEs).

• Could you talk about the influence, or lack thereof, of ACEs on your school counseling program?

• Describe your training related to ACEs.

The interviews were recorded via a video web-based technology, Webex, that also transcribed the interviews. These videos were kept secured through a password-protected account.

Within the coding process, we assessed the transcripts for accuracy and assigned pseudonyms for each participant before beginning the coding process. In keeping with Moustakas’s (1994) transcendental approach, we individually read through the transcripts, discussing our reactions, experiences, and potential biases to be prepared to focus on the participants’ experiences. We then conducted systematic data analysis, starting with narrow and moving to broader themes. We individually coded the first transcript line by line, meeting afterward as a coding team to discuss the first codes and establish a preliminary codebook. Specifically, the first author focused on transcripts one through three, the second author on four through six, the third author on seven and eight, and the fourth author on transcripts nine and ten. We individually coded two to three transcripts at a time and then met with the coding team and updated the codebook after each coding meeting (a total of three times) until we established final codes (Moustakas, 1994). The repeated cycle of coding ensured that the dialogue evolved into broader themes with evidence to represent the majority of the participants’ experiences (Merriam & Tisdell, 2016). The coding team agreed on the final themes following the data collection and analysis.

Strategies for Trustworthiness

Research is only valuable if the manner in which it is conducted is ethical, valid, and reliable, and, therefore, trustworthy (Creswell & Poth, 2018; Hays & Singh, 2012; Merriam & Tisdell, 2016). Our team used various measures to ensure trustworthiness, including engaging in bracketing through debriefing after each interview and journaling throughout the research process. Second, we established triangulation through the coding team, collaborative coding meetings, and consensus coding with each theme needing at least three supporting statements (Hays & Singh, 2012; Merriam & Tisdell, 2016). In line with the recommendations for qualitative research (Merriam & Tisdell, 2016), we identified and interviewed 10 participants (Hays & Singh, 2012). If necessary, we would have continued to interview, but the research team determined that the data we had collected answered the research questions. The team also simultaneously interviewed and coded responses to ensure good question protocol and sampling adequacy (Hays & Singh, 2012; Merriam & Tisdell, 2016). We employed member checking (Creswell & Poth, 2018), with all 10 participants reviewing and confirming their transcripts and offering no changes to the themes gathered from the interview. We further enhanced reliability by creating an audit trail (Merriam & Tisdell, 2016) and all researchers engaged in a reflexive journal throughout the process to bracket their biases and assumptions (Creswell & Poth, 2018). We also utilized an external auditor who is an assistant professor of counselor education and a former school counselor in an alternative and Title 1 public school who worked with students who experienced ACEs and has experience with qualitative research. Finally, we included a reflexivity statement including our positionality and experience with ACEs.

Results

We identified three main themes with multiple subthemes through the data analysis. The themes are: (a) continuum of understanding about ACEs, with two subthemes: varied understanding of ACEs and trauma, and influence of training on understanding; (b) views of students due to knowledge of ACEs; and (c) school counselor as an instrument, with four subthemes: collaboration, direct interventions, barriers, and self-care. We describe the results below, including sample participant quotes to illustrate each theme.

Continuum of Understanding About ACEs

Although criteria for study participation included prerequisite knowledge of ACEs, participants differed in the depth of knowledge of ACEs, how ACEs relate to trauma, and how their understanding was influenced by training. Thus, participants expressed a varied and layered understanding of ACEs. This theme includes two subthemes: (a) varied understanding of ACEs and trauma and (b) influence of training on understanding.

Varied Understanding of ACEs and Trauma

Specifically, when asked about their knowledge of ACEs, some participant responses focused on trauma and student outcomes while others shared extensive knowledge of ACEs. For example, when asked specifically about ACEs, Participant 2 shared how her district worked hard to be at the forefront of trauma-informed schools work: “I do feel like our district (has) at some point in time been in the forefront of trauma. We’ve had a trauma team in our district for like 4 or 5 years.” Participant 4 relayed: “We’ve actually done training with our staff to be a trauma-informed school.”

