ACEs Resources

Adverse Childhood Experiences (ACEs) Resources

ACEs can be generally categorized into three main groups: abuse, neglect, and household dysfunction. These categories can manifest in multiple areas of a child’s life ranging from witnessing events and actions, to experiencing behaviors that destabilize a child’s environment, safety, or bonding with others.

Source: Robert Wood Johnson Foundation

From ages 0-17, further examples of ACEs are:

Experiencing or witnessing violence, abuse or neglect
Living in an environment with substance use problems
Living in an environment with mental health problems
Instability due to separation of parents
Instability due to incarcerated members of the household
Having immediate or extended family members attempt or die by suicide
Experience food or housing insecurity
Experiencing discrimination

However, it is important to note that the examples listed are not an exhaustive list of possible causes of ACEs, and many other traumatic events can lead to a negative impact to a child's health and wellbeing.

Trauma

ACEs are understood through the lens of trauma. Trauma as defined by the National Institute of Health as events that can be shocking or dangerous experiences and affect people emotionally and physically. They include acts of violence (e.g., assault, physical or emotional abuse, war), mass shootings, natural disasters, car crashes, and other accidents.

Reactions to trauma manifest differently in adults compared to children. And no trauma response is alike, demonstrating the range of responses one may experience. If you feel you have experienced a traumatic event, seek resources to learn about self-care and when to seek professional help.

Frequency

Nationally, ACEs are quite common with 64% of Adults reporting having experienced at least one type of ACE before the age of 18. Whereas nearly a quarter of the US population have reported experiencing three or more ACEs.

Separate from the entirety of the United States, North Carolina itself has reported 14.8% of the population have experienced 2 or more ACEs between the ages 0-17. This puts North Carolina as the 60th percentile in the United States meaning it has a better score than 30 other states.

ACEs can be linked to social determinants of health which can be categorized in five domains: Economic Stability, Education Access and Quality, Health Care Access and Quality, Neighborhood and Built Environment, and Social and Community Context. ACEs are more common among communities living in under-resourced or racially segregated communities.

Signs of ACEs

ACEs can be diagnosed through observation and screening of a child’s or adult’s behaviors. For children, symptoms of experiencing ACEs may include:

Fear of others
Difficulty sleeping
Bedwetting
Changes in mood
Difficulty showing affection
Avoiding situations or events related to a traumatic experience
Difficulty learning

Typically, these symptoms develop after the child has had time to process a traumatic event or experience. And in some instances reactions are caused by a trigger which directly reminds one of a traumatic event. Understanding the response signs of ACEs can allow a child to receive earlier care and support in treating the effects of trauma and reduce likelihood of further developing health outcomes related to ACEs.

Certain demographics within childhood may be more likely to experience ACEs including but not limited to:

Minority racial or ethnic groups
Those experiencing socioeconomic challenges
Those whose parents or caregivers experience stress
Girls or children assigned female at birth
Children with family members or friends experiencing a substance use disorder

Outcomes and Health Risks

As adults, persons who have experienced ACEs may exhibit behaviors or health traits that can be linked to ACEs. These effects may reach to every part of an adult's life such as physical health, mental health, general quality of life, and access to career and educational opportunities. Additionally, ACEs can increase risk of sexually transmitted infections and involvement in sex trafficking. Mothers and children may experience higher rates of teen pregnancy, complicated pregnancies, and fetal death. Chronic diseases and leading causes of death such as cancer, diabetes, heart disease, and suicide are found at higher rates in those who have experienced ACEs.

Source: Robert Wood Johnson Foundation

Stress

In particular, ACEs are linked with toxic stress, defined as extended or prolonged stress. Toxic stress negatively affects brain development, the immune system, and stress response and affect attention and decision-making

Growing up with toxic stress creates difficulty forming healthy, attached, and stable relationships. It can cause unstable work history and struggle with finance, jobs, and depression in adults. Toxic stress can also create more situations where other children may experience ACEs and perpetuate continuation of similar traumas and responses.

Mitigation and Prevention

While the effects of ACEs can be intense there are many ways to mitigate or prevent negative outcomes from these experiences. Responses vary in intensity and all can work towards helping a person recover from trauma and toxic stress.

