ACEs (Adverse Childhood Experiences) Basics

by Pat Shelly

What Is the Adverse Childhood Experiences [ACEs] Study and What Is Its Significance? 

The ACEs Study [published in 1998] is important because it found links between childhood trauma and long-term health, behavior and social consequences among adults.

How Were These Links Discovered?

Per the below infographic, the authors – from Permanente Medical Group (Kaiser Permanente), Centers for Disease Control and Prevention (CDC), Emory University and the University of Arizona – asked adult patients about any exposure they had as a child to the following:

  • Recurrent physical abuse
  • Recurrent emotional abuse
  • Contact sexual abuse
  • Alcohol and/or drug abuser in the household
  • An incarcerated household member
  • Someone in the household who is chronically depressed, mentally ill, institutionalized or suicidal
  • Mother is treated violently
  • Parents are separated or divorced
  • Emotional neglect
  • Physical neglect
The Truth About ACEs - Robt. Wood Johnson Foundation

The Truth About ACEs –                     Robert Wood Johnson Foundation

A comparison to the participant’s adult health status was made, and strong links were found between high ACE scores (on a scale of 1 to 4+, having more than 2 or more adverse experiences) and impaired health/mental health.

In addition to the negative impact adverse childhood experiences are likely to have on a person, this graphic also shows the prevalence of ACEs and the three primary types of ACES: abuse, neglect and household dysfunction.

The ACE study has provided social workers and other clinicians with an invaluable tool to assess the types of trauma an individual had as a child. It is a way to begin to discuss, “What happened?” with a person. ACEs help establish a history that de-pathologizes the person and enhances a trauma-informed practice.

Below is a pyramid chart created by the CDC that illustrates the gaps that still exist in our knowledge of the full impact of ACE , emphasizing the need for ongoing research.

ACE Pyramid - CDC

ACE Pyramid – CDC

Longitudinal studies of the ACE Study participants continue through Kaiser and the CDC.

Find out your ACE score here:

UB School of Social Work curricular module on ACEs

Illustration credits:

The Truth About ACEs Infographic – Robert Woods Johnson Foundation

ACE Pyramid: Centers for Disease Control and Prevention ACE Study site
                 Here you will find the pyramid, plus CDC ACE studies and updates.

Additional resources:

  • The ACE Study
    The original (1998) study, published in the American Journal of Preventive Medicine
  • ACES Too High
    Great site for background, news and information about the ACE study, including
    developmental neurobiology — how severe stress and trauma affect a child’s developing brain and nervous system, and epigenetics — how our genes turn off and on in response to our experiences and social environment.

How has the ACE Study affected your practice? Teaching? Please share with us your use of or views on ACE.

62 comments

  • My SSC420 Instructor sent me here. Thank you for sharing “The Truth About ACES” Graphic – as someone who is a visual learner, it breaks down the different elements very simply. It was also interesting to find out my own ACES score and see how it relates to potential future health problems.

    • I think it is very interesting to see the possible risk outcomes with ACEs. It makes you wonder if there is something else that could also be a factor in this. For example, children who grow up in poverty and ACEs. It would explain other social factors that may increase someones chance for the possible risk outcomes.

    • My SSC420 Instructor also sent me here. Looking at these possible ACES, i can relate to two of them. My parents are divorced along with my father being diagnosed with depression and a lot of my family on his side have dealt with depression, been passed down. I agree that the more you experience and live with as a child, the more that it can effect your health in the future. I wasn’t too young when this all happened so i knew how to deal with it and did not let it bring me down. Getting help from friends or family or even professionally can greatly help you in the future both emotionally and physically. This is a very interesting article and thank you for sharing it.

    • I was sent here by my Child Mental Health professor. We are currently learning about the ACES. I personally cant relate to any of these but I would love to work someday with people that have a higher score in this.

      • Kimberly Harrington

        I was sent to this site by my Child Mental Health Professor. I am unable to relate to any of the criteria to give myself an ACES score however I feel that it is important or people to realize the impact of having a score at all. This article was very interesting and i enjoyed reading it!