Participant 5 described the interconnection between ACEs and trauma: “Adverse childhood experiences are just a number of trauma or experiences that a child has experienced.” Other participants shared more specific knowledge of ACEs, starting with the definition of the ACE categories. Participant 1 shared: “I don’t remember all of them off the top of my head, but I remember a divorce of parents or changing caregivers . . . abuse of any kind.” Participant 3 went even further in defining ACEs:

Adverse childhood experiences, also known as ACEs, is looking at the hard stuff kids go through living within their homes in relation to how they’re cared for and . . . in the environment in which they live. . . . I think that it really starts to identify the potential dramatic events that kids may or may not have been through through the 10-question survey . . . and how throughout the body, the, when kids aren’t regulated, when they're having a lot of traumatic experiences that aren’t regulated and then how to help them regulate.

As reflected in the quote above, participants with a greater understanding of ACEs provided insights into how ACEs impacted their students. In sharing their understanding of ACEs, participants spoke of the lifelong effects, with Participant 10 stating: “[ACEs] can also have an impact on their physical health [and] . . . can lead to some pretty severe traumas that can have a lasting lifetime impact on our students.” Similarly, Participant 6 explained the impact of ACEs on students as “social awareness, the struggle with relationships, the difficulty to build trust and the unhealthy coping strategies and unhealthy relationship patterns.”

Influence of Training on Understanding

Within the interviews, participants described varying levels of training related to ACEs. First, seven of the 10 participants stated that their graduate programs did not introduce them to ACEs or only did so briefly. Most learned about ACEs through professional development opportunities and other job-related exposures.

Through the interviews, the participants described how their training impacted their understanding of ACEs. Participant 1 shared:

I think the first time that I was really introduced to the idea of it was when in my first year of counseling, I had a behavior specialist that I was working with who did training, and then I became really drawn to those students.

Participant 6, who has trained through a school professional development opportunity, said,

The train-the-trainer was a really strong, powerful one for me, because it helped me figure out how I wanted to communicate [ACEs] to teachers, and then taking back to see what worked, and developing that into a series has been really incredible.

Mentorship also influenced how participants approached ACEs. Related to Participant 1’s description of being influenced by her behavioral specialist, Participant 8 shared:

I was mentored by some really smart trauma-informed people, so I feel drawn to those kiddos. It was that worldview and framework that was given to me, and then I was given a lot of support to practice that and to really think about kids in a different way to show up and meet their mental health and emotional and social needs first and create safety and sense of trust.

Another participant reiterated that she

became very involved with working with families impacted by incarceration . . . and that’s where I really got in-depth knowledge about ACE factors and specific traumas, and the impact that has on a child’s mental well-being, their health . . . and how I could use that to help students at school.

Finally, Participant 3 learned about ACEs through a therapy model and discussed how “it’s important that there is a heavier therapeutic focus [as a school counselor] because that’s where you really learn those deeper needs.”

Views of Students Due to Knowledge of ACEs

Multiple participants discussed how the knowledge of ACEs has impacted their own understanding of students. Participant 3 stated: “It has made me be able to recognize why kiddos may be struggling at school. There’s probably a lot more going on in their lives than just not wanting to learn.” Similarly, Participant 9 described: “The students that were having difficulties focusing . . . and then you start to kind of talking and interviewing and getting to know these kids and you realize there’s a lot more going on in their family life or how they’ve been raised.” Participant 7 elaborated:

You may have a child who totally shuts down when a teacher raises their voice. It may make them scared, may remind them of a bad situation. And so then we totally shut down. You may have another child who, when they hear the teacher raise their voice . . . will raise their voice back and see it as a normal, typical way of communicating. So, you can try to look at this child and their factors, and how it might motivate some of their behaviors, and if they are not responding positively to us, you can forget about all the academic stuff because it's not gonna happen.

Many participants discussed how knowledge of ACEs impacted the way they looked at student behaviors. Participant 7 continued:

Even though the student may be [an ACEs score of] six, the skills that they have learned are skills that they’ve learned to help them survive in the environment in which they’re in. And that environment can be very different than the school environment, but they haven’t learned the skills to cope in the school environment.

Participant 8 reiterated:

I think for me, oftentimes, the kids that have those behaviors, or who aren't able to concentrate or have the executive functioning to do to have those good outcomes in a school are often because they have ACEs in their background.

Participants recognized that not all students with ACEs had difficulties in school. Participant 7 stated:

I think the resiliency of students who have ACES, and just the fact that they are here, and they’re still not going kind of down that path of negativity. What surprises me is the fact that a lot of our kids that have a ton of ACES are super resilient.

Participant 5 explained: “Even if you have an ACE, you don’t have to turn out a certain way. I just think that as counselors or as adults . . . we can kind of be that support system in helping them.”

