Adverse Childhood Experiences (ACEs)

What are ACEs?

Adverse childhood experiences, or ACEs, was a phrase coined in a 1998 study between the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente to define events that occur during childhood (ages 0-18) that cause toxic stress and poor health outcomes into adulthood. ACEs can be broken down into three categories: abuse, neglect, and household dysfunction. These events are extremely common with 67% of the population having at least one ACE, and 13% having four or more ACE risk factors. ACEs cause toxic stress, which increases the frequency and severity of delays in cognitive, social-emotional and physical development in children and, as adults, the risk of heart disease, diabetes, obesity and premature death. The more ACEs, the greater the risk one has for these outcomes.

What can we do about ACEs?

The Center for Youth Wellness (CYW), national experts on ACEs, has demonstrated that by addressing ACEs and building resilience through community resources, behavioral therapy, and support, the health outcomes of individuals can improve. A key goal of CYW is to have every pediatrician universally screening for ACEs in order to identify risks early and empower families to take action to address toxic stress in their lives.

What is resilience?

Resilience is when you acknowledge you may be struggling and cultivate your well-being despite these struggles by building trusting relationships and restoring your physical and emotional health through a healthy lifestyle. Sometimes, medical intervention, therapy and/or medication can help with managing stress, but there are lots of things you can do at home to help build resilience with your child. For ideas on how to build a healthy lifestyle, check out for ideas to promote good nutrition, exercise, and sleep habits. There are also suggestions on how to build a better relationship with your child and mindfulness activities to teach you how to manage stress.

How is Docs for Tots helping?

Docs for Tots has partnered with CYW to bring together diverse pediatric offices across Long Island and assist them in implementing universal ACEs screening.  Docs for Tots has previously been successful in using an intensive technical assistance model with quality improvement framework to implement standardized screening at well child visits in the pediatric primary care offices of the Long Island Federally Qualified Health Centers in Nassau County.  CYW has used a learning collaborative model to successfully implement ACEs screening in health centers across the country. This partnership, which combines both techniques, allows Docs for Tots to reach practices across a wider geographic region, while allowing CYW to expand their reach.
Utilizing this innovative approach, Docs for Tots, CYW, and pediatric practices will work together to establish a protocol for ACEs screening and referral that can be replicated within and across health systems. The ACEs Learning Collaborative will:

  • Establish referral pathways for low, medium, and high levels of toxic stress
  • Integrate ACE awareness and education into routine clinical care management
  • Increase family satisfaction through improved communication around traumatic experiences
  • Strengthen partnerships across diverse pediatric offices and community organizations on Long Island

Here is a print-friendly summary to download.

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