      • I would be interested to learn what populations you think you might work with that have with high ACE scores.
        Pat

  • Cherrelle Collins

    I am taking a Scientific Research methods Course and we were discussing how early childhood trauma could have implications on adult life. These factors listed above could also hinder people from development (Eriksonian Stages of Development).It’s enjoyable seeing how the things we spoke about in SSC relates to so many facets and positions when trying to understand human behavior. The pyramid was a great visual illustration of how the individual is impacted, from the time these adverse events occur until death. An interesting point to mention is the outliers who are not affected by childhood trauma, as they may have intepreted their traumatic event differentl., We’ve learned that a traumatic event is categorized by how the person peceives that event individually. All in all this was very informative.

  • Jessica Reszitnyk

    My SSC professor sent me to this site and it was kind of an eye opener for how much site can help others to learn about decreasing these problems and being able to help others who have been through some of these traumatic experience. Also was interesting seeing possible health problems I could face.

  • My SSC420 professor also sent me here. This was a good refresher as I’ve already learned about ACEs and the impact it has on childhood development. The visuals also helped a lot.

  • I found this blog post very informative. When reading the post for some reason Erikson’s stages came to mind. As mentioned in the post there are links between childhood trauma and long-term health, behavior, and social consequences among adults. Many believe that with the stages of erikson if one is disrupted emotional growth is affected. When a child is faced with trauma during a phase such as trust vs. mistrust (stage1) or initiative vs. guilt (stage 3-5) the child develops fear along there growth and inadequacy to survive on their own. When events such as trauma happen as the child grows they have difficulties in certain aspects in their life as an adult.

  • Thank you a for your comments – it is great to hear that it provided useful information. I too am a visual learner and like using graphic illustrations when possible. Erikson’s Stages can help inform us how trauma – introduced at any stage – could delay or stymie progress in control, autonomy, identity development, etc. Resiliency continues to be a fertile area for research – why and how some people can go through trauma with fewer long-lasting effects than others.
    I appreciate the feedback – do continue to follow this blog!
    Pat

  • I don’t think people really take the time to look at all the aspects and future impacts that ACE’s have on a person. It would also be interesting to look into seeing if socioeconomic status or living with a single or teen parent has any effect on ACE’s as well.

  • SSC 420: Refered to this site by my professor, I found it very interesting to learn about the ACEs that affect a child as they grow up. Although one learns that abuse and neglect can be damaging in the long run, seeing the results of how prevelant an ACE is or what it can do to a person’s mental health was very upsetting. There were more participants that had been exposed to an ACE than had not. I feel very lucky to be able to say I have not had any ACEs, but know now that is not the norm.

  • I was referred here from my professor for SSC420: I think its important to see realize that events that occur early on in a persons life can have a lasting impact on a person. The post showed many consequences of an ACE on a persons physical as well as mental and emotional help. Its important that people realize that these events can have a bigger impact than expected and should be recongnized at a young age. Making people aware of the negative impacts certain events can have will help to have a more proactive mindset.

  • This was a very interesting study. It makes sense that ACEs would lead to cognitive impairments, then risky behaviors, then health outcomes, and even earlier death. However, since this is just a correlational study and causation cannot be determined, I can’t help but wonder if there is a mediating factor. Similar to the above comment, it’s possible that people who are exposed to these ACEs may come from a family of lower socio-economic status (SES), which leads to low levels of education, which could lead to behaviors such as smoking or poor diet due to lack of knowledge, bringing along health outcomes and death. This is just an example, but SES could be a mediating factor in many ways. It would not be surprising that parents of low SES are more likely to abuse their children or have substance abuse issues. This is a great study that could definitely benefit from some longitudinal studies to eliminate the third variable problem.

  • Its amazing to see the impact that adverse childhood experiences have in a childs life. I am interning at a school of refugee’s and it makes me think about the transition that they have had to go through and how it will affect their development as children now. It’s also interesting to see the reflection my own ACE scores compared to the life I had growing up. This information is all very informative especially after learning about childhood traumatic events today in my SSC420 class.

  • This article was suggested to me by my SSC420 – Child Mental Health professor and I am so glad I checked it out. It is very interesting to read about ACE’s because my brother (11) and sister (9) have just gone through a terrible divorce because of alcoholism. Things like thing help me realize what they have gone through at such a small age, and it helps me better understand how they grieve with their pain, because it is different from the way my mom and I have dealt with the traumatic time in our lives. Thanks for sharing, it was a great read!

  • It is great to see that some students, like Abigail, Morgan and Loren, can make connections to their own lives: ACE can include difficult divorces and forced dislocation. Socio-economic status (SES), as pointed out by Jessica, can mean poverty and disadvantage; yet we know that affluence does not protect one from being abused by parents or having a family member living with a mental illness. It appears, from all your comments, that knowledge of childhood trauma provided a more nuanced understanding of health, disadvantage, and privilege.