School Counselor as an Instrument

Participants shared how their understanding of students’ experiencing ACEs or trauma influenced the lens they use as school counselors. This led to a broad theme of school counselor as an instrument, with four subthemes: collaboration, direct interventions, barriers, and self-care.

Collaboration

Through their knowledge of ACEs, the participants discussed the importance of collaboration with teachers, families, and staff. The school counselors described how they were able to share their professional lens of ACEs with individuals in their schools. Participant 5 stated: “We’re teaching the teachers. And then the teachers can use that in the classroom.” Participant 6 related:

In the training I provide . . . it’s just sort of understanding, recognizing things that our students may be coming in with, and how we can set up the environment? How we can approach our interaction? How we can recognize emotional regulation and build this into our curriculum, work with other professionals? And then we build up to understanding ACEs and trauma and secondary trauma and how their trauma that they bring in can interfere, or interact with their relationships that they have with students and how to manage all of these things.

Participant 4 tried “a book club with, with families. It wasn’t so successful, but the idea was we tried to help families. It was a book on resiliency to try to better be able to interact with your kids.” This participant also gave a book to teachers, “especially if we’ve got that teacher who’s like, ‘I’m not gonna treat him like he’s 3 if he’s in fourth grade.’ And I’m like, ‘Well, you know, if he didn’t know how to read, you’re gonna go to a different strategy . . . so let’s put the same thinking into behavior.’” This participant also explained that the school’s counselors

have tried to share that [ACEs information] with our school and our teachers. Spreading the word and spreading the seed with other adults so that in turn, they can, like, maybe they react differently to students who have ACES, or at least be a lot more empathetic with other students.

Participant 2 discussed the need for

within the classroom setting, [teachers] understanding that not all kids walk in those doors with the same level of readiness. I mean, they may be academically able without those things in their lives, but I think sometimes it’s difficult . . . for instructors to understand.

This collaboration leads directly to the interventions that schools and school counselors provide.

Direct Interventions

Participants discussed how they address ACEs or trauma through their service delivery. Their responses ranged from their direct work with students to more systemic classroom and school-wide programs and interventions. First, participants shared how they address ACEs and trauma through empowering students. Participant 1 explained:

I try to get skills to my students, so that they can learn how to deal with things themselves. . . . I try to get students into the habit of finding ways to work through their own grief and trauma or understanding other people that they can go to. I really try to foster in them that they have avenues to help them, even if they don't really know it yet.

Participant 2 agreed:

I feel like my role within that is to advocate for kids . . . because there’s so much that they can’t control, but there is a lot that they can, and to empower them talk to the adults in the building.

Participant 8 shared that in her building, “all kids feel empowered . . . and some of that did revolve on some trauma-sensitive awareness.” As Participant 3 said, “They have a lot more power over themselves, so we talk about circle of control, what’s in their control, what’s outside of their control, and how to manage their own emotional space.”

Participants also discussed the creativity that goes with working with students with ACEs. For instance, Participant 7 mentioned: “We have a kid and his dad is a hardcore criminal felon [and] probably will not be out of jail in this kiddo’s life, and he really responded to writing his feelings down as a song.” Similarly, Participant 1 shared how she is a

big fan of trying to do visual things. . . . A lot of my students have not had very much success in school and they don't retain things very well. It seems to help them if they see something. The ones that are very skilled in writing, I try to encourage them to keep it in a journal so that they can get their thoughts out that way. . . . If somebody, if there’s a movie with a quote, write that down—anything that lets you get your feelings on paper. . . . I also try to encourage my artistic students to draw or paint or create things.

Beyond direct work with students, participants described interventions that align with the ASCA National Model and comprehensive school counseling programs. Participant 3 stated: “I do a lot of small groups, and a lot of my small groups and individual counseling is focused on self-care, because they can’t control the environment that they’re in, but they can control themselves.” Participant 4 shared that ACEs “provides the counselors a roadmap” for “interventions that we’re gonna provide, whether it be individual or small group. . . . Kids who have probably some sort of ACEs score, then we’re going to level Tier 2 or Tier 3 interventions.” Participant 7 noted:

I am in every classroom every Wednesday . . . so during those days, I get to go in and teach social/emotional skills to each of the students. So that has been incredibly beneficial with helping address some behaviors proactively.

