Resources to Help Prevent and Address Adverse Childhood Experiences

Adverse childhood experiences (ACEs) are potentially traumatic experiences that occur during childhood, from birth to age 17, and can include child abuse, neglect, and other traumatic incidents. ACEs are a serious public health concern and can have long-term implications for health and well-being. Data shows that ACEs are common, about 61 percent of adults surveyed across 25 states report experiencing at least one ACE, and around one in six adults report having experienced four or more types of ACEs.

But, ACEs can be prevented; strengthening economic supports to families, providing quality care and education early in life, and enhancing primary care and behavioral parent training programs are strategies that help prevent ACEs from occurring and mitigate current harm. Preventing ACEs can potentially reduce many health conditions, research shows that up to 1.9 million cases of heart disease and 21 million cases of depression can be avoided by preventing ACEs.

The first step to reducing negative health outcomes from ACEs and trauma is identification through screenings.

• The American Academy of Pediatrics (AAP) has compiled a comprehensive list of various screening tools for children and parents.
• The National Center for Mental Health and Juvenile Justice has guidance for screening for trauma in schools citing that universal screening is a proactive measure of identifying students who are at-risk for future difficulties.
• The Substance Abuse and Mental Health Services Administration (SAMHSA) developed a trauma informed guide to aid schools that may not have the resources to connect students to further services.
• California Department of Health Care Services’ ACEs Aware Screening Tool is also available in Spanish and other languages.

According to the Behavioral Risk Factor Surveillance System (BRFSS), since 2009, 48 states and Washington, DC have included at least one question on ACEs. The ability to measure ACEs data can help shape national and state strategy to ensure children’s well-being.

• Child Trends report, The Prevalence of Adverse Childhood Experiences, Nationally, by State, and by Race or Ethnicity, February 2019. The report states that the two most common ACEs are economic hardship and the divorce or separation of a guardian.
• Healthy North Carolina 2030 Report: A Path toward Health, January 2020. This report includes ACEs (health indicator #5) as part of the state’s comprehensive strategy to measure child well-being.

Referring children with ACEs and their families to appropriate resources or necessary interventions, including care coordination, educational materials, or community health workers, is a key step to promote healthy development.

• California Department of Health Care Services ACEs Aware Clinical Assessment and Treatment

These resources cite consistent messaging for providers to ensure children and families receive appropriate screening and follow-up care.

• Arizona Health Zone ACEs and Trauma-Informed Care Reference Guide
• Centers for Disease Control and Prevention (CDC) ACEs Resources
• CDC’s Preventing Child Abuse and Neglect: A Technical Package for Policy, Norm, and Programmatic Activities, 2016. Also available in Spanish
• Child Trends policy report: Childhood Adversity Screenings Are just One Part of an Effective Policy Response to Childhood Trauma, July 2019
• SAMHSA Guide to Understanding Child Trauma

People of color, low-income individuals, and women are at greater risk for experiencing ACEs and subsequent related health issues. Below are resources that highlight the importance of reducing disparities to improve children’s health outcomes.

• American Academy of Pediatrics (AAP) Bright Futures: Integrating Social Determinants of Health into Health Supervision Visits, April 2019
• AAP Policy Statement: Impact of Racism on Child and Adolescent Health, August 2019

COVID-19 and its associated social and economic stresses can negatively impact children’s development. Big life shifts, including virtual schooling and physical distancing from friends and loved ones, affect children and they may face familial challenges as well, like parents or grandparents experiencing unemployment, or exacerbated substance misuse, and other mental health problems. Several organizations have released resources highlighting strategies to identify and prevent exacerbating ACEs during COVID-19.

• California Surgeon General’s Playbook: Stress Relief for Caregivers and Kids during COVID-19, April 2020
• Child Trends policy report: Promoting Children’s Resilience to the COVID-19 Pandemic, April 2020
• Association of State and Territorial Health Officials report: Preventing Adverse Childhood Events during COVID-19, April 2020

• New Jersey released an Adverse Childhood Experiences Action Plan intended to prevent and reduce childhood trauma.

• The Office of the California Surgeon General released a Roadmap for Resilience: The California Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress, and Health. The report serves as a blueprint for how communities, states, and nations can recognize and effectively address Adverse Childhood Experiences (ACEs) and toxic stress as a root cause of harmful, persistent, and expensive societal and health challenges.