  • I was referred to this blog by Dr. Denise Krause who instructs my SSC420 lecture. After Dr. Krause’s classes and reading the blog, it is shocking to see how much neglect and suffering children go through across all nations. Statistics are so high when referring to the rates of teen pregnancy, early drug and alcohol use and mental handicaps as well. Studies like this help to put into perspective what adversity truly is, and how there are so many young ones who are in such a desperate need for love, attention and a happy and safe place to grow and simply be children.

  • I took the ACEs test and got a score of 1. But I had a few questions on whether or not the other questions on the test pertained to me. Coming from an Asian American background my parents disciplined me when I was bad physically. And depending on how bad I was was how often they’d hit me. So do you take that into account? Also in my SSC 420 class my professor briefly went over when physical disciplining turn into physical abuse. And she said when you’re hit anywhere other then the buttocks with anything other then a hand. And I definitely remember my dad using belts, an Asian feather duster , and even throwing a small trashcan at me. I once told on him to my grandmother and he got chewed out for hitting me on the head. But in my opinion I don’t feel like I was abused… I was just disciplined.

  • I was also referred to this article by my SSC420 professor; I found this study to be very interesting. I have always thought, yes your childhood experiences and the traumatic events that you have experienced definitely impact you as a person but I didn’t think that it can possibly lead to cancer. I feel as though now that we are aware that these adversities can lead to lasting long term detrimental effects, we should make more of an effort to help those who has experienced traumatic events and start to help them at a younger age.

  • I think that thinking about ACEs reveals an important strategy for addressing widespread issues. Consider the analogy of a person’s life to a river. If you pollute the river closer to the source, that pollution will be carried through the whole length of the river. If you pollute closer to the mouth, that is still very bad, but relatively less bad in the sense that the pollution is more contained, and does not corrupt the entire river.

    It is not a perfect analogy, but I think it illustrates the point well enough. If we want to effectively address multiple complex issues, a powerful method is to focus energy and resources on the lynchpins, those factors of trauma that hold others together. The river analogy hopefully illustrates that ACEs are a lynchpin in that sense. Understanding and accounting ACEs and their causes can help us to develop powerful interventions that will have long lasting and self-multiplying effects.

    Of course, the as the river analogy also reminds us, the fact that effects of downstream pollution are not as far reaching does not mean it should be ignored. So too with adverse experiences that occur later than in childhood.

    • Steven: I find that your analogy also allows for the sense of fluidity in the capacity for change in humans; we are resilient as are rivers that revive should the polluting source be removed.

  • What I found most interesting about this post was the link between social, mental, and physical health. While it seems intuitive that Adverse Childhood Experiences can impact behavior, it is more surprising to see the effects on health outcomes such as cancer and stroke. It is distressing to understand the disadvantage that someone faces when they have exposure to abuse, neglect, or household dysfunction. This shows me how important it is for service providers to recognize these disadvantages and intervene early in a child’s life.

    The bright side here is that there are many facets of the problem that interventions can be aimed at. In my social work courses, we have discussed the idea that an intervention focused on one aspect of a pattern or cycle will in turn influence the rest of the pattern. The way this connects to ACEs is that there are many ways to improve outcomes for the children: interventions to improve the family situation, mental health interventions, physical health interventions. Either way, by working with the child in one area, it can improve all the other long-term outcomes.

    • An emphasis on early intervention would advance health, indeed! Let’s hope recent initiatives to increase funding for pre-K and other early childhood efforts are successful.

  • Stephanie Bauer

    Prior to reading this, I never heard of ACEs. I knew that there were negative physical and emotional effects that can impact children who go through trauma. What I did not realize was how significant these effects could be and how long they can impact a person. The physical, emotional, and psychological effects last well into adulthood and that can effect interventions that social workers may use. Often times, social workers may work with a client for a short amount of time, focus on one problem, and find a solution. There may not be a lot of time to discuss the client’s history. With a trauma-informed perspective, it also begs the question whether a social worker would want to discuss past childhood trauma with a client because it may re-traumatize them. However, if the social worker does not discuss the trauma, the problems the client is facing as an adult may never truly get solved. Because of this, social workers could have some possible ethical dilemmas in treating adult clients with past trauma. It seems that social workers should adapt a trauma-informed view when working with clients who have experienced trauma as a child and decide with each individual case whether it makes sense to discuss the trauma with the client instead of doing the same thing with every client.