Finally, participants spoke of specific programs available within their schools and districts. Participant 2 shared:

I think alone a lot of those kids who would probably normally drop out, they end up going through our alternative program and alternative program is not behavior based. . . . And that’s been probably the only reason why we have such a high graduation rate in our district, because a lot of those kiddos who had adverse childhood experiences, who maybe are still experiencing those adversities, they’re able to work full time and get their diploma all at the same time.

Participant 6 discussed the Signs of Suicide program (Mindwise, n.d.) and how

we also share a little bit about an ACEs survey with our students. . . . It’s voluntary and we share with the parents that we would be asking them these questions. And then the students know, they have opportunities for follow-ups.

She elaborated that they “also have interventions like the . . . [author removed for anonymity] and additional supports for resiliency building and focusing on their strengths,” and noted: “I’m gonna have to target them with additional programming, small groups.” This participant also mentioned a class for at-risk students that teaches mental health and other strategies for students’ well-being.

Barriers

In addition to the successes, participants described barriers to intervening with students with ACEs or who have experienced trauma, citing concerns with time, staff, and systems. First, five of the 10 participants shared not having enough time in the day to intervene effectively with students with ACEs. Participant 1 shared: “I’m so busy, because I have so many students with so many different things going on and so many extra tasks at hand that are not typically school-counselor-related things.” Relatedly, Participant 2 stated:

We don’t have good enough staffing to support [interventions] because [of] administrative responsibilities, but we take our students who are the most at risk on our list and we do a female group when we do a male group for freshmen.

In the same vein, Participant 9 said, “They just keep on adding on tasks that are non-counseling related until 90% or more of our job is non-counseling related . . . we’re test managers . . . we’re [the] schedulers.” One participant, who serves in a district-level director role, shared that his counselors “don’t have time for [ACEs interventions] because [they’re] already overwhelmed with all these other things. . . . They want to stick to the scheduling, to the testing, to that kind of stuff, because you [keep adding] more to their plate.”

Three participants brought up the lack of formal systems and expressed concern over what formalized ACEs interventions would look like in a school or how accurate the screening information might be. Participant 8 elaborated how, through her Signs of Suicide screening,

we do have a column for ACEs, and of course, it’s under-counted because we don’t know all the ACEs. . . . There’s a lot we do know, just from what kids have shared with us. So we actually, and this is like a confidential spreadsheet that only the counselors look at you know, and so that’s one way that ACEs has informed our work in terms of identifying and trying to support students who likely really need it.

Participant 9 created a tracking system:

We’re trying to keep a note of when I see those kids. . . . I have a lot [of] anecdotal notes that I keep to try to track, but I don’t think that system is necessarily the appropriate system or the best.

Participant 2 reiterated:

In terms of any type of screening for ACEs or anything like that, we don’t do anything, mostly because when we looked at the research [it] had said that it’s really not even that appropriate to do an ACEs inventory.

Self-Care

Through the discussion of ACEs, participants mentioned the importance of self-care for school counselors to enable them to work with students who have experienced ACEs. Participant 8 said, “You don’t have to be perfect. You just have to show up and be consistent and predictable. That’s what these kids need: consistency and predictability, but not perfection.” Participant 1 even suggested that therapy for counselors should be mandatory:

I feel like every mental health professional should have their own therapy first. I think it’s a good bar to set because I think everybody needs to understand their own experiences and how that has affected themselves, before they can truly do work with other people and understand how their experiences have affected them.

Participant 10 discussed why self-care is important:

It’s difficult to see these young people having to go through these things. I think for me, having to make sure that I’m practicing self-care, too, so then I can at least be who I need to be for them and have the appropriate responses to them . . . I have to make sure that it’s about them and not about me. So, then I have to make sure that I’m working through. I guess making sure that I’m a neutral source of support for them.

Discussion

The purpose of this study was to examine how school counselors are approaching their work with children who have been affected by ACEs. Using Advocating Student-Within-Environment (ASE; Zyromski et al., 2022) as a theoretical lens is beneficial in providing a framework for contextualizing and understanding this work. The results identified themes of (a) continuum of understanding about ACEs, with two subthemes: varied understanding of ACEs and trauma, and influence of training on understanding; (b) views of students due to knowledge of ACEs; and (c) school counselor as an instrument, with four subthemes: collaboration, direct interventions, barriers, and self-care. The discussion below frames these results within the general research related to how those in the helping professions often conflate ACEs with trauma, the influence of professional identity and practices on school counselors’ understanding of trauma, the system work required by school counselors to understand and work against harmful ACEs, and the barriers school counselors often face when trying to do that work.

