{"id":1451,"date":"2020-04-10T10:49:24","date_gmt":"2020-04-10T15:49:24","guid":{"rendered":"https:\/\/www.zvhc.org\/?page_id=1451"},"modified":"2020-04-10T10:50:58","modified_gmt":"2020-04-10T15:50:58","slug":"adverse-childhood-experience","status":"publish","type":"page","link":"https:\/\/www.zvhc.org\/adverse-childhood-experience\/","title":{"rendered":"Adverse Childhood Experience"},"content":{"rendered":"\n\t<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_safari gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_19' ><div id='gf_19' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_19' id='gform_19'  action='\/wp-json\/wp\/v2\/pages\/1451#gf_19' data-formid='19' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_19' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_19_2\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_19_2\" ><h2 class=\"gsection_title\">Finding your ACE Score<\/h2><\/li><li id=\"field_19_13\" class=\"gfield gfield--type-name hipaa_forms_name gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_19_13\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_19_13'>\n                            \n                            <span id='input_19_13_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_13.3' id='input_19_13_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_19_13_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_19_13_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_13.6' id='input_19_13_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_19_13_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_19_15\" class=\"gfield gfield--type-date gfield--input-type-datedropdown gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_19_15\" ><label class='gfield_label gform-field-label' >Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div id='input_19_15' class='ginput_container ginput_complex gform-grid-row'><div class=\"clear-multi\"><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_19_15_1_container'><select name='input_15[]' id='input_19_15_1'   aria-required='true'  ><option value=''>Month<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_19_15_2_container'><select name='input_15[]' id='input_19_15_2'   aria-required='true'  ><option value=''>Day<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><option value='13' >13<\/option><option value='14' >14<\/option><option value='15' >15<\/option><option value='16' >16<\/option><option value='17' >17<\/option><option value='18' >18<\/option><option value='19' >19<\/option><option value='20' >20<\/option><option value='21' >21<\/option><option value='22' >22<\/option><option value='23' >23<\/option><option value='24' >24<\/option><option value='25' >25<\/option><option value='26' >26<\/option><option value='27' >27<\/option><option value='28' >28<\/option><option value='29' >29<\/option><option value='30' >30<\/option><option value='31' >31<\/option><\/select><\/div><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_19_15_3_container'><select name='input_15[]' id='input_19_15_3'   aria-required='true'  ><option value=''>Year<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><\/div><\/div><\/li><li id=\"field_19_14\" class=\"gfield gfield--type-email hipaa_forms_email field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_19_14\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label gfield_label_before_complex' >Email<\/label><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_19_14_container'>\n                                <span id='input_19_14_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_14' id='input_19_14' value=''     aria-invalid=\"false\"  \/>\n                                    <label for='input_19_14' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                <\/span>\n                                <span id='input_19_14_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_14_2' id='input_19_14_2' value=''     aria-invalid=\"false\"  \/>\n                                    <label for='input_19_14_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/li><li id=\"field_19_5\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_19_5\" ><label class='gfield_label gform-field-label' >1. Did a parent or other adult in the household often \u2026  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?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_19_5'>\n\t\t\t<li class='gchoice gchoice_19_5_0'>\n\t\t\t\t<input name='input_5' type='radio' value='1'  id='choice_19_5_0'    \/>\n\t\t\t\t<label for='choice_19_5_0' id='label_19_5_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_19_5_1'>\n\t\t\t\t<input name='input_5' type='radio' value='0'  id='choice_19_5_1'    \/>\n\t\t\t\t<label for='choice_19_5_1' id='label_19_5_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_19_6\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_19_6\" ><label class='gfield_label gform-field-label' >2. Did a parent or other adult in the household often \u2026  Push, grab, slap, or throw something at you?  or Ever hit you so hard that you had marks or were injured?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_19_6'>\n\t\t\t<li class='gchoice gchoice_19_6_0'>\n\t\t\t\t<input name='input_6' type='radio' value='1'  id='choice_19_6_0'    \/>\n\t\t\t\t<label for='choice_19_6_0' id='label_19_6_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_19_6_1'>\n\t\t\t\t<input name='input_6' type='radio' value='0'  id='choice_19_6_1'    \/>\n\t\t\t\t<label for='choice_19_6_1' id='label_19_6_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_19_7\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_19_7\" ><label class='gfield_label gform-field-label' >3. Did an adult or person at least 5 years older than you ever\u2026  Touch or fondle you or have you touch their body in a sexual way?  or  Try to or actually have oral, anal, or vaginal sex with you?