  • As the blog states, the ACEs Study not only links mental health impairment with adverse experiences, but reinforces trauma-informed practice within professionals. It also demonstrates the significance of the idea that childhood experiences shape adulthood and the quality of life. I think the study can be helpful when initially assessing a client system but I am concerned with the “scientific gaps” within the ACE Pyramid. The gaps may be essential to validity of the study. Influential outside factors that may be impacting the study include children who were raised in low socio-economic-status families. Abuse, neglect, and household dysfunction are likely to be repercussions of a low SES. The study, although, addresses their gaps by emphasizing the importance of future studies on the full impact of ACE. Furthermore, although the study helps social workers and other clinicians to think in a “what happened to you” framework (trauma-informed), it does little to account for how trauma varies across individuals (I noticed this after taking the quiz to find out my own ACE score). One may experience a similar traumatic event in a very different way than someone else, and with very different effects (or no effects). The study was very informative, interesting, and a great starting point for many more questions and research regarding childhood trauma and connection to poor health and early death. A comparison between SES statuses/other demographics of children with similar traumatic experiences may be very noteworthy to credibility of the ACEs Study.

  • Elizabeth Merritt

    I was directed to this post by my SSC professor as well. Understanding the long term implications of childhood trauma are crucial in service professions as childhood trauma clearly has a huge impact on physical and mental health in adult life. Childhood trauma carries over into adulthood and has a huge impact on an individual’s success in adult life, so learning how to recognize how childhood trauma will continue to impact a person as they age is an invaluable tool for service providers. Addressing childhood trauma is difficult for adults who have adopted other coping habits but recognizing childhood trauma as the root of an adult’s mental and physical health issues is essential to ending cycles of abuse and helping individuals improve their physical and mental health. The ACE study reminded me in particular the difficulties faced by American and Canadian Native peoples, as Native communities are faced with high alcoholism and suicide rates, as well as higher obesity and diabetes risks, all of which are associated with the trauma experienced at boarding schools in the 19th and 20th centuries. This example proves how without adequate resources like counseling, individuals who face childhood trauma are likely to engage in high risk behavior and continue the cycle of abuse.

  • Melissa Owczarzak

    After reading this, my initial thought was that I wish all teachers, daycare employees, social workers, and anyone else that works with children on a regular basis was made aware of the ACEs. This is such a powerful tool and concept in understanding traumatic childhood experiences and their effects across a lifetime. It is amazing to see how all of these social, cognitive, and physical conditions link together. Having interned at a school with children who face many of these experiences, for example having an incarcerated parent or living through their parents divorce, I have already seen many immediate behavioral and physical symptoms as a response to their situations. As this article notes, these symptoms could really worsen over time if the children do not receive the proper attention and interventions to help them.

    When children misbehave, it is easy to react negatively to their behavior. However, by working with a trauma-informed mindset and keeping the ACEs in mind, it is easier to empathize and work with the children. In addition, it is also important to extend that trauma-informed thinking when considering their parents as well. It may be very likely that the parents experienced some kinds of traumatic childhood experiences as well, which have impacted how they grew up and now affect how they are now parenting and other conditions the children are experiencing in their homes.

  • Thank you for this post. I have read a little about ACEs before but never fully grasped how they could relate childhood traumas to physical health diagnoses but the visuals you added really helped. I think this should be a big motivator for clinician in the child and adolescent field to really help children resolve issues related to a trauma they may have experienced and encourage them to seek assistance whenever they are in need. It really proves the point that childhood experiences have major effects in the long-term not just cognitively and emotionally but physically as well. I think it could be a very important tool to use in a reactive and a preventative fashion and really promotes trauma-informed practice.

  • The ACE study was such an important turning point for research on understanding the impact of traumatic events on lifelong health outcomes, however, I believe that focusing on only the negative aspects of exposure to adverse experiences deprives the individual of both hope and accountability. For example, someone may say, “I am who I am because this happened to me.” In this way, the individual stays in the role of being a victim of circumstances. If instead, we focus on the strengths and skills that helped the individual to survive childhood trauma, the individual begins to see themselves as not a victim, but as a survivor. This is a much healthier viewpoint, because it allows for hope of recovery and recognition of both internal strength and empowerment in making changes to patterns of behavior.