Conflating ACEs With Trauma

The school counselors interviewed in this study were familiar with trauma and its effects on students; however, they had varying levels of awareness about ACEs. Some of the participants conflated ACEs with trauma and used the terms interchangeably. This is not surprising because the research literature offers many definitions of ACEs and the term itself has been broadened to emphasize ACEs within both the family context and social context (Kalmakis & Chandler, 2014). Trauma-focused literature often uses terms interchangeably, such as ACEs, trauma, complex trauma, toxic stress, and maltreatment (Hays-Grudo & Morris, 2020; Petruccelli et al., 2019; Waite & Ryan, 2020). This can lead to confusion about understanding and treating ACEs (Ray et al., 2021). These results are consistent with recent research that has noted the inconsistent training school counselors receive during their graduate programs on trauma-informed practices overall (Wells, 2022).

Professional Identity and Practice

Although our participants had varying levels of understanding about ACEs, working with students who have experienced ACEs clearly impacted their work as school counselors and influenced how they work with school staff. Many of the school counselors interviewed described providing interventions for their students by empowering them in individual counseling sessions, conducting small groups, and teaching classroom lessons that targeted social/emotional skills development. Much like these focused interventions, Racine et al. (2020) suggested that interventions for children who have experienced ACEs should focus on emotional regulation skills. Further, the work of the participant school counselors aligns with the ASCA School Counselor Professional Standards and Competencies (2019a), which calls for school counselors to understand ACEs, explain them to others, and support students who have experienced them (B-SS, 3d.), by becoming “systems change agents” (B-PF, 9a.).

The majority of the participants interviewed described implementing interventions with small groups and individual students at the Tier 2 and Tier 3 levels of multitiered systems of support (MTSS). Only one school counselor described implementing Tier 1 interventions around ACEs. This suggests that school counselors may not necessarily know what interventions to provide at a school-wide level, that they are not considering systems work, or that they face barriers to these tiered interventions. Identifying interventions can be difficult for school counselors because little research addresses ACEs interventions with students. Struck et al. (2021) noted that a large number of studies describe the potential outcomes, comorbidities, and identification of ACEs, but only 10% of the studies within ACEs literature focus on treatment of ACEs, with most of these treatment studies being with adults. Zyromski et al. (2020) observed that, at the time of their study, only three publications among school-counseling-related journals used the term adverse childhood experiences in their title or abstract.

System Work

School counselors are called to be systems change agents (ASCA, 2019b), which means advocating, supporting, and intervening on behalf of students at all levels of the school system. While some of the participants reported that they were providing interventions for students experiencing ACEs, some did not conceptualize ACEs as systemic work that addresses student trauma. ASCA (2022) suggests that not only should school counselors work to understand and address ACEs, but they should also develop trauma-informed practices and frameworks that promote positive school climates and community engagement. Many participants described engaging in collaboration and training with school staff and attempting to build frameworks to address ACEs. These frameworks could include implementing trauma-informed classroom systems, developing restorative practices, addressing school policies and procedures, training staff, and utilizing mental health practitioners in schools (Oehlberg, 2008; Thomas et al., 2019; Zyromski et al., 2022), all of which can be delivered through MTSS.

Barriers

The participants reported barriers related to time, staff, and systems in providing tiered services for students who are affected by ACEs. These includeed (a) not enough time in the day, (b) poor staffing support, (c) non-counseling related duties, and (d) lack of formal systems for tracking students affected by ACEs. These barriers are consistent with much of the literature that suggests school counselors are still being required to perform non-counseling-related duties, which may indicate confusion over the role of the school counselor (Chandler et al., 2018; Fye et al., 2018; Shi & Brown, 2020). Johnson and Brookover (2021) shared similar findings of school counselors encountering negative biases and lack of support from other faculty and staff. Perhaps most important, Fye et al. (2018) wrote: “National educational trends, statewide high-stakes testing, high student-to-school counselor ratios, and engagement in non-counseling duties have negatively impacted school counselors’ ability to implement comprehensive school counseling programs (Dixon Rayle & Adams, 2007)” (p. 2).

In summary, our findings help to clarify how school counselors are understanding and working with students who are affected by ACEs. Although our participants had varying levels of understanding and practice, they highlighted the important work that school counselors are doing to support students with ACEs.

Implications

This study contributes to our understanding of school counselors’ knowledge of ACEs and professional experiences in the educational setting with ACEs, specifically how their understanding impacts their school counseling practices. Our study results offer implications for school counselors and school counselor educators.