Harvard University’s Center for the Developing Child lists potential interventions and treatments in order from most intensive to least. Most intensive is therapeutic intervention including in-paitent treatment to scheduled and regular sessions with a mental health professional. Next is trauma-informed care, which is an understanding within the fields of social work, medicine, and education that informs the professionals how to interact and treat patients who have experienced trauma. Even further this can include acts such as meditation, breathing and physical exercise, and identifying social support systems.

The most common approach is ACEs-based screening and referral where a patient is given an ACE score based on a brief survey of personal history. This screening assigns a ACE score which when high serves as an estimate of risk from former ACEs. However these screenings are non-specific and cannot inform a patient about specific risks or recommended actions.

Risk Factors and Protective Factors

There are multiple ways to conduct a general screening for ACEs and many are free.The screening is conducted by answering yes or no questions and summing scores. The determining score estimates likelihood for the exhibition of risk factors in adult life. Examples of such screenings are from Center for Health Care Strategies, NAADAC, or even this NPR article.

The CDC compiled lists of further risk factors along with protective factors which can help to determine probability for future health outcomes. To see an in depth explanation of various risk and protective factors read this webpage produced by the CDC.

Primarily, experts recommend an approach that is not singular but is instead community based. To prevent many of the experiences that cause toxic stress and ACEs the source of stress in a community must be reduced. This can manifest in ensuring needs such as food, housing, and childcare are assured in a community, or creating further supports for substance discrimination, poverty, abuse, mental illness, violent relationships and crime. Through this the CDC has determined the best way to prevent the effects of ACEs is by reducing stress, building responsive relationships, and strengthening life skills.

Community Resiliency Model

Supporting communities creates more opportunities to support their children.The CDC further listed both strategies and approaches to prevent ACEs through community support. Such as:

Promoting social norms protecting against violence
Strengthening economic supports to families
Enhanced primary care
Victim centered services
After school programs

While not comprehensive, the lists created by the CDC create a blueprint for communities to understand what steps need to be taken for positive change to be made and for children across the country and North Carolina to grow up in safer, less stressful environments.

Source: Centers for Disease Control and Prevention

ACE Resources

There are many resources for ACEs across the country and within North Carolina Specifically. The CDC outlined many resources through their resource guide: Adverse Childhood Experiences Prevention Resource for Action Adverse Childhood Experiences (ACEs) Prevention Resource for Action. This resource provides a general overview of ACEs and evidence for specific programs and interventions for the identification, screening, treatment, mitigation, and prevention of ACEs.

The North Carolina Department of Health and Human Services (NCDHHS) Created a document containing state specific progress on ACEs and provides links to resources within the state by identifying partner organizations working directly with the state government to combat ACEs and their effects.

The University of North Carolina has both academic and clinical resources for ACEs through the UNC Health Sciences Library.

Example screening resources can be found through both the Center for Health Care Strategies, ACEs too High, and NAADAC.

Smart Start provides resources for understanding the state of North Carolina through the lens of metrics such as resilient communities measures, social vulnerabilities, poverty, food insecurity, and child abuse. An interactive map of North Carolina can be found on their website. Additionally, data on specific metrics grouped by North Carolina county can be found using their community trends tab. (Google Chrome is recommended for proper use of the website).

If you think you or a loved one is experiencing suicidal thoughts or tendencies, you are not alone. Help is available, seek with someone you trust or contact the National Suicide and Crisis Lifeline by calling 988 today.

References

America’s Health Rankings. “America’s Health Rankings | AHR.” Accessed October 17, 2024. https://www.americashealthrankings.org/explore/measures/ACEs_8/NC.

CDC. “About Adverse Childhood Experiences.” Adverse Childhood Experiences (ACEs), October 8, 2024. https://www.cdc.gov/aces/about/index.html.

CDC “Risk and Protective Factors.” Adverse Childhood Experiences (ACEs), July 11, 2024. https://www.cdc.gov/aces/risk-factors/index.html.

Center on the Developing Child at Harvard University. “What Are ACEs? And How Do They Relate to Toxic Stress?” Accessed October 17, 2024. https://developingchild.harvard.edu/resources/aces-and-toxic-stress-frequently-asked-questions/.

Cleveland Clinic. “Adverse Childhood Experiences (ACEs) & Childhood Trauma.” Accessed October 17, 2024. https://my.clevelandclinic.org/health/symptoms/24875-adverse-childhood-experiences-ace.

“Coping With Traumatic Events - National Institute of Mental Health (NIMH).” Accessed October 17, 2024. https://www.nimh.nih.gov/health/topics/coping-with-traumatic-events.

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