    Whenever I use the ACE study as a teaching tool, I also pair it with the Search Institute’s Developmental Assets (http://www.search-institute.org/research/developmental-assets). The Developmental Assets approach to building internal and external supports helps to balance the negativity of the ACE research, and shows that there are ways to enhance resiliency.

    Thanks for covering such a great topic, and sharing the infographic. I will add it to my folder of training resources, and will bring it with me the next time I go to Albany to advocate for children’s mental health.

    • In advocacy work, it is important to use research and evidence-based practices to inform new legislation and the allocation of resources affecting an area such as children’s mental health. Using ACEs as an initial screening tool (shorter than the 40 item Development Assets assessment or profile) for trauma helps primary health providers seek more intensive services for the individual based on the two-or-more ACEs criteria. ACEs is trauma-based and used with adult subjects. The Developmental Assets tool appears to be utilized with youth, middle- or high school subjects, a different life stage. I look forward to future ACEs research results, as well as those for the Developmental Assets instruments.

  • This is also for SSC 420–I think this post definitely makes us look more closely at the way children are treated in their homes. I wasn’t aware before of the physical effects of childhood trauma. I thought that things such as PTSD or depression and anxiety were the main effects that were present later on in life, but never considered the physical repercussions as well. This study could and most likely will be able to help us in preventing problems developed later in life by first educating parents of the long lasting effects of abuse, and also by being able to catch things early on. Physicians, therapists, social workers, and anyone else in health related fields could work better together to lessen the risk of later life trauma to children who have already have 1 or more on the ACES score.

    • Cristina, your comment brought to mind the old complaint – we make people take a test before they get a license to drive a car, but no one looks at your ability to parent or knowledge of how to be a parent. Glad this post was helpful to you.

  • This graphic is a great illustration of how much effect ACEs can have on children (as adults). The visual components of this blog can really help to illustrate how long lasting and varied the aftermath of ACEs can be. It is important that this information is used to justify additional funding for additional research, as well as taken into account in terms of child protective legislation.

    The more we know about ACEs the better we can support the children who suffer from them during the incidents, as well as better support adults. The more we know about how to bolster children in these situations the more resilient they can become. The more we know about how to address the trauma histories of adults the better able they will be to heal. ACEs are so important to remember as social workers and I’m glad to read this point as a reminder.

  • Jenna Christensen

    One of the most important things when it comes to mental health is discovering the cause of poor mental health and what leads to developing a mental disorder. Discovering the cause can directly help with preventing poor mental health for people in the future. The ACE study has definitely allowed us to some insight on what may cause adverse health effects later in life, and hopefully this will help create and develop more programs for at risk families to try to combat the cycle of poor mental health in the family dynamic, as well as reducing the stigma of seeking treatment. What I think could be researched into more, however, is looking at people who had negative childhood trauma but who did not experience long term negative health, and discover what factors caused them to be resilient to this childhood trauma.

  • Hi Pat,

    Thanks for sharing this information about the ACE Study and its significance. This study is one that was presented in one of the modules in my classes, and so prior to reading your blog post, I had had some knowledge about it. However, despite this, I wanted to share that your blog post made me think quite critically about the significance of ACEs, particularly in relation to your question asking how the ACE study has impacted the reader’s practice.

    To answer your question, I wanted to first share that your blog post made me think a lot about trauma-informed care, and the importance of questioning what has happened to an individual, rather than wondering what is wrong with an individual. As you shared, the number of ACEs is correlated with certain negative physical and mental health outcomes as well as negative behavior outcomes. Many times, these outcomes become the symptoms resulting in a child being suspended for fighting, or a teenager being expelled for repeated drug use, etc. Often, our society does wonder what is wrong with that individual, and I think that this study highlights the importance of asking what happened to the individual that may have resulted in these outcomes for that person. Therefore, in my own work where I work with troubled youth, and the caregivers of these youth, I try to always remember that there is something behind the troubled behavior, and that the person is not innately “bad.” This gives me perspective and patience, and also allows me to form a positive, trusting, and genuine therapeutic relationship with my clients. As we know from our education and work, a positive therapeutic relationship is one of the most important parts of treatment and providing effective help to our clients.