Implications for School Counselors

Zyromski et al. (2020) noted the need for consistent language across research and practice around ACEs so that practitioners can better understand and address them in schools. Our findings highlight that school counselors’ understanding of ACEs is sometimes conflated with trauma. It is important for school counselors to understand that children who have been exposed to ACEs do not always experience trauma; however, trauma is a possible outcome of ACEs (Ray et al., 2021). Children respond to ACEs in various ways, and some recover more quickly than others (Alisic et al., 2014; Zyromski et al., 2020).

School counselors can incorporate this strengths-based understanding into their comprehensive school counseling programs through intentional focus across tiers of support. For example, because school counselors in this study consistently discussed barriers to working with students who experienced ACEs, including a lack of time to address the needs of all students and families, Tier 1 prevention and intervention could be the priority. At the systemic level, school counselors can be leaders in staff development around ACEs, trauma, and the associated impact with school staff, all while advocating for trauma-informed policies (e.g., staff wellness, whole-school SEL, discipline policies; Rumsey & Milsom, 2019). School counselors can advocate for evidence-based, trauma-informed programs across tiers, including evidence-based SEL programs at Tier 1 and targeted interventions to address ACEs (e.g., CBITS) at Tiers 2 and 3 (Alvarez et al., 2022). Expanding upon the suggestions by Johnson and Brookover (2021) and Johnson et al. (2023) to address policy change and advocacy at the school, community, and national levels to address root causes of social determinants of health, a subcategory of ACEs, would be helpful for school counselors focused on attacking ACEs in general.

As participants also described, barriers of time and resources consistently challenge school counselors’ work supporting the mental health needs of students (Chandler et al., 2018; Dixon Rayle & Adams, 2007; Fye et al., 2018; Shi & Brown, 2020). Lobbying for lower student-to-school-counselor ratios is imperative, as is emphasis on school counselors’ training to address the mental health needs of students so that more time is allotted for school counselors to work with the students’ mental health needs.

Implications for Counselor Educators

Consistent with previous research focused on trauma-informed practices (Wells, 2022), school counselors in this study indicated a need for additional training around ACEs throughout their graduate education. Thus, counselor educators can teach consistent language around ACEs and trauma that underscores the overlap and differences between these two terms. Counselor educators might incorporate specific coursework on ACEs to help future school counselors recognize the difference between ACEs and trauma and the impact of ACEs on brain and nervous system development, and introduce potential interventions and how they align with comprehensive school counseling programs. This can be integrated into classes on counseling children and adolescents, school counseling internships, or special topics in school counseling.

Counselor educators can also collaborate with school divisions on ACEs research and implications to inform school division practices. Following models on school division and counselor education partnerships (Goodman-Scott et al., 2022), counselor educators can create partnerships or training opportunities for school divisions on ACEs and trauma and assist with resources to track or analyze the data on interventions.

Limitations and Recommendations

This study is not without limitations. First, although we recruited from a national sample, our results are not representative of every school counselor’s experiences with ACEs. We did not account for differences in caseloads and school levels, which may influence experiences working with children with ACEs. Similarly, we screened for school counselors’ knowledge of ACEs as part of inclusion in the study, which may have unknowingly affected results. The interviews took place via Webex, so the researcher was not able to gather observational data of the participant’s office, school, or their mannerisms and expressions while answering questions. However, similar studies have successfully used web-based interviews (e.g., Milsom & Moran, 2015). All of our participants but one were White and identified as the gender matching their sex; the majority were also women. A more diverse sample would allow for broader ethnicity, gender, and partnership perspectives. All members of the research team identified as White.

Further research on ACEs should include more specific data on school counseling interventions while tracking ACEs at the school level, district interviews on selection of programming and professional development, and representation from counselor educators in how they approach educating their students on ACEs. Future research might also focus on how theoretical approaches, like ASE (Zyromski et al., 2022), may contribute to school counselor practice around systems-level and student-level asset building related to ACEs. Finally, examining how programs and professional development impact student outcomes would be important next steps in uncovering the impact of school counselor knowledge on students.

Conclusion

This study was conducted to establish baseline knowledge of school counselors’ knowledge, professional experiences, and practices related to ACEs in order to consider how to increase school counselors’ effectiveness in supporting students suffering from negative outcomes as a result of ACEs. We discussed recommendations for school counselors and counselor educators and directions for future research.