Benevolent Childhood Experiences (BCEs) scale

The BCEs scale also measures two primary dimensions of positive childhood experiences:

1. Common Protective Factors – assesses the presence of frequently reported protective childhood experiences, capturing internal and relational safety and security (e.g., having at least one safe caregiver, a good friend, a supportive teacher) and a positive, predictable quality of life.
2. Discriminating Protective Factors – evaluates the presence of experiences such as beliefs that provide comfort, positive self-image, fair treatment, and regular access to restorative factors (like good sleep and time outdoors).

Example BCEs Items

For clinicians, the BCEs scale offers several distinct advantages, particularly in settings where understanding resilience factors is crucial for intervention planning. The measure is especially valuable for working with individuals who have experienced adversity, as it identifies existing strengths that can be leveraged in treatment. The BCEs scale can function as a strength-focused counterpart to adversity measures such as the Adverse Childhood Experiences (ACEs) scale, enabling a more balanced assessment of developmental influences.

The BCE offers clinicians a versatile tool for formulation, treatment planning, and therapy, particularly in trauma-focused settings. As a formulation tool, it can function as a strengths-based counterpart to adversity measures such as the Adverse Childhood Experiences (ACEs) scale, enabling a more balanced assessment of developmental influences. It can help clinicians identify protective factors in a client’s early life that may have buffered against adversity, while the absence of BCEs can highlight unmet needs that may have contributed to the formation of maladaptive beliefs or schemas.

In treatment planning, clients with few or no BCEs may benefit from a greater initial focus on establishing safety and trust in the therapeutic relationship before engaging in deeper trauma work. During therapy, understanding and exploring BCEs can foster hope and facilitates a strengths-based approach to meaning making and identity development. Additionally, BCEs can serve as existing strengths or resilience factors, which can be developed as internal resources for navigating trauma work in modalities such as EMDR and other trauma-focused therapies. 

When using the BCEs scale in clinical practice, consider the following:

1. Integration with adversity measures: The BCEs scale is designed to complement, not replace, assessment of childhood adversity. Optimal clinical practice involves assessing both positive and adverse childhood experiences. For example, using the BCEs in conjunction with the ACEs scale can provide a comprehensive overview of the child’s positive and adverse experiences. Indeed individuals can often have both high ACEs and BCEs, but higher scores on BCEs predict more favourable outcomes (Han et al., 2023).
2. Interpretation context: BCEs scores should be interpreted in the context of the individual’s full clinical presentation, including current symptoms, life circumstances, and reported adversity.
3. Promotive versus protective effects: Research suggests that BCEs may have both direct promotive effects on wellbeing and protective (interactive) effects that buffer against adversity (Han et al., 2023). Clinical interpretation should consider both mechanisms.

The BCEs uses a dichotomous (Yes/No) response format, with “Yes” responses summed to create total scores. The BCEs results in three scores:

1. Total Score: Sum of “Yes” responses to all 20 items. Scores range from 0-20. The total score represents the sum of all positive childhood experiences endorsed across multiple ecological domains, providing a comprehensive measure of protective factors that research links to enhanced resilience and better mental health outcomes even in the presence of childhood adversity.
2. Common Protective Factors: Sum of “Yes” responses to items 1-10. Scores range from 0-10. The common protective factors subscale assesses more frequently reported protective childhood experiences, capturing internal and relational safety and security (e.g., having at least one safe caregiver, a good friend, a supportive teacher) and a positive, predictable quality of life. 
3. Discriminating Protective Factors: Sum of “Yes” responses to items 3, 4, 6, 7, 9, 10, 11, 13, 16, and 19. Scores range from 0-10. The discriminating protective factors subscale assesses experiences such as beliefs that provide comfort, positive self-image, fair treatment, and regular access to restorative factors (like good sleep and time outdoors), which may provide clinicians with insights into deeper, more nuanced aspects of a client’s developmental resources. Note that 6 of the items for the discriminating protective factors are also used in the common protective factors subscale, so there is some cross-over between the two.

For each of these three dimensions, raw scores are converted to percentiles based on normative data derived from research with diverse populations. The percentiles provide a comparative framework for interpretation by indicating how an individual’s score compares to the reference population. A percentile of 50 indicates typical childhood experiences. 