    Molly

    • Hi, Molly,
      Your examples of how ACEs and a trauma-informed approach can allow for better interventions in a social worker’s practice are great! It underlines the need to recognize ACEs and incorporate the sensitivity that you write about: “there is always something behind the troubled behavior” – Thanks for contributing to this discussion.
      Pat

  • I am taking SSC420/Child Mental Health where we are discussing this topic. I think the ACEs study is really good at showing how our early life experiences shape our later life outcomes. We often do not think about how trauma can effect us in the long term, when in reality it has a lasting impact on the person that we become. I personally have experienced some of the household dysfunctions as a child and can definitely see how they have had a ripple affect and impacted my life today. One way to look at it is: if a person badly injures their leg, there is a great possibility that they will have further complications down the line (such as needing multiple surgeries/physical therapy, arthritis, etc), so it absolutely makes sense that when we endure Adverse Childhood Experiences we will have further complications down the line as well (like physical/behavioral/mental health outcomes discussed in this study), and these can be just as- if not more- severe and should be taken seriously when working with a population with high ACE scores.

  • Hi there. I saw this under the “related links” section and it caught my attention immediately. I think this is amazing. I work for social services, child protection. This information could be used in various ways in that setting. I could see myself referencing this to clients who are being investigated for abuse/neglect. I could also see myself using this with coworkers who may not be taking their job seriously or may not have any trauma knowledge. Also, at my internship I work with teen mothers in foster care. This is a great tool to use to show them why they are the way they are today, and how they can stop the cyclical behaviors we so often see. Thank you for this!

  • My SSC420 professor also sent me here. This article is interesting and helps put things in perspective. It helps explain why it is important for young children to be bought up in a positive environment. I know a few friends that can relate to this article. This helps me understand their behavior. A child’s life experience will shape them in the long run. Therefore, it is crucial for them to receive proper care and intervention earlier on.

  • Our professor for SSC 420 recommended that we look at this post. I think this study is an interesting and important study. I think it is a great way for professionals to understand the trauma someone has went through in their life and how it relates to them today. This study also just proves that what you go through in childhood does greatly affect you as an adult. This can help us prevent abuse early on by showing just how big of an effect abuse has during childhood.

  • Alexandria Kornfeld

    I am here by recommendation of my Child Mental Health Professor. I find the ACES tool so fascinating. It is a wonderful insight at looking at behaviors of children who have experienced trauma in their past. It is a great key for anyone working with children so that they are aware of signs of abuse, trauma, and illnesses. I think it is important for there to be such an existing tool in which health professionals can commonly use. Now, this does not mean that if you experience this trauma, you will carry out these certain behaviors listed above. However, it is not uncommon for it to happen. I truly believe having a common language about the subject matter is important for proper diagnoses and a shared language and assessment among colleagues.

  • My Child Mental Health Professor also recommended that we look at this post. I find this study very interesting because it gives you the opportunity to understand what another person may have gone through. I like how the study gives you the impacts and prevalence of certain things occurring. Although I have not been personally affected with these traumatic experiences I look forward to working with and helping someone who has.

  • The ACES study is a landmark study in the field of childhood trauma. It increases awareness that children are affected by several environmental factors and experiences. I work as a therapist in a school system through an outpatient mental health agency. I have used this study in my work with the school system. The school uses a PBIS model that is comparable to this study (https://www.pbis.org/). I have shown the pyramids side by side and explained what is behind the high risk, moderate risk, low risk children in the school system. I then show interventions in the same way to make it more integrated and related. It has been very effective in bridging the gap between fields as well as in increasing awareness and understanding. It has also had a positive effect on empathy to these students from teachers and staff which has positively affected interactions and performance. I am glad to see the ACES study discussed on this blog. I am going to propose a trauma informed climate survey next for this year through the National Council for the student body and parents in the community as a next step. It is a part of our involvement in the National Council Trauma Informed Learning Community (http://www.thenationalcouncil.org/consulting-best-practices/areas-of-expertise/trauma-informed-care-learning-community/). Thanks!

    • I can see how PBIS – Positive Behavioral Interventions and Supports – is complementary to a trauma-informed approach. Good to hear that you are considering the climate survey for your school – You may want to look at our Institute on Trauma and Trauma-Informed Care (ITTIC) which offers consultation and training: http://ow.ly/D3nSl – Good luck!

