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Brief: Adverse Childhood Experiences and Trauma

70% of adults in the U.S. have experienced at least one form of traumatic event in their lives.

Traumatic childhood experiences have a significant impact on individuals and the consequences can affect entire communities, making it a serious public health issue. Trauma is defined as a person’s response to one or multiple events that are physically or emotionally harmful or threatening.(2) Many events that cause trauma include natural disasters, childhood abuse or neglect, sexual assault, and other forms of violence, which can have a lasting effect on behavior and health.(3) If left unaddressed, these traumatic experiences can increase the likelihood of individuals developing mental illnesses, substance use disorders, and other mental and physical health conditions that affect the overall quality of life.(4)

This fact sheet, developed by Addiction Policy Forum and the National District Attorneys Association, discusses the impact of childhood trauma and subsequent health and social consequences, strategies to prevent trauma, and innovative approaches to support children and young adults with high number of Adverse Childhood Experiences (ACEs) across the country.

What Are ACEs

Adverse Childhood Experiences (ACEs) is the term used to describe potentially traumatic events experienced by persons under 18.(5) They can be categorized into three types:(6)

  • Childhood abuse – physical, emotional, or sexual abuse;

  • Neglect – physical or emotional neglect; and

  • Household challenges – mental illness, parental separation or divorce, and parental violence or substance misuse.

When children are exposed to stressful events, brain development can be impacted. These altered brain developments can cause unhealthy coping mechanisms.(7) The higher the number of ACEs results in a higher risk for long-term negative outcomes such as depression, heart disease, liver disease, trouble at school and work, financial stress and substance misuse and addiction.(8)

What Can Be Done

  • While many states have implemented ACEs screening, research recommends pairing screening with intensive intervention and focusing on prevention.

  • According to Harvard University’s Center on the Developing Child, “The ideal approach to ACEs is one that prevents the need for all levels of services: by reducing the sources of stress in people’s lives, whether basic needs like food, housing, and diapers, or more entrenched sources of stress, like substance abuse, mental illness, violent relationships, community crime, discrimination, or poverty.”(9)

  • Primary prevention to stop ACEs from happening can include:(10) Home visits for families with newborns; Parenting training programs; family wellness; and Child welfare and criminal justice early interventions.

  • Policymakers and practitioners in many different sectors can improve outcomes for children and families by implementing interventions built on the science of child development. 

  • In Three Principles to Improve Outcomes for Children and Families, Harvard researchers recommend three areas for those with ACEs scores(:11) Support responsive relationships for children and adults; Strengthen core life skills; and Reduce sources of stress in the lives of children and families.

  • Trauma should not go unaddressed, and trauma-informed care promotes positive health outcomes. The core values of trauma-informed care include safety, transparency, trustworthiness and dignity.(12)

  • Trauma-informed care means treating a whole person, taking into account past and present experiences, and service delivery mechanisms when attempting to understand behaviors and treat the patient.(13)

  • Prevention begins with protective factors in a youth’s life. The Child Welfare Information Gateway defines protective factors as “conditions or attributes of individuals, families, communities, or the larger society that mitigate risk and promote healthy development and wellbeing. Put simply, they are the strengths that help to buffer and support families at risk.”14

Case Studies

Several states and local jurisdictions are improving services to support children, families, and young adults with high ACEs scores, including:


Pediatrician Training: Through community organizations and collaborative group efforts, Alaska has increased awareness and prevention of ACEs through pediatric training, resource development, and programs to improve healthcare services for children and families.  www.cdc.gov/violenceprevention/pdf/ACE-Case-Study.pdf


Breed All Stars Program: The Breed All Stars Program, located in Lynn, Massachusetts, is a leadership program designed for at-risk children that teaches students about substance misuse and prevention, while creating a positive rapport with adults. www.addictionpolicy.org/blog/making-everyday-kids-all-stars 


Expansion of Work Opportunities: Families receiving Temporary Assistance for Needy Families (TANF) can participate in Head Start programs, such as parenting education, home visiting, and volunteer in a child’s school or care setting, as part of the work requirements. Increased Support in Juvenile Courts: Juvenile offenders with high prevalence of ACEs can be prioritized into programs to prevent future adverse outcomes.Trauma-Informed Schools Initiative: Training, guidance, referral, and technical assistance are provided to schools to adopt a Compassionate Schools Infrastructure. Using a traumainformed approach, Compassionate Schools have improved outcomes for children impacted by trauma, while strengthening families and preventing child maltreatment.    www.cdc.gov/violenceprevention/acestudy/pdf/ACE_Case_Study_Washington.pdf


Children of Incarcerated Parents: To support children growing up with an incarcerated parent(s), Wisconsin is developing services to help reduce exposure to additional ACEs for children with a parent(s) who is incarcerated and for individuals who have a history of trauma. www.cdc.gov/violenceprevention/acestudy/pdf/ACE_Case_Study_Wisconsin.pdf


Infographic: Adverse Childhood Experiences: Looking at How ACEs Affect our Lives & Society (Centers for Disease Control and Prevention):  https://vetoviolence.cdc.gov/apps/phl/resource_center_infographic.html

Infographic: The Truth About ACEs Infographic (Robert Wood Johnson Foundation):  www.rwjf.org/en/library/infographics/the-truth-about-aces.html

Center on the Developing Child at Harvard University:  https://developingchild.harvard.edu/

8 Things to Remember about Child Development (Center on the Developing Child at Harvard University): https://developingchild.harvard.edu/resources/8-things-remember-child-development/

Brief: The Science of Early Childhood Development (Center on the Developing Child at Harvard University): https://developingchild.harvard.edu/resources/inbrief-science-of-ecd/

Brief: Early Childhood Program Effectiveness (Center on the Developing Child at Harvard University):  https://developingchild.harvard.edu/resources/inbrief-early-childhood-program-effectiveness/

Brief: The Impact of Early Adversity on Children’s Development (Center on the Developing Child at Harvard University): https://developingchild.harvard.edu/resources/inbrief-the-impact-of-early-adversity-on-childrens-development/


National Council for Behavioral Health. How to Manage Trauma. Retrieved from  www.thenationalcouncil.org/wp-content/uploads/2013/05/Trauma-infographic.pdf

SAMHSA-HRSA Center for Integrated Health Solutions. Trauma. Retrieved from  www.integration.samhsa.gov/clinical-practice/trauma

American Psychological Association. Psychology Topics: Trauma. Retrieved from   www.apa.org/topics/trauma/

Center on the Developing Child at Harvard University. ACEs and Toxic Stress: Frequently Asked Questions. Retrieved from https://developingchild.harvard.edu/resources/aces-and-toxic-stress-frequently-asked-questions/

Centers for Disease Control and Prevention. About Adverse Childhood Experiences.  Retrieved from www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/aboutace.html

Centers for Disease Control and Prevention. About the CDC-Kaiser ACE Study.  Retrieved from https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/about.html

Center on the Developing Child at Harvard University. InBrief: The Impact of Early Adversity on Children’s Development. Retrieved from https://developingchild.harvard.edu/resources/inbrief-the-impact-of-early-adversity-on-childrens-development/

Centers for Disease Control and Prevention. About Adverse Childhood Experiences.Center on the Developing Child at Harvard University. ACEs and Toxic Stress: Frequently Asked Questions.Centers for Disease Control and Prevention. Adverse Childhood Experiences: Looking at How ACEs Affect our Lives & Society. Retrieved from https://vetoviolence.cdc.gov/apps/phl/resource_center_infographic.html

Center on the Developing Child at Harvard University. Three Principles to Improve Outcomes for Children and Families. Retrieved from https://developingchild.harvard.edu/resources/three-early-childhood-development-principles-improve-child-family-outcomes/

SAMHSA-HRSA Center for Integrated Health Solutions. Trauma. Retrieved from  https://www.integration.samhsa.gov/clinical-practice/trauma-informed Withers, M. (2017).

Trauma-Informed Care and Why It Matters. Psychology Today.  Retrieved from https://www.psychologytoday.com/us/blog/modern-day-slavery/201707/trauma-informed-care-and-why-it-matters

Child Welfare Information Gateway. (2014). Protective Factors Approaches in Child Welfare.  Retrieved from www.childwelfare.gov/pubPDFs/protective_factors.pdf


Addiction Policy Forum is a national nonprofit organization dedicated to eliminating addiction as a major health problem. Our national headquarters are located in Washington, DC, with resources and services in every state.

For more information on the Addiction Policy Forum, please visit: www.addictionpolicy.org.


Formed in 1950, NDAA is the oldest and largest national organization representing state and local prosecutors in the country. With more than 5,300 members representing over two thirds of the state and local prosecutors’ offices, NDAA is recognized as the leading source of national expertise on the prosecution function and is a valuable resource for the media, academia, government, and community leaders. NDAA’s mission is to provide state and local prosecutors with the knowledge, skills, and support they need to ensure that justice is done and that public safety rights are protected.

For more information on the National District Attorneys Association, please visit: www.ndaa.org.


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