Qualitative descriptors are assigned to BCEs scores according to the following percentile thresholds:

• Very Low: 5th percentile and below
• Low: 6th-15th percentile
• Below Average: 16th-35th percentile
• Average: 36th-60th percentile
• Above Average: 61st-75th percentile
• High: 76th percentile and above

These descriptors offer clinically meaningful categorisations that facilitate interpretation and communication of results. When interpreting BCE scores, consider the following clinical guidance:

1. Total Score: Provides a global index of protective childhood experiences. Lower scores indicate fewer positive experiences and potentially greater vulnerability to adverse outcomes, while higher scores suggest stronger protective resources.
2. Subscale Comparison: Comparing common protective factors and discriminating protective factors can offer insights into the pattern of protective experiences.
   1. Consistent profile (similar levels on both subscales): Indicates uniformity in access to both common and discriminating protective factors.
   2. Discrepant profile with higher common than discriminating factors: Suggests access to commonly reported protective experiences but fewer less common protective experiences.
   3. Discrepant profile with higher discriminating than common factors: Represents an unusual pattern that may indicate unique protective resources despite lacking common ones.
3. Individual Item Analysis: For clients with low scores (Very Low to Below Average), examining which specific protective experiences were absent can inform targeted intervention planning.

Research indicates that each additional positive childhood experience is associated with incremental benefits to mental health and wellbeing.

Upon first administration a plot is displayed showing the BCEs total score (made up of the common and discriminant protective factors and the six additional items that aren’t in either factor) and subscale percentiles. Qualitative descriptors are presented in the background of this plot for ease of translation. If administered on multiple occasions, an additional plot is presented showing the total score and subscale percentiles over time.

The BCEs scale contains 20 items but incorporates two different versions of the BCEs within those. Firstly, the BCEs-Original (common protective factors) which was developed by Narayan et al. (2018) and the BCEs-Revised (discriminating protective factors; Narayan et al., 2023) which was specifically developed to address ceiling effects in the original scale by focusing on less commonly reported positive experiences (those endorsed at rates below 80% across diverse samples). There are six remaining items that do not form part of either subscale but contribute to the total score on the BCEs. 

Construct validity of the BCEs scale is supported by its ability to correlate with measures of wellbeing. The scale demonstrates expected inverse relationships with measures of depression, stress, and loneliness (Doom et al., 2021). Narayan et al. (2018) found that higher levels of BCEs predicted lower levels of PTSD symptoms and fewer stressful life events in pregnant women after accounting for women’s ACEs, and began to offset the effects of ACEs on negative outcomes even when ACEs were high.

Convergent validity has been established through correlations with other measures of resilience and positive experiences. The BCEs scale shows moderate to strong correlations with measures such as the Connor-Davidson Resilience Scale (r = .51) and the Protective Factors Survey (r = .63). Discriminant validity is supported by negative correlations with ACEs (Merrick et al., 2019), although these are only moderate in nature (r = -.33) indicating that they are not simply opposite ends of the same construct and that some individuals may experience high levels of both.

Cross-cultural validity is a notable strength of the BCEs scale. The initial psychometric study revealed that mean differences in total scores did not significantly differ between individuals who identified as White versus Black versus Latino/a, between individuals who were English-speaking or monolingual Spanish-speaking, nor between individuals who were born in the U.S. versus foreign born (Narayan et al., 2018).

Predictive validity has been demonstrated in multiple studies showing that BCEs scores predict mental health outcomes over time (Han et al., 2023; Narayan et al., 2018). For example, Doom et al. (2021) found that higher BCEs scores predicted lower levels of depression and anxiety symptoms during the COVID-19 pandemic, even after controlling for baseline mental health and demographic factors.

Normative data and percentiles for the BCEs total score were derived from item endorsement frequencies reported in research by Narayan et al. (2023), using data from two large samples of U.S. young adults (pre-pandemic sample, N=548, and pandemic sample, N=1,198). NovoPsych combined these using a weighted approach to create a statistically-derived normative reference population for the BCEs-20 total score. For the BCE-20, the estimated mean is 15.5 (SD = 5.38), for the common protective factors (BCE-Original) the mean is 7.72 (SD = 2.14; Narayan et al., 2023) and for the discriminating protective factors (BCE-Revised) the mean is 6.98 (SD = 2.70; Narayan et al., 2023). Raw scores are then converted to percentiles using a standard normal distribution transformation based on these estimated parameters. These percentiles are used to create qualitative descriptors as follows:

• Very Low: 5th percentile and below
• Low: 6th-15th percentile
• Below Average: 16th-35th percentile
• Average: 36th-60th percentile
• Above Average: 61st-75th percentile
• High: 76th percentile and above

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