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  • I was recommended to this article by my SSC420 professor. This past week we discussed the ACES study in class. I think that this study is really ground breaking in the sense that there is data now for more than 17,000 people. The data shows direct correlation between the scores and negative outcomes. I was very surprised to hear that many of the people working in fields such as social work, psychology, and other health and human service employees are unaware of this study. I hope that more educators teach their students in the health and human services about this study because the impact of this study will increase over time.

  • Gabrielle Rosier

    My professor also recommended this site to me. I recently watched a TED talks video where a lady named Dr. berke out in California and her colleagues did some ground breaking work and opened a clinic to assess for ACES scores in underprivileged children. They found a strong correlation between high ACE scores and health issues later on in life. It obviously isn’t just an issues confined to this area its an issue across the country and even across the world. It barely gets enough attention along with proper intervention here. I also think this should be implemented into the field of social work along with any medically related profession. I think any profession where they are mandated reporters just to start .https://www.youtube.com/watch?v=95ovIJ3dsNk

  • My SSC teacher sent me here. It very exciting to see that finally someone has connected the dots. Being that all around experience from with childhood to adulthood to death, can cause a lot of damage and growth and for someone to finally piece out the crucial piece which is childhood is amazing. To see my score and learn that I could have so many different outcomes amaze me.

  • Thank you, Terasa, Gabrielle and Ilana, for your comments. I hope that over the next decade that the ACEs study will become “common” knowledge. Kudos to your SSC professor for exposing you to this ground-breaking study early in your preparation for a career. You three are now in a position to carry forward this knowledge!

    A recent series on NPR underlined the importance of taking childhood trauma into account:

    http://www.npr.org/blogs/health/2015/03/02/387007941/take-the-ace-quiz-and-learn-what-it-does-and-doesnt-mean

    http://www.npr.org/blogs/health/2015/03/02/377569413/can-family-secrets-make-you-sick

    http://www.npr.org/blogs/health/2015/03/03/377569539/even-some-doctors-fear-these-10-questions

    http://www.npr.org/blogs/health/2015/03/09/377569414/to-head-off-traumas-legacy-start-young

    http://www.npr.org/blogs/health/2015/03/10/377566905/a-sheriff-and-a-doctor-team-up-to-map-childhood-trauma

  • Erika Skotnicki

    I find this study to be very interesting and useful. I love that it gives you the opportunity to take the test yourself so that you can find out what your own ACE score is. I believe it is important to make others aware of ACE’s and the impact they have on certain individuals.

  • – I love that this study is being acknowledged by all audiences in the health field or working towards the field. This is an aspect of behavior that’s extremely important when working with people. Everyone comes from different backgrounds and encounter different experiences. One that may build us or even break us. To pay close attention to possible factors that may explain why something present is occurring, is wonderful. We are stooping to understand one another. We are listening, and creating a plan to work with the individual (s), because we are educated about the effects of just one negative childhood experience and are aware of how just one circumstance can lash back on the individual in the present and years later. I love that one can have an idea of where this outcome may be growing from, to make an effective approach.

    • Suri, it sounds like you have already incorporated ACEs into your future assessments and intakes involving clients. Perhaps you will use this in developing future policies or funding decisions about health care resource allocation! Thank you for your thoughtful reply.

  • I was directed to this post by my ‘child mental health’ class professor as well. According to ACEs, higher ACEs score is higher risk for negative health outcome. In my opinion, ACEs basic theory concept is right however, I feel like it is important to consider about child background such as cultural differences. For instance As I am from Asian country, I never thought that child getting hit by parent when there is reasons such as child did not listen to the parents are wrong until I came to the United States. This could be considering as physical abused. Different countries have different social norms therefore I believe that it is very important to know child cultural background before measuring the ACEs task.

    • EunHye,
      A culturally appropriate version of ACEs will lead to a better understanding of of childhood trauma in other “non-Western” parts of the world. How might you revise the ACEs instrument? Thanks for this reminder of the need to think globally – a human rights issue!
      Pat

  • I found this post from my SSC 420 professor. I have never heard of ACE before my professor introduced it to us. Since I am a visual learner, I was able to have a clearer understanding of how children’s traumatic experiences may lead to negative outcomes. I think resilience is an important aspect because I believe that individuals should overcome problems that they are facing. I also found it very helpful to take my own ACE score.

    • Lommie, the ACEs pyramid is a great depiction of its basic concepts. About resilience: It might be interesting for you to look at your ACEs score and think of how you’ve shown resilience in your own life-
      Pat

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