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_19_7'>\n\t\t\t<li class='gchoice gchoice_19_7_0'>\n\t\t\t\t<input name='input_7' type='radio' value='1'  id='choice_19_7_0'    \/>\n\t\t\t\t<label for='choice_19_7_0' id='label_19_7_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_19_7_1'>\n\t\t\t\t<input name='input_7' type='radio' value='0'  id='choice_19_7_1'    \/>\n\t\t\t\t<label for='choice_19_7_1' id='label_19_7_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_19_8\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_19_8\" ><label class='gfield_label gform-field-label' >4. Did you often feel that \u2026  No one in your family loved you or thought you were important or special?  or  Your family didn\u2019t look out for each other, feel close to each other, or support each other?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_19_8'>\n\t\t\t<li class='gchoice gchoice_19_8_0'>\n\t\t\t\t<input name='input_8' type='radio' value='1'  id='choice_19_8_0'    \/>\n\t\t\t\t<label for='choice_19_8_0' id='label_19_8_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_19_8_1'>\n\t\t\t\t<input name='input_8' type='radio' value='0'  id='choice_19_8_1'    \/>\n\t\t\t\t<label for='choice_19_8_1' id='label_19_8_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_19_9\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_19_9\" ><label class='gfield_label gform-field-label' >5.  Did you often feel that \u2026  You didn\u2019t 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?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_19_9'>\n\t\t\t<li class='gchoice gchoice_19_9_0'>\n\t\t\t\t<input name='input_9' type='radio' value='1'  id='choice_19_9_0'    \/>\n\t\t\t\t<label for='choice_19_9_0' id='label_19_9_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_19_9_1'>\n\t\t\t\t<input name='input_9' type='radio' value='0'  id='choice_19_9_1'    \/>\n\t\t\t\t<label for='choice_19_9_1' id='label_19_9_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_19_25\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_19_25\" ><label class='gfield_label gform-field-label' >6.  Were your parents ever separated or divorced?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_19_25'>\n\t\t\t<li class='gchoice gchoice_19_25_0'>\n\t\t\t\t<input name='input_25' type='radio' value='1'  id='choice_19_25_0'    \/>\n\t\t\t\t<label for='choice_19_25_0' id='label_19_25_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_19_25_1'>\n\t\t\t\t<input name='input_25' type='radio' value='0'  id='choice_19_25_1'    \/>\n\t\t\t\t<label for='choice_19_25_1' id='label_19_25_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_19_26\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_19_26\" ><label class='gfield_label gform-field-label' >7.  Was your mother or stepmother often pushed, grabbed, slapped, or had something thrown at her? Sometimes or often kicked, bitten, hit with a fist, or hit with something hard? Ever repeatedly hit over at least a few minutes or threatened with a gun or knife?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_19_26'>\n\t\t\t<li class='gchoice gchoice_19_26_0'>\n\t\t\t\t<input name='input_26' type='radio' value='1'  id='choice_19_26_0'    \/>\n\t\t\t\t<label for='choice_19_26_0' id='label_19_26_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_19_26_1'>\n\t\t\t\t<input name='input_26' type='radio' value='0'  id='choice_19_26_1'    \/>\n\t\t\t\t<label for='choice_19_26_1' id='label_19_26_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_19_10\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_19_10\" ><label class='gfield_label gform-field-label' >8. Did you live with anyone who was a problem drinker or alcoholic or who used street drugs?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_19_10'>\n\t\t\t<li class='gchoice gchoice_19_10_0'>\n\t\t\t\t<input name='input_10' type='radio' value='1'  id='choice_19_10_0'    \/>\n\t\t\t\t<label for='choice_19_10_0' id='label_19_10_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_19_10_1'>\n\t\t\t\t<input name='input_10' type='radio' value='0'  id='choice_19_10_1'    \/>\n\t\t\t\t<label for='choice_19_10_1' id='label_19_10_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_19_11\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_19_11\" ><label class='gfield_label gform-field-label' >9. Was a household member depressed or mentally ill or did a household member attempt suicide?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_19_11'>\n\t\t\t<li class='gchoice gchoice_19_11_0'>\n\t\t\t\t<input name='input_11' type='radio' value='1'  id='choice_19_11_0'    \/>\n\t\t\t\t<label for='choice_19_11_0' id='label_19_11_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_19_11_1'>\n\t\t\t\t<input name='input_11' type='radio' value='0'  id='choice_19_11_1'    \/>\n\t\t\t\t<label for='choice_19_11_1' id='label_19_11_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_19_12\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_19_12\" ><label class='gfield_label gform-field-label' >10. 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