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Adverse Childhood Experiences (ACEs)

ACEs are linked to chronic health problems, mental illness, substance abuse in adulthood

Economic Burden

ACEs are costly. The economic and social costs to families, communities, and society total hundreds of billions of dollars each year2. As one example, the estimated annual U.S. population economic burden of child maltreatment alone, a major contributor to ACEs, was $428 billion.3

Overview

Safe, stable, nurturing relationships and environments are essential to children’s health and wellbeing. However, many children don’t have these types of relationships and environments, placing them at risk for adverse childhood experiences (ACEs). While all children are at risk of ACEs, numerous studies have documented inequities in such experiences attributed to the historical, social, and economic environments in which some families live.

ACEs have a tremendous impact on future violence victimization and perpetration, and lifelong health and opportunity.

ACEs are potentially traumatic events that occur in childhood (0-17 years) such as neglect, experiencing or witnessing violence, and having a family member attempt or die by suicide. Also included are aspects of the child’s environment that can undermine their sense of safety, stability, and bonding, such as growing up in a household with substance use problems, mental health problems, or instability due to parental separation or incarceration of a parent, sibling or other member of the household.1

ACEs are linked to chronic health problems, mental illness, and substance use in adulthood. ACEs can also negatively impact education and job opportunities. However, ACEs can be prevented. The mission of the Injury Center is to prevent ACEs before they happen, identify those who have experienced ACEs, and respond using trauma-informed approaches in order to create the conditions for strong, thriving families and communities where all children and youth are free from harm and all people can achieve lifelong health and wellbeing.

Risk Factors

ACEs are common and anyone can experience them. However, individual, relational, community, and societal factors can put some children at higher risk for experiencing ACEs than others.

Specific risk factors4:

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Parents facing financial hardship are more likely to experience stress, depression, and conflict

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Lack of access to affordable childcare increases the risk of parental stress and maternal depression

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Family history of using harsh punishment

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Living in under-resourced neighborhoods with higher than average rates of crime and economic disadvantage

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Living in communities with high rates of unemployment

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Living in communities with easy access to drugs and alcohol

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Living in communities with housing instability and low social connection

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Strengthen Economic Support for Families

Policies that strengthen household financial security (e.g., tax credits, childcare subsidies, other forms of temporary assistance, and livable wages) and family-friendly work policies can prevent ACEs by increasing economic stability and family income, reducing parental stresspdf icon, increasing maternal employment, and improving parents’ ability to meet children’s basic needs and obtain high-quality childcare.  Strengthening economic supportspdf icon for families is a strategy that addresses the needs of parents and children so that both can succeed and achieve lifelong health and well-being.

Promote Social Norms that Protect Against Violence and Adversity

Public education campaignspdf icon are one way to shift social norms and reframe the way people think and talk about ACEs, and who is responsible for preventing them. They can help shift the narrative away from individual responsibility to one that engages the community and draws upon multiple solutions to promote safe, stable, nurturing relationships and environments for all children. Legislative approaches to reduce corporal punishment can help establish norms around safer, more effective discipline strategies to reduce the harms of harsh physical punishment, particularly if paired with public education campaigns. Bystander approaches and efforts to mobilize men and boys as allies in prevention can be used to change social normspdf icon among young people in ways that support healthy relationship behaviorspdf icon. Such approaches work by fostering healthy norms around gender, masculinity, and violence with the goal of spreading these social norms through peer networks. They also work by teaching young people skills to safely intervene when they see behavior that puts others at risk and reinforcing social norms that reduce their own risk for future perpetration.

Ensure a Strong Start for Children

A child’s relationship with others inside and outside the family plays a role in healthy brain development, as well as in the development of physical, emotional, social, behavioral, and intellectual capacities. Early childhood home visitation can prevent ACEs by providing information, caregiver support, and training about child health, development, and care to families in their homes to build a safe, stable, nurturing and supportive home environment.  Additionally, high-quality childcare and preschool enrichment programs help children build a strong foundation for future learning and opportunity by improving their physical, social, emotional and cognitive development, language and literacy skills, and school readiness.

Teach Skills

Teaching children and youth skills to handle stresspdf icon, resolve conflicts, and manage their emotions and behaviors can prevent violence victimization and perpetrationpdf icon, as well as substance use, sexually transmitted infections, including HIV, and teen pregnancy. Social emotional learning programspdf icon are used to enhance interpersonal skills related to communication, problem-solving, alcohol and drug resistance, conflict management, empathy, coping, and emotional awareness and regulation. Safe dating and healthy relationship programspdf icon address similar skills within the context of dating with the goal of promoting caring, respectful, and non-violent relationships. Parenting skills and family relationship programspdf icon cover developmentally appropriate expectations for child behavior; teach behavior management, monitoring, and problem-solving skills; safe and effective discipline; healthy relationship behaviors; and work with parents to enhance parent-child communication and ways to support children and youth.

Connect Youth to Caring Adults and Activities

Relationships with caring adults who are positive role models can prevent ACEs and improve future outcomes for young people. Mentoring and after-school programs are ways to connect youth to caring adults and activities. Mentoring programs pair youth with an adult volunteer with the goal of fostering a relationship that will contribute to the young person’s growth opportunities, skill development, academic success, and future schooling and employment outcomes.  Mentoring programs may be delivered in a school or community setting and to youth of all ages, from early childhood through adolescence. After-school programs are a way to provide opportunities for youth to strengthen their behavioral, leadership, and academic skills and become involved in school and community activities.

Programs range from those offering tutoring and homework assistance to more formal skill-based programming and structured learning activities. These programs also address other key risk and protective factors for high-risk behavior by providing adult supervision during critical periods of the days, such as between 3:00 to 6:00 p.m., when youth crime and violence peaks. Mentoring and after-school programs can reduce the prevalence of crime, violence, and other adolescent risk behavior and pave the way for positive outcomes in adulthood.

Intervene to Lessen Immediate and Long-term Harms

Timely access to assessment, intervention, and effective care, support, and treatment for children and familiespdf icon in which ACEs have already occurred can help mitigate the health and behavioral consequences of ACEs, strengthen children’s resilience, and break the cycle of adversity.

Enhanced primary care may be used to identify and address ACE exposures with brief screening assessments and referral to intervention services and supports.  For children and adult survivorspdf icon of violencepdf icon, victim-centered services can be both lifesaving and helpful in reducing the harms of violence.  Treatmentpdf icon to lessen the harms of ACEs may be also used to address depression, fear and anxiety, post-traumatic stress disorderpdf icon (PTSD), problems adjusting to school, work, or daily life, and other symptoms of distress.  Treatment to prevent problem behavior and future involvement in violence includes therapeutic interventions and other supports to address the social, emotional, and behavioral risks associated with ACE exposures.

Featured Resources

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Preventing Adverse Childhood Experiences (ACEs): Leveraging the Best Available Evidencepdf icon

This resource helps states and communities leverage the best available evidence to prevent ACEs from happening in the first place as well as lessen harms when ACEs do occur.

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Preventing Child Abuse & Neglect: A Technical Package for Policy, Norm, and Programmatic Activitiespdf icon

This technical package identifies a number of strategies based on the best available evidence to help states and communities prevent and reduce child abuse and neglect.

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Essentials for Childhood Framework

The Essentials for Childhood framework proposes strategies that communities can consider to promote the types of relationships and environments that help children grow to be healthy and productive citizens so that they, in turn, can build stronger and safer families and communities for their children.

Featured Tools

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Preventing Adverse Childhood Experiences online trainings

These accredited online trainings will help you understand, recognize, and prevent ACEs. Get the insights you need to create healthier, happier childhoods for kids today and bright futures for adults tomorrow.

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ACEs Infographic

This infographic uses data from the CDC Kaiser Permanente Adverse Childhood Experiences (ACEs) Study and recent findings to show the impact of ACEs and how preventing ACEs can help create neighborhoods and communities where every child thrives.

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Making the Case: Engaging Business

This free online resource explains how communities can work with the business sector to assure safe, stable, nurturing relationships, and environments for all children and families.

1 – Centers for Disease Control and Prevention (2019). Preventing Adverse Childhood Experiences: Leveraging the Best Available Evidence. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.

2 – Centers for Disease Control and Prevention (2019). Preventing Adverse Childhood Experiences: Leveraging the Best Available Evidence. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.

3 – Peterson C, Florence C, Klevens J. The economic burden of child maltreatment in the United States, 2015. Child Abuse Negl. 2018 Dec;86:178-183

4 Centers for Disease Control and Prevention (2019). Preventing Adverse Childhood Experiences: Leveraging the Best Available Evidence. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.