Adverse childhood experiences (ACEs) are potentially traumatic events that occur during childhood and are linked to chronic health problems, mental illness, and substance misuse in adulthood. Increasingly, health care providers are screening for ACEs and providing follow-up care, especially during the COVID-19 crisis. Below are screening tools and resources for policymakers, providers, and others working to prevent ACEs and address their impact.
Background
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.
Screening
The first step to reducing negative health outcomes from ACEs and trauma is identification through screenings.
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.
Measurement
February 2019
This Child Trends report states that the two most common ACEs are economic hardship and the divorce or separation of a guardian.
January 2020
This Healthy North Carolina 2030 report includes ACEs (health indicator #5) as part of the state’s comprehensive strategy to measure child well-being.
Referrals
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.
Outreach and Engagement
These resources cite consistent messaging for providers to ensure children and families receive appropriate screening and follow-up care.
Social Determinants and Equity
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.
COVID-19
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.
